Penanganan Dietary Protein Enterocolitis Karena Alergi Makanan Gastrointestinal

Alergi makanan gastrointestinal adalah spektrum gangguan yang diakibatkan reaksi simpang respon imun terhadap antigen makanan. Gangguan tersebut mencakup hipersensitivitas gastrointestinal imediet (anafilaksis), sindrom alergi oral, alergi eosinophilic esophagitis, gastritis, dan gastroenterocolitis; diet protein enterocolitis, proctitis, dan enteropati; dan penyakit celiac. Gangguan lain kadang-kadang dikaitkan dengan alergi makanan termasuk kolik, gastroesophageal reflux, dan konstipasi. Dokter anak kadang menghadapi beberapa kesulitan dan tantangan dalam menangani gangguan ini karena dalam menerapkan diagnosis memerlukan kecermatan dalam menyingkirkan gangguan alergi penyebab lain yang sangat banyak tetapi dengan gejala yang sama, Demikian pulan dalam penanganannya tidak mudah karena faktor kesulitan melakukan identifikasi makanan penyebab, penerapan diet terapi atau obat-obatan, dan pemantauan penanganan gangguan ini

Gejala yang diamati pada bayi dengan Dietary Protein Enterocolitis sekilas hampir mirip tetapi lebih parah daripada yang diamati dalam enteropathy.protein lainnya. Karena pada gangguan ini terdapat keterlibatan sekaligus kedua usus kecil dan besar sehingga digunakan istilah “enterocolitis”. Kelainan ini harus dibedakan dari penyebab enterocolitis  non alergi lain se[erti infeksi atau enterocolitis neonatal. Protein susu sapi adalah penyebab paling umum, tetapi kira-kira setengah dari pasien juga bereaksi terhadap kedelai. Berbagai makanan tambahan telah terlibat, termasuk beras, gandum dan biji-bijian sereal lainnya, Selama mngkonsumsi protein makanan penyebab baik jangka panjang terus menerus atau intermiten, bayi mungkin mengalami muntah dan diare seperti yang dehidrasi, lesu, asidosis, dan methemoglobinemia dapat mengakibatkan, Pda beberapa bayi mungkin tampak septik dengan polimorfonuklear darah yag tinggi, jumlah leukosit perifer meningkat. Penanganan gejala terjadi setelah identufikasi penyebab dan penghindaran diet yang tepat.

Sebuah tampilan klinis yang berbeda dari gangguan ini adalah reintroduksi protein penyebab reaksi lambat (> 2 jam) timbulnya gejala dramatis yang telah digunakan untuk mengkonfirmasi diagnosis oral challenge makanan.  Konfirmasi diagnosis alergi termasuk pencarian menyingkirkan penyebab lain; Terjadi peningkatan bila tidak mengkonsumsi protein penyebab; Hasil positif oral challenge makanan mengakibatkan muntah, diare dan bukti peradangan gastrointestinal melalui pemeriksaan feses untuk darah, eosinofil, dan peningkatan jumlah leukosit polimorfonuklear perifer lebih dari 3500 sel / mL.22

Perhatian lebih sangat diperlukan saat melakukan oral challenge makanan karena sekitar 20% dari reaksi menyebabkan gangguan berat seperti syok anafilaksi. Diagnosis biasanya dibuat tanpa biopsi, tetapi biopsi kolon pada pasien bergejala mengungkapkan abses crypt dan sel inflamasi difus menyusup dengan sel plasma menonjol; biopsi usus halus mengungkapkan edema, peradangan akut, dan peradangan vili ringan .

Mekanisme yang mendasari gangguan ini tampaknya melibatkan respon sel T spesifik terhadap susu dengan penjabaran dari nekrosis sitokin TNF-α yang juga dapat menjelaskan beberapa gejala sistemik  Beberapa makanan yang sering terlibat mungkin menggambarkan masalah yang lebih umum dalam toleransi imun untuk bayi tersebut. Kelainan ini tidak terkait dengan antibodi IgE (tapi subset kecil pasien akhirnya dapat membentuk respon antibodi IgE) .

