To review epidemiologic correlations between
asthma and
atopic dermatitis (AD), identify common features in disease pathophysiology, and review steps involved in the development of
asthma therapy guidelines to assess the appropriateness of a similar process and approach for AD.
METHODS: A 7-member panel representing specialists in dermatology,
allergy,
asthma, immunology, and pediatrics from around the United States convened to review the current literature and evolving data on AD. Participants presented reviews to the panel on the epidemiology of
asthma and AD, the
genetic predisposition to allergic disease, the current understanding of the immunopathophysiology of AD, interrelationships between the pathologic pathways of
asthma and AD, evolving treatment concepts and options in AD, and the applicability of the
asthma treatment model and how it may be adapted for guideline development for AD. Commentary and criticism were recorded for use in document preparation.
RESULTS: There are clear epidemiologic parallels in
asthma and AD. Importantly, AD frequently is the first manifestation of an atopic
diathesis, which occurs in genetically predisposed individuals and also includes
asthma and
allergic rhinitis. Up to 80% of children with AD will eventually develop
allergic rhinitis or
asthma later in childhood. This classic "atopic triad" has numerous pathophysiologic elements in common, including
cyclic nucleotide regulatory abnormalities, immune cell alterations, and inflammatory mediators and allergic triggers. New therapeutic options that target underlying immune mechanisms are available, and their place among treatments for AD is becoming established. Guidelines of care have been developed for
asthma. The panel noted that the National Institutes of Health/National Heart, Lung, and Blood Institute guidelines for diagnosis and management of
asthma, first issued in 1991, had a tremendous positive impact on many aspects of
asthma treatment. It not only created a heightened awareness that
asthma is a disease of chronic
inflammation, but it also provided unified approaches for
therapy and opened new areas of basic science and clinical research. In addition, the guidelines spurred interactions among physicians of various specialties and stimulated a great quantity of research in
asthma therapy. It is anticipated that AD
therapy guidelines would have similar positive outcomes.
CONCLUSIONS: The panel concluded that, on the basis of current information and evolving therapeutic options, a clear rationale exists to support AD guideline development. The many parallels between AD and
asthma suggest that processes and approaches used for the
asthma therapy guidelines would be appropriate for AD.