**3. Conclusion**

There have only been a few reports about early intervention for patients with a high risk of developing asthma. Iikura et al. reported a research of early intervention (34). To evaluate the prophylactic effect of ketotifen against the onset of asthma they selected 121 infants with atopic dermatitis. A placebo syrup group and an active syrup group were followed for 1 year, with bimonthly evaluations. During the 1 year study, asthma was observed in eight children of the ketotifen group (13.1%) and in 25 children of the placebo group (41.6%) (P less than .001). As a result, they concluded that Ketotifen is effective for early intervention in children with atopic dermatitis.

Suplatast tosilate is an oral agent that has been available in Japan for 12 yr since 1995. It is highly safe, and there have been no reports of serious adverse reactions to this drug (35). The manufacturer of Suplatast, (Taiho Pharmaceutical Co., Ltd., Tokyo, Japan) summarized the adverse events that were detected among 154 children under 3 yr old in a study of actual use. According to this report, adverse reactions were only noted in two patients. This shows that Suplatast is also safe for patients under 3 yr old and thus is thus suitable for long-term administration to high risk patients in order to prevent the onset of asthma. It is one of the few drugs available that act as a non-specific regulator of the immune system. Then, it showed that the allergic predisposition is improved in suppressing the symptom. Therefore it can be said that suplatast tosilate is an antiallergic fundamentally curative drug. In the future, we hope to collect more cases and explore whether this drug can change the natural history of asthma.

#### **4. References**

[1] Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. N Engl J Med 1995: 332: 133–8.

The present investigation was only a pilot study, but it is still clinically significant that more than half of our patients with atopic dermatitis and food allergies developed asthma before age three during treatment with ketotifen, while only 20% of the suplatast group did so. Among the criteria in the asthma predictive index (API) (32), which is based on the Tucson Children's Respiratory Study, as well as the major and minor criteria in the modified asthma predictive index (mAPI) (33) based on the PEAK trial, a parental history of asthma, physician-diagnosed atopic dermatitis, and allergic sensitization to milk, egg, or peanuts correspond to the criteria used in the present study. These other studies have suggested that early intervention with suplatast can prevent progression to chronic asthma if patients meeting the criteria that suggest an increased likelihood of progression to chronic asthma in the future are treated before they develop wheezing. Both the API and the mAPI include the criterion of an eosinophil count ‡4%. Most of the patients in the present study met this criterion and showed a significant decrease of eosinophils after treatment with suplatast. Therefore, early intervention with suplatast may prevent progression to chronic asthma even in patients with a high eosinophil count, who have an increased risk of developing chronic asthma. The finding that a lower percentage of patients in the suplatast group needed hospital admission for asthma also serves as evidence that this drug may prevent

There have only been a few reports about early intervention for patients with a high risk of developing asthma. Iikura et al. reported a research of early intervention (34). To evaluate the prophylactic effect of ketotifen against the onset of asthma they selected 121 infants with atopic dermatitis. A placebo syrup group and an active syrup group were followed for 1 year, with bimonthly evaluations. During the 1 year study, asthma was observed in eight children of the ketotifen group (13.1%) and in 25 children of the placebo group (41.6%) (P less than .001). As a result, they concluded that Ketotifen is effective for early intervention in

Suplatast tosilate is an oral agent that has been available in Japan for 12 yr since 1995. It is highly safe, and there have been no reports of serious adverse reactions to this drug (35). The manufacturer of Suplatast, (Taiho Pharmaceutical Co., Ltd., Tokyo, Japan) summarized the adverse events that were detected among 154 children under 3 yr old in a study of actual use. According to this report, adverse reactions were only noted in two patients. This shows that Suplatast is also safe for patients under 3 yr old and thus is thus suitable for long-term administration to high risk patients in order to prevent the onset of asthma. It is one of the few drugs available that act as a non-specific regulator of the immune system. Then, it showed that the allergic predisposition is improved in suppressing the symptom. Therefore it can be said that suplatast tosilate is an antiallergic fundamentally curative drug. In the future, we hope to collect more cases and explore whether this drug can change the natural

[1] Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. N Engl J Med 1995: 332: 133–8.

progression to chronic asthma.

children with atopic dermatitis.

**3. Conclusion** 

history of asthma.

**4. References** 


**18** 

**as an Option** 

*ALK Abellò Medical Department,* 

Massimo Milani

*Lainate, Milan* 

*Italy* 

**Thinking Atopic Dermatitis Treatment** 

Atopic Dermatitis (AD) is a common inflammatory itching skin disease1. This skin disorder affects a large number of children and adults2. Epidemiological studies show that up to 25% of children and up to 3% of adult are affected worldwide3. Several studies in addition suggest an increasing prevalence of AD. The clinical picture of AD is dominated by chronic eczematous skin lesions in typical localizations4. In infants and small children, the rash is often present on the skin around the knees and elbows and the cheeks5. In teenagers and adults, the rash is often present in the creases of the wrists, elbows, knees or ankles, and on the face or neck. Symptoms commonly could vary from person to person. The most common symptoms are dry, itchy skin and rashes on the face, inside the elbows and behind the knees, and on the hands and feet6. Itching is the most relevant and common symptom of atopic dermatitis. Scratching and rubbing in response to itching irritates the skin, increases inflammation, and actually increases itchiness. Itching is a particular problem during sleep when conscious control of scratching is lost. The appearance of the skin that is affected by atopic dermatitis depends on the amount of scratching and the presence of secondary skin infections. The skin may be red and scaly, be thick and leathery, contain small raised bumps, or leak fluid and become crusty and infected. These features can also be found in people who do not have atopic dermatitis or who have other types of skin disorders. Atopic dermatitis may also affect the skin around the eyes, the eyelids, and the eyebrows and lashes. Scratching and rubbing the eye area can cause the skin to redden and swell. Some people with atopic dermatitis develop an extra fold of skin under their eyes. Patchy loss of eyebrows and eyelashes may also result from scratching or rubbing. In addition clinically unaffected skin in AD is not normal. It is frequently dry and has a greater irritant skin response than normal healthy skin7. Microscopic studies reveal a sparse perivascular T-cell infiltrate in unaffected AD skin

There is a marked infiltration of CD41 activated memory T cells in acute AD9. Antigenpresenting cells (eg, Langerhans cells inflammatory dendritic epidermal cells and macrophages) in lesional and, to a lesser extent, in nonlesional skin bear IgE molecules10.

**1. Introduction** 

that is not seen in normal healthy skin8.

**Differently: Specific Immunotherapy** 