Penanganan

  • Mengingat tingginya tingkat alergi penyerta  terhadap susu sapi dan kedelai, pengobatan dengan formula hipoalergenik ekstensif  (kasein hidrolisat) disarankan dan biasanya efektif.
  • Bila tidak, maka formula berbasis asam amino dapat digunakan. Kelainan in mungkin juga disarankan untuk menunda pengenalan makanan alergi lainnya, terutama biji-bijian, pada anak-anak.
  • Pengobatan reaksi akut (reexposure) mungkin memerlukan resusitasi cairan, dan pemberian steroid dianjurkan. Kebanyakan bayi mengalami perbaikkan alergi pada usia 2 atau 3 tahun, tetapi beberapa tampaknya berkepanjangan hipersensitivitas hingga usia anak. Karena penanganan harus dibuktikan melalui oral chalange makanan yang dapat menyebabkan reaksi yang parah, evaluasi harus dilakukan secara hati-hati di bawah pengawasan dalam pengaturan terkontrol, biasanya dengan akses intravena di perawatan Rumah Sakit.

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ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 29614252 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen ***
Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr Widodo Judarwanto, Pediatrician Editor: Audi Yudhasmara email : judarwanto@gmail.com Mobile Phone O8567805533 PIN BBM 76211048 Komunikasi dan Konsultasi online : twitter @widojudarwanto facebook dr Widodo Judarwanto, pediatrician Komunikasi dan Konsultasi Online Alergi Anak : Allergy Clinic Online Komunikasi dan Konsultasi Online Sulit makan dan Gangguan Berat Badan : Picky Eaters Clinic Komunikasi Profesional Pediatric: Indonesia Pediatrician Online

Curriculum Vitae Widodo Judarwanto
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved

Manifestasi Klinis Berbagai Alergi Makanan Gastrointestinal Pada Usia Anak

Alergi makanan gastrointestinal adalah spektrum gangguan yang diakibatkan reaksi simpang respon imun terhadap antigen makanan. Gangguan tersebut mencakup hipersensitivitas gastrointestinal imediet (anafilaksis), sindrom alergi oral, alergi eosinophilic esophagitis, gastritisgastroenterocolitis,  “Dietary protein enterocolitis”, proktitis, dan enteropati; dan penyakit seliak. Gangguan lain kadang-kadang dikaitkan dengan alergi makanan termasuk kolik, gastroesophageal refluks, dan konstipasi. Dokter anak kadang menghadapi beberapa kesulitan dan tantangan dalam menangani gangguan ini karena dalam menerapkan diagnosis memerlukan kecermatan dalam menyingkirkan gangguan alergi penyebab lain yang sangat banyak tetapi dengan gejala yang sama, Demikian pulan dalam penanganannya tidak mudah karena faktor kesulitan melakukan  identifikasi makanan penyebab, penerapan diet terapi atau obat-obatan, dan pemantauan penanganan gangguan ini

Manifestasi Klinis Alergi makanan Gastrointestinal Pada Usia Anak 

GANGGUAN TANDA DAN GEJALA KLINIS
IgE antibody mediated, acute onset
 Immediate gastrointestinal hypersensitivity Onset Akut: mual, muntah, nyeri perut, diare setelah mengkonsumsi susu, telor, gandum, kedelai, kacang atau ikan laut
 Oral allergy syndrome Pruritus, edema ringan, gangguan kavum oral karena  IgE antibodies originally dipicu sensitisisasi  pollen yang bereaksi silang dengan homologous proteins dalam makanan yang terkandung buah atau sayur.
IgE antibody associated in some cases/cell mediated, delayed-onset/chronic
 Eosinophilic gastroenteropathies
Gejala sangat bervariasi tergantung reaksi inflamasi dari eosinofil; esophagealrefluks: disfagia, nyeri perut; ascites generalisata, gangguan kenaikkan berat badan, protein losing enteropathy, edema, obstruksi
Cell-mediated, delayed-onset/chronic
 Dietary protein enterocolitis Paparan Kronis: muntah, diare, gangguan pertumbuhan, letargi.  reexposure setelah retriksi : emesis, diare, hipotension (15%). Atau 2 jam setelah konsumsi makanan: susu, kedelai atau kacangan-kacangan lainnya
 Dietary protein proctitis Berak lendir, darah.
 Dietary protein enteropathy Malabsorption, edema, emesis, berat badan kurang, biasanya disebabkan karena alergi susu sapi
 Celiac disease Malabsorpsi, diare, respon terhadap gluten, berkaitan denagn HLA-DQ2
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ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 29614252 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen ***
Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr Widodo Judarwanto, Pediatrician Editor: Audi Yudhasmara email : judarwanto@gmail.com Mobile Phone O8567805533 PIN BBM 76211048 Komunikasi dan Konsultasi online : twitter @widojudarwanto facebook dr Widodo Judarwanto, pediatrician Komunikasi dan Konsultasi Online Alergi Anak : Allergy Clinic Online Komunikasi dan Konsultasi Online Sulit makan dan Gangguan Berat Badan : Picky Eaters Clinic Komunikasi Profesional Pediatric: Indonesia Pediatrician Online

