Dermatitis

Major modifiable risk factors for childhood food allergies include delayed introduction of solid foods and early treatment with antibiotics. James W. Mold, MD, MPH

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Importance: The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Objective: To estimate the incidence and quantify risk factors for food allergy development.

Data sources: MEDLINE and Embase were systematically searched to January 1, 2025. Data were analyzed from June 1, 2025, to November 25, 2025.

Study selection: Incidence estimates included studies confirming food allergy via food challenge. Risk factor analyses included cohort, case-control, and cross-sectional studies in any language assessing children younger than 6 years using multivariable analyses.

Data extraction and synthesis: Paired reviewers independently extracted data. Random-effects meta-analyses pooled incidence and adjusted odds ratios (ORs). Risk of bias was assessed using the QUIPS tool, and certainty of evidence assessed using GRADE.

Main outcome and measure: The primary outcome was food allergy to age 6 years.

Results: A total of 190 studies involving 2.8 million participants across 40 countries were analyzed. Among studies using food challenge, overall food allergy incidence was likely 4.7% (moderate certainty). Among 176 studies identifying 342 risk factors with varying certainty, the strongest and most certain factors included prior allergic conditions (eg, atopic dermatitis [eczema] within the first year of life [OR, 3.88; risk difference [RD], 12.0%; 95% CI, 8.8%-15.7%], allergic rhinitis [OR, 3.39; RD, 10.1%; 95% CI, 6.7%-14.4%], and wheeze [OR, 2.11; RD, 5.0%; 95% CI, 2.1%-8.8%]), severity of atopic dermatitis (OR, 1.22; RD, 1.0%; 95% CI, 0.6%-1.6%), increased skin transepidermal water loss (OR, 3.36; RD, 10.0%; 95% CI, 6.3%-14.8%), filaggrin gene sequence variations (OR, 1.93; RD, 4.2%; 95% CI, 2.4%-6.4%), delayed solid food introduction (eg, peanut after age 12 months [OR, 2.55; RD, 6.8%; 95% CI, 1.9%-14.6%]), infant antibiotic use (first month [OR, 4.11; RD, 12.8%; 95% CI, 0.4%-40%], first year [OR, 1.39; RD, 1.8%; 95% CI, 0.8%-3.1%], during pregnancy [OR, 1.32; RD, 1.5%; 95% CI, 0.6%-2.5%]), male sex (OR, 1.24; RD, 1.1%; 95% CI, 0.7%-1.6%), firstborn child (OR, 1.13; RD, 0.6%; 95% CI, 0.3%-1.0%), family history of food allergy (eg, mother [OR, 1.98; RD, 4.4%; 95% CI, 2.5%-6.8%], father [OR, 1.69; RD, 3.2%; 95% CI, 1.3%-5.5%], both parents [OR, 2.07; RD, 4.8%; 95% CI, 1.3%-5.5%], siblings [OR, 2.36; RD, 6.0%; 95% CI, 4.4%-8.0%]), parental migration (OR, 3.28; RD, 9.7%; 95% CI, 4.9%-16.3%), self-identification as Black (vs White [OR, 3.93; RD, 12.1%; 95% CI, 5.2%-22.5%], vs non-Hispanic White [OR, 2.23; RD, 5.5%; 95% CI, 3.0%-8.7%]), and cesarean delivery (OR, 1.16; RD, 1.0%; 95% CI, 0.3%-1.2%). Factors like low birth weight, postterm birth, maternal diet, and stress during pregnancy showed no significant risk difference.

Conclusions and relevance: In this meta-analysis, the most credible risk factors associated with development of childhood food allergy are a combination of major and minor risk factors, including early allergic conditions (atopic march/diathesis), delayed allergen introduction, genetics, antibiotic exposure, demographic factors, and birth-related variables.

Author/s:

Nazmul Islam, Alexandro W L Chu, Falana Sheriff, Farid Foroutan, Gordon H Guyatt, Romina Brignardello-Petersen, Paul Oykhman, Alfonso Iorio, Ariel Izcovich, Katherine M Morrison, Yetiani Roldan Benitez

Treatment of Atopic Dermatitis

Megan George — Thu, 21 Aug 2025 15:59:01 +0000

Date Added:

August 21, 2025

Journal/Publication:

JAMA

Publication Date:

August 20, 2025

URL:

Treatment of Atopic Dermatitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.11589

Keywords

dermatology

atopic dermaitis

A review of currently available treatment methods for patients with atopic dermatitis. James W. Mold, MD, MPH

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Not Available

Author/s:

Aaron M. Drucker

Hand eczema

Alex Haga — Tue, 17 Dec 2024 19:23:37 +0000

Date Added:

December 17, 2024

Journal/Publication:

Lancet

Publication Date:

December 14, 2024

Issue:

10470

Volume:

404

Pages:

2476-2486

URL:

Hand eczema

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(24)01810-5

Keywords

eczema

hand

PMID (1):

39615508

MeSH

Dermatitis

Atopic / diagnosis

Eczema*

Hand Dermatoses* / diagnosis

Phototherapy

A review of the recognition and management of hand eczema. James W. Mold, MD, MPH

