Section of Paediatrics, Department of Medicine, Imperial College, London, UK.
Department of Paediatric Allergy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Clin Exp Allergy. 2018 May;48(5):594-603. doi: 10.1111/cea.13105. Epub 2018 Mar 13.
Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression.
To evaluate the effect of the temperature-controlled laminar airflow (TLA) treatment in children/adolescents with severe AE.
We recruited 15 children aged 2-16 years with long-standing, severe AE and sensitization to ≥1 perennial inhalant allergen. Run-in period of 6-10 weeks (3 visits) was followed by 12-month treatment with overnight TLA (Airsonett , Sweden). The primary outcome was eczema severity (SCORAD-Index and Investigator Global Assessment-IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient-oriented eczema measure (POEM), medication requirements and healthcare contacts. The study is registered as ISRCTN65865773.
There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12-month intervention period (P < .001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75-45.15] at Baseline to 17.2 [12.95-32.3] at the final visit, and IGA improved significantly from 4 [3-4] to 2 [1-3]. We observed a significant improvement in FDQLI (16.0 [12.25-19.0] to 12 [8-18], P = .023) and DFI (P = .011), but not CDQLI or POEM. Compared to 6-month period prior to enrolment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P = .033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non-responders.
Addition of TLA device to standard pharmacological treatment may be an effective add-on to the management of difficult-to-control AE.
患有严重、持续性特应性皮炎（AE）的儿童选择有限，通常需要全身免疫抑制治疗。
评估温度控制层流（TLA）治疗对患有严重 AE 的儿童/青少年的疗效。
我们招募了 15 名年龄在 2-16 岁之间、患有长期严重 AE 且对≥1 种常年吸入性过敏原过敏的儿童。在进行为期 6-10 周（3 次就诊）的导入期后，他们接受了为期 12 个月的夜间 TLA（Airsonett，瑞典）治疗。主要结局是湿疹严重程度（SCORAD 指数和研究者整体评估-IGA）。次要结局包括儿童/家庭皮肤病生活质量和家庭影响问卷（CDQLI、FDQLI、DFI）、患者导向的湿疹测量（POEM）、药物需求和医疗保健接触。该研究在 ISRCTN65865773 注册。
在 12 个月的干预期间，AE 严重程度通过 SCORAD 和 IGA 显著降低（P < 0.001）。SCORAD 从基线时的中位数 34.9（四分位距 28.75-45.15）降至最后一次就诊时的 17.2（12.95-32.3），IGA 从 4（3-4）显著改善至 2（1-3）。我们观察到 FDQLI（16.0 [12.25-19.0] 至 12 [8-18]，P = 0.023）和 DFI（P = 0.011）显著改善，但 CDQLI 和 POEM 没有。与入组前 6 个月相比，在干预开始后 6 个月时，强效外用皮质类固醇的用量显著减少（P = 0.033）。探索性聚类分析显示出两种强烈的反应模式，9 名患者被归类为应答者，6 名患者为无应答者。
在标准药物治疗的基础上增加 TLA 设备可能是治疗难以控制的 AE 的有效辅助手段。