Curriculum Vitae Widodo Judarwanto
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved

Eosinophilic Gastroenteropathies and Gastrointestinal Food Allergy in Childhood

Eosinophilic Gastroenteropathies and Gastrointestinal Food Allergy in Childhood

Eosinophilic Gastroenteropathies (Eosinophilic Esophagitis, Gastroenterocolitis, and Gastritis)

Gastrointestinal food allergies are a spectrum of disorders that result from adverse immune responses to dietary antigens. The named disorders include immediate gastrointestinal hypersensitivity (anaphylaxis), oral allergy syndrome, allergic eosinophilic esophagitis, gastritis, and gastroenterocolitis; dietary protein enterocolitis, proctitis, and enteropathy; and celiac disease. Additional disorders sometimes attributed to food allergy include colic, gastroesophageal reflux, and constipation. The pediatrician faces several challenges in dealing with these disorders because diagnosis requires differentiating allergic disorders from many other causes of similar symptoms, and therapy requires identification of causal foods, application of therapeutic diets and/or medications, and monitoring for resolution of these disorders.

This heterogeneous group of eosinophilic gastroenteropathies has in common an eosinophilic inflammation of the gut. The nomenclature used to describe particular disorders relates to the locations of eosinophilia; the depth and severity of eosinophilic inflammation influences the symptoms. Named subtypes include allergic eosinophilic gastritis, allergic eosinophilic gastroenterocolitis, and allergic eosinophilic esophagitis. The symptoms caused by these disorders overlap those caused by many other pathologic gastrointestinal processes: postprandial nausea, dysphagia, abdominal pain, vomiting, and diarrhea, and if inflammation is very dense, obstruction can result. Small bowel involvement may result in protein-losing enteropathy and weight loss. Serosal involvement can induce eosinophilic ascites. The disorder requires confirmation of an eosinophilic infiltration of the gut by biopsy (sometimes patchy) and elimination of other causes of eosinophilia, such as parasites, inflammatory bowel disease, and vasculitis. All age groups may be affected, and the disorder has been diagnosed in preterm infants with symptoms that overlap those of necrotizing enterocolitis. Peripheral eosinophilia is sometimes observed (∼50% of patients). The pathophysiologic basis of the disorder has remained elusive, and the role of allergens is debated. At least a subset of those with the disorder are food responsive and reactive to the usual causative agents (eg, milk, egg, wheat, soy) but with an increased degree of multiple food allergies. In patients with food-responsive eosinophilic gastroenteropathies, the pathophysiological mechanisms seem to include both cell-mediated and IgE antibody-mediated forms.

Perhaps the most common type of eosinophilic gastroenteropathy and most difficult to diagnose and manage is allergic eosinophilic esophagitis. This disorder is particularly challenging to diagnose because the symptoms overlap those of GER. Patients with allergic eosinophilic esophagitis have a predominance of dysphagia (∼85%), and there is an overrepresentation of young, atopic male patients. Although symptoms overlap those of GER, in some patients reflux is absent on pH probe. Some authors have evaluated the number of eosinophils per high-power field as a means to differentiate this disorder from GER, and when the numbers exceed 7, especially when they are >24, allergic and/or intrinsic eosinophilic inflammation is likely. In this scenario, medical treatment for GER may fail, but anti-inflammatory medications such as oral steroids have proved efficacious. The ability of dietary management to ameliorate the inflammation has been provedmbut is not universally curative. Orenstein et al52 documented positive prick skin tests or RASTs in 13 of 19 children with eosinophilic esophagitis (median: 7 foods). Dietary elimination was undertaken in 12 of the 13 with positive tests. Of 10 who were compliant with the diet, all were believed to benefit with resolution of symptoms. Seven of the patients had concomitant therapies (steroid, 3; antireflux medications, 2; cromolyn, 1; or fundoplication, 1); however, lapses in the diet were accompanied by recurrence of symptoms in the months after diagnosis despite the other therapies. In a study that specifically addressed the role of food allergy in children with eosinophilic esophagitis, Kelly et al evaluated patients for whom standard GER treatment or fundoplication failed (6 patients) and who had persistent eosinophilia on esophageal biopsy. These patients were placed on a very restricted diet (1–2 solid foods, eg, apple, corn) and an amino acid-based formula. Eight of 10 patients became symptom-free, and 2 had significant reduction in symptoms within 2 to 6 weeks after starting the dietary program. The patients also demonstrated a decline in the median numbers of eosinophils from 40 to 0.5/high-power field. The causal foods were primarily milk, soy, egg, peanut, and wheat. The correlation of causal foods with positive skin test results was poor, and improved diagnostic methods are under investigation. Oral steroids have been effective, including case reports of high-dose inhaled/swallowed steroids (eg, the off-label use of inhaled steroids sprayed into the mouth and swallowed), and additional anti-inflammatory therapies such as cromolyn and leukotriene antagonists have been tried but require additional study. A trial of an elemental diet may prove beneficial in many of these patients, but the process of identifying causal allergens is time-consuming and often frustrating. If there is a response to elimination diets—which entails at least 6 weeks on the diet and may require a biopsy to confirm—then foods are slowly added back into the diet. The onset of symptoms after addition of a problematic food may be delayed, adding to the diagnostic difficulties.