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Hand eczema is a highly prevalent skin disease and one of the most common work-related disorders. In up to two-thirds of individuals affected by hand eczema, the disease becomes chronic and results in substantial personal and occupational disability. Manifestations of chronic hand eczema vary in severity and appearance over time, and people with eczema typically experience itch, pain, and a burning sensation. The pathophysiology of chronic hand eczema is multifactorial. Major risk factors are current or past atopic dermatitis and excessive or prolonged exposure to irritants or allergens. Based on the suspected main causes, chronic hand eczema is commonly classified into irritant, allergic, and atopic hand eczema. Diagnosis and assessment can be complex, and management is often challenging. Strategies include structured education, avoidance of trigger factors, primary to tertiary prevention, topical anti-inflammatory treatment with glucocorticosteroids, calcineurin inhibitors, or januskinase inhibitors, phototherapy, systemic retinoids, and off-label use of immunosuppressive drugs. Topical and systemic immunomodulatory therapies approved for atopic dermatitis could be used in severe atopic hand eczema and some of them are under clinical development for chronic hand eczema. Additional research is needed to better understand chronic hand eczema subtypes and underlying mechanisms, and the comparative effectiveness and safety of therapies. This Review combines established knowledge with ongoing changes in our understanding of the disease and their implications for prevention, management, and future research.

Author/s:

Stephan Weidinger, Natalija Novak

JAK 1-3 inhibitors and TYK-2 inhibitors in dermatology: Practical pearls for the primary care physician

Alex Haga — Wed, 23 Oct 2024 15:38:30 +0000

Date Added:

October 23, 2024

Journal/Publication:

Journal of Family Medicine and Primary Care

Publication Date:

October 1, 2024

Issue:

Volume:

Pages:

4128-4134

URL:

JAK 1-3 inhibitors and TYK-2 inhibitors in dermatology: Practical pearls for the primary care physician

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.4103/jfmpc.jfmpc_112_24

Keywords

Alopecia areata

atopic

Atopic Dermatitis

Janus Kinase inhibitors

psoriasis

tyrosine-protein kinase inhibitors

MeSH

Janus Kinase Inhibitors

A review of JSK and TYK inhibitors for treatment of dermatologic conditions. James W. Mold, MD, MPH

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Guidelines for primary care clinicians on monitoring and safety guidelines regarding Janus kinase and tyrosine kinase 2 inhibitors in the treatment of inflammatory skin conditions are often unclear. This review aims to provide the primary care physician with a review of clinically relevant and updated information regarding the monitoring and overall profile of these medications. To do so, a systematic review was conducted using the PubMed database and relevant Food and Drug Administration (FDA) approved drug inserts from manufacturers. Janus kinase and tyrosine kinase 2 inhibitors have recently gained FDA approval for the treatment of several inflammatory skin conditions including atopic dermatitis, plaque psoriasis, alopecia areata, and vitiligo. There is a known box warning associated with the Janus kinase inhibitors that create the need for monitoring and close follow-up while patients are undergoing these treatments. Although these medications are often prescribed by specialists, as their use becomes more prevalent and therapies continue to gain approval for the treatment of these commonly encountered conditions, it is important for the primary physician to be updated and aware of the current monitoring guidelines and safety profile for this class of medication. Both Janus kinase inhibitors and tyrosine kinase 2 inhibitors display significant efficacy in the treatment of their approved conditions and research continues to move forward with the approval of more medications from these classes.

Author/s:

Beard, Abigail, Trotter, Shannon C.

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations

Alex Haga — Sun, 11 Aug 2024 18:08:48 +0000

Date Added:

August 11, 2024

Journal/Publication:

Ann Allergy Asthma Immunol

Publication Date:

December 17, 2023

Issue:

Volume:

132

Pages:

274-312

URL:

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.anai.2023.11.009

Keywords

allergy

asthma

Atopic Dermatitis

PMID (1):

38108679

MeSH

adrenal cortex hormones

Asthma*

Dermatitis

Atopic* / drug therapy

Eczema*

A 2023 updated guideline for management of patients with atopic dermatitis. James W. Mold, MD, MPH

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Background: Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.

Objective: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.

Methods: A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles.

Results: The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts.

Conclusion: These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).

Author/s:

AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, Derek K Chu, Lynda Schneider, Rachel Netahe Asiniwasis, Mark Boguniewicz

Poison Ivy, Poison Oak, and Poison Sumac

Alex Haga — Thu, 30 May 2024 22:06:52 +0000

Date Added:

May 30, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

May 16, 2024

URL:

Poison Ivy, Poison Oak, and Poison Sumac

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.26355

Keywords

PMID (1):

38753316

MeSH

Patient information regarding poison ivy, oak, and sumac. James W. Mold, MD, MPH

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This JAMA Patient Page describes allergic skin reactions from contact with poison ivy, poison oak, and poison sumac plants, and how to treat rashes caused by these plants.

Author/s:

Lauren Weinberg, Preeti N Malani