Atopic dermatitis and indoor use of energy sources in cooking and heating appliances

Background: Atopic dermatitis (AD) prevalence has considerably increased worldwide in recent years. Studying indoor environments is particularly relevant, especially in industrialised countries where many people spend 80% of their time at home, particularly children. This study is aimed to identify the potential association between AD and the energy source (biomass, gas and electricity) used for cooking and domestic heating in a Spanish schoolchildren population. Methods: As part of the ISAAC (International Study of Asthma and Allergies in Childhood) phase III study, a cross-sectional population-based survey was conducted with 21,355 6-to-7-year-old children from 8 Spanish ISAAC centres. AD prevalence, environmental risk factors and the use of domestic heating/cooking devices were assessed using the validated ISAAC questionnaire. Crude and adjusted odds ratios (cOR, aOR) and 95% confidence intervals (CIs) were obtained. A logistic regression analysis was performed (Chi-square test, p-value < 0.05). Results: It was found that the use of biomass systems gave the highest cORs, but only electric cookers showed a significant cOR of 1.14 (95% CI: 1.01-1.27). When the geographical area and the mother’s educational level were included in the logistic model, the obtained aOR values differed moderately from the initial cORs. Electric heating was the only type which obtained a significant aOR (1.13; 95% CI: 1.00-1.27). Finally, the model with all selected confounding variables (sex, BMI, number of siblings, mother’s educational level, smoking habits of parents, truck traffic and geographical area), showed aOR values which were very similar to those obtained in the previous adjusted logistic analysis. None of the results was statistically significant, but the use of electric heating showed an aOR close to significance (1.14; 95% CI: 0.99-1.31). Conclusion: In our study population, no statistically significant associations were found between the type of indoor energy sources used and the presence of AD

Pruritus and atopic dermatitis.

Atopic eczema is one of the most pruritic skin diseases. Mediators of atopic eczema itch in the skin are still mostly unknown, but recent studies showed that the histamine 4 receptor plays an important role in itch pathophysiology; tryptase and interleukin-31 are also involved. Differences in itch perception and itch kinetics between healthy volunteers and eczema patients point towards an ongoing central nervous inhibitory activity in patients. Questionnaire studies reported comparatively higher loads in affective items chosen by patients with atopic eczema. In the concept of patient management, the therapy of clinical pruritus has to consider origin and perception of itch, namely the skin and the central nervous system, by combining topical and systemic treatment

Idiopathic environmental intolerances : Psychosomatic and somatic aspects.

Multiple chemical sensitivity (MCS) or idiopathic envi- ronmental intolerances (IEI) (also called &lsquo;eco-syndrome&rsquo;) describes a syndrome of somatic and/or psychosomatic complaints of mostly subjective nature, attributed to en- vironmental noxious agents. We report the case of a 58- year-old woman with a long-lasting history of hypersen- sitivity phenomena and manifold symptoms which she believed to be provoked by environmental influences. Thorough and interdisciplinary diagnostics including ex- tensive allergological testing procedures (provocative tests) revealed both somatic diagnoses (contact allergy, pseudo-allergic reactions, sicca syndrome, liver steato- sis, porokeratosis superficialis disseminata actinica) as well as psychiatric diagnoses (predisposition to depres- sion). Some symptoms improved in the course of the disease. The basis for successful &lsquo;management&rsquo; of these patients is co-operation between allergists, specialists in the relevant field, and psychiatrists or psychologists