The natural course of the allergic eosinophilic gastroenteropathies is not well-defined. For at least some patients, the disorder seems to be long-lived and can continue (or present) through adulthood with a waxing and waning course with an element of improvement over time.

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ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 29614252 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen ***
Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr Widodo Judarwanto, Pediatrician Editor: Audi Yudhasmara email : judarwanto@gmail.com Mobile Phone O8567805533 PIN BBM 76211048 Komunikasi dan Konsultasi online : twitter @widojudarwanto facebook dr Widodo Judarwanto, pediatrician Komunikasi dan Konsultasi Online Alergi Anak : Allergy Clinic Online Komunikasi dan Konsultasi Online Sulit makan dan Gangguan Berat Badan : Picky Eaters Clinic Komunikasi Profesional Pediatric: Indonesia Pediatrician Online

Curriculum Vitae Widodo Judarwanto
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved

Clinical Features of Food Allergic Children with Malnutrition

Journal of Allergy and Clinical Immunology Volume 125, Issue 2, Supplement 1, Page AB87, February 2010

Clinical Features of Food Allergic Children with Malnutrition

T. Takamasu, M. Miyagawa,M. Wada,S. Harada,K. Hiroki,K. KuriharaKanagawa Children’s Medical Center, Yokohama-shi, JAPAN

Abstract

RATIONALE: The prevalence of food allergy is 7% in Japan. Elimination diet is the only measure for food allergy, and sometimes causes malnutrition. We investigated the background of malnutrition in food allergic children.

METHODS: We sampled 24 food allergic children with malnutrition, which is found by growth curve. Growth curve showed loss of weight gain in 15 cases, and weight loss in 9 cases. Medical records for these patients were examined.

RESULTS: Subjects were 20 boys and 4 girls. Mean age of the subjects was 1.3±0.8 years. Mean SD for standard height was -1.0±1.2, and mean SD for standard weight was -1.3±0.9. Mean number of foods which should be eliminated was 2.9. The cause of malnutrition was over-elimination in 11 cases, umbalanced diet in 6 cases, reject of weaning food in 4 cases, and exercerbation of atopic dermatitis in 3 cases. Serum albumin was examined in 21 cases, and showed below 3.0g/dl only in 2 cases. Prealbumin was examined in 10 cases, and showed below 20mg/dl in all cases, and below 15mg/dl in 6 cases.

CONCLUSIONS: Most cases of food allergy with malnutrition had psychological or social problems. Therefore psychological or social counseling were needed for these cases. Growth curve and prealbumin was useful for nutritional assessment.

 

 

 
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ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 97730777 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen *** Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr WIDODO JUDARWANTO, pediatrician email : judarwanto@gmail.com Creating-hashtag-on-twitter: @WidoJudarwanto www.facebook.com/widodo.judarwanto Mobile Phone O8567805533 PIN BB 25AF7035
Curriculum Vitae Widodo Judarwanto

We are guilty of many errors and many faults. But our worst crime is abandoning the children, neglecting the fountain of life.

Allergy Clinic Online Facebook Page

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved

Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema.

Contact Dermatitis. 2012 Oct;67(4):184-92.

Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema.

Boehm D1, Schmid-Ott G, Finkeldey F, John SM, Dwinger C, Werfel T, Diepgen TL, Breuer K.
Abstract

BACKGROUND: Occupational hand eczema is one of the most frequent occupational diseases. Few data about the prevalence of mental comorbidities are available. Objectives. We aimed to investigate the prevalence of anxiety, depression symptoms, the impairment of health-related quality of life (HRQoL) and their correlates in patients with occupational hand eczema.

PATIENTS AND METHODS: A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale, the Dermatology Life Quality Index (DLQI) as a specific instrument and the Short Form Health Survey-36 (SF-36) as a generic instrument for HRQoL was applied in 122 patients. The severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index (OHSI).

RESULTS: Twenty per cent of patients had a positive anxiety score, and 14% had a positive depression score. Higher anxiety levels, a greater impairment in the SF-36 mental component summary score and a higher DLQI category score for symptoms and feelings was detected in females than in males. The OHSI correlated with the impairment in HRQoL, and an association of severe hand eczema with symptoms of anxiety and depression was found in males.

CONCLUSIONS: We found a high prevalence of anxiety and depression in our study population of patients with occupational hand eczema. Preventive measures should consider the psychosocial implications of occupational hand eczema.

Widodo Judarwanto

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ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 97730777 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen *** Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr WIDODO JUDARWANTO, pediatrician email : judarwanto@gmail.com Creating-hashtag-on-twitter: @WidoJudarwanto www.facebook.com/widodo.judarwanto Mobile Phone O8567805533 PIN BB 25AF7035
Curriculum Vitae Widodo Judarwanto

We are guilty of many errors and many faults. But our worst crime is abandoning the children, neglecting the fountain of life.

Allergy Clinic Online Facebook Page

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved

Allergy-Behaviour: Infant-onset eczema in relation to mental health problems

J Allergy Clin Immunol. 2010 Feb;125(2):404-10.

Infant-onset eczema in relation to mental health problems at age 10 years: results from a prospective birth cohort study (German Infant Nutrition Intervention plus).

Schmitt J1, Apfelbacher C, Chen CM, Romanos M, Sausenthaler S, Koletzko S, Bauer CP, Hoffmann U, Krämer U, Berdel D, von Berg A, Wichmann HE, Heinrich J; German Infant Nutrition Intervention plus Study Group.

Abstract

BACKGROUND:

Cross-sectional studies suggest an association between eczema and mental health problems, but the temporal relationship is unclear.

OBJECTIVE:

To assess the association between infant-onset eczema and mental health problems in a prospective study.

METHODS:

Between 1995 and 1998, a birth cohort study was recruited and followed until age 10 years. Physician-diagnosed eczema, comorbidities, and a broad set of environmental exposures were assessed at age 1, 2, 3, 4, 6, and 10 years. First, we investigated the association between infant-onset eczema (age 1-2 years) and mental health problems at age 10 years according to the Strengths and Difficulties Questionnaire. Second, we analyzed the likelihood of mental health problems at age 10 years in relation to the course of eczema.

RESULTS:

A total of 2916 infants were eligible for analysis. Compared with participants never diagnosed as having eczema, children with infant-onset eczema had a significantly increased risk for possible/probable mental health problems (Strengths and Difficulties Questionnaire total score) at age 10 years (odds ratio, 1.49; 95% CI, 1.13-1.96) and for emotional symptoms (odds ratio, 1.62; 95% CI, 1.25-2.09). Eczema limited to infancy predicted a significantly higher risk for conduct problems at age 10 years. The strength of the association between eczema and emotional problems at age 10 years increased with increasing eczema persistence.

CONCLUSION:

Infants with eczema are at increased risk for mental health problems at age 10 years. Even if cleared afterward, eczema at age 1 to 2 years may cause persistent emotional and behavioral difficulties.

Widodo Judarwanto

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ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 97730777 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen *** Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr WIDODO JUDARWANTO, pediatrician email : judarwanto@gmail.com Creating-hashtag-on-twitter: @WidoJudarwanto www.facebook.com/widodo.judarwanto Mobile Phone O8567805533 PIN BB 25AF7035
Curriculum Vitae Widodo Judarwanto

We are guilty of many errors and many faults. But our worst crime is abandoning the children, neglecting the fountain of life.

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Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved

Mental health comorbidity in patients with atopic dermatitis.

J Allergy Clin Immunol. 2013 Feb;131(2):428-33.

Mental health comorbidity in patients with atopic dermatitis.

Yaghmaie P1, Koudelka CW, Simpson EL.
Abstract

BACKGROUND:,Recent data, primarily from Europe, suggest that children with atopic dermatitis (AD) might be at increased risk of mental health disorders.

OBJECTIVE: We aimed to quantify the mental health burden associated with pediatric AD in the United States.

METHODS: A cross-sectional study design was used analyzing data from the 2007 National Survey of Children’s Health, a survey reporting on the health status of 92,642 noninstitutionalized children aged 0 to 17 years. The lifetime prevalence of various provider-diagnosed mental health conditions was calculated for those with and without a history of AD.

RESULTS: The odds of having attention deficit hyperactivity disorder was significantly increased in children with AD compared with the odds in control subjects without AD (odds ratio, 1.87; 95% CI, 1.54-2.27), even after controlling for known confounders. The adjusted odds ratios for depression, anxiety, conduct disorder, and autism were 1.81 (95% CI, 1.33-2.46), 1.77 (95% CI, 1.36-2.29), 1.87 (95% CI, 1.46-2.39), and 3.04 (95% CI, 2.13-4.34), respectively, and these estimates were all statistically significant. A clear dose-dependent relationship was observed between the prevalence of a mental health disorder and the reported severity of the skin disease.

CONCLUSIONS: Our data reveal a striking association between mental health disorders and AD in the US pediatric population. The severity of the skin disease alters the strength of the association. Prospective cohort studies are needed to verify these associations and to explore underlying mechanisms. Strategies to prevent AD or to aggressively treat early skin inflammation might modify the risk of mental health disorders in at-risk children.

 

ARTIKEL TERKAIT:

 

  • Schmitt, J., Apfelbacher, C., Chen, C.M., Romanos, M., Sausenthaler, S., Koletzko, S. et al. Infant-onset eczema in relation to mental health problems at age 10 years: results from a prospective birth cohort study (German Infant Nutrition Intervention plus). J Allergy Clin Immunol. 2010; 125: 404–410
  • Schmitt, J., Romanos, M., Pfennig, A., Leopold, K., and Meurer, M. Psychiatric comorbidity in adult eczema. Br J Dermatol. 2009; 161: 878–883
  • Wittkowski, A., Richards, H.L., Griffiths, C.E., and Main, C.J. The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis. J Psychosom Res. 2004; 57: 195–200
  • Yaghmaie, P., Koudelka, C.W., and Simpson, E.L. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013; 131: 428–433

 

 

 

 

Widodo Judarwanto

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www.allergycliniconline.com

ALLERGY ONLINE CLINIC FOR CHILDREN, TEEN AND ADULT Yudhasmara Foundation www.allergycliniconline.com GROW UP CLINIC I JL Taman Bendungan Asahan 5 Jakarta Pusat, Jakarta Indonesia 10210 Phone : (021) 5703646 – 44466102 GROW UP CLINIC II MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430 phone 44466103 – 97730777 http://growupclinic.com http://www.facebook.com/GrowUpClinic Creating-hashtag-on-twitter@growupclinic Working together support to health of all by clinical practice, research and educations. Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult
“GRoW UP CLINIC” Jakarta Focus and Interest on: ***Allergy Clinic Online *** Picky Eaters and Growup Clinic For Children, Teen and Adult (Klinik Khusus Gangguan Sulit Makan dan Gangguan Kenaikkan Berat Badan)*** Children Foot Clinic *** Physical Medicine and Rehabilitation Clinic *** Oral Motor Disorders and Speech Clinic *** Children Sleep Clinic *** Pain Management Clinic Jakarta *** Autism Clinic *** Children Behaviour Clinic *** Motoric & Sensory Processing Disorders Clinic *** NICU – Premature Follow up Clinic *** Lactation and Breastfeeding Clinic *** Swimming Spa Baby & Medicine Massage Therapy For Baby, Children and Teen *** Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr WIDODO JUDARWANTO, pediatrician email : judarwanto@gmail.com Creating-hashtag-on-twitter: @WidoJudarwanto www.facebook.com/widodo.judarwanto Mobile Phone O8567805533 PIN BB 25AF7035
Curriculum Vitae Widodo Judarwanto

We are guilty of many errors and many faults. But our worst crime is abandoning the children, neglecting the fountain of life.

Allergy Clinic Online Facebook Page

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2014, Allergy Clinic Online Information Education Network. All rights reserved