Вопросы врачу Вадиму Асадулину

[Вадим Асадулин]

REFERENCES.
1.Augustin M, Zschocke I, Buhrke U. Attitudes and prior experience with respect to alternative medicine among dermatological patients: the Freiburg questionnaire on attitudes to naturopathy (FAN). Forsch Komplementä rmed 1999;6:26–29. Universitäts-Hautklinik Freiburg. augustin@haut.ukl.uni-freiburg.de
Abstract.
OBJECTIVES: 1) Development and validation of a questionnaire on the attitudes and prior therapies with respect to naturopathy. 2) Clinical application in patients with atopic dermatitis in conventional and unconventional inhospital therapy.
METHODS: A questionnaire for patients with skin diseases was developed, which includes the following areas: 1. prior therapies (conventional, unconventional, and psychotherapeutic procedures), 2. attitudes to the procedures, 3. previous therapists, 4. sources of information about the disease. The questionnaire was validated on 1,288 inpatients and outpatients in three clinics. A comparison study using the questionnaire was performed with 73 inpatients with atopic dermatitis under conventional therapy and 59 inpatients under alternative-medical therapy.
RESULTS: The patients undergoing alternative-medical therapy reported significantly more prior experience in both conventional and unconventional procedures. The unconventional procedures were rated significantly higher by these patients, while the patients under conventional treatment rated several conventional procedures significantly higher. With respect to previous therapists, patients under unconventional treatment had been treated significantly more frequently by physicians oriented toward naturopathy and nonmedical practitioners. Prior information concerning the disease had been obtained significantly more frequently by the patients under alternative-medical treatment.
DISCUSSION: Patients with atopic dermatitis under conventional or alternative medical treatment differ widely from one another with respect to previous therapies and prior experience and attitudes to conventional and unconventional procedures. These selection effects must be taken into consideration when comparing various therapeutic approaches, e. g. in multicenter studies.
http://www.ncbi.nlm.nih.gov/pubmed?t...0I%2C%20Buhrke
2. Ehlers A, Stangier U, Gieler U. Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. J Consult Clin Psychol 1995;63:624–635. Department of Psychiatry, University of Oxford, Great Britain.
Abstract.
A randomized controlled trial compared the effectiveness of 4 group treatments for atopic dermatitis, a chronic skin disorder characterized by severe itching and eczema: dermatological educational program (DE), autogenic training as a form of relaxation therapy (AT), cognitive-behavioral treatment (BT), and the combined DE and BT treatments (DEBT). BT comprised relaxation, self-control of scratching, and stress management. Group treatments were also compared with standard medical care (SMC). Assessments at 1-year follow-up showed that the psychological treatments (AT, BT, and DEBT) led to significantly larger improvement in skin condition than intensive (DE) or standard (SMC) dermatological treatment, accompanied by significant reductions in topical steroids used. The results corroborate preliminary reports that psychological interventions are useful adjuncts to dermatological treatment in atopic dermatitis.
http://www.ncbi.nlm.nih.gov/pubmed/7673540

3. Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol 1998;9:13–19. Department of Dermatology, Royal Hospital for Sick Children, Glasgow, United Kingdom.
Abstract.
BACKGROUND: The role of exclusion diets in the management of atopic eczema in young children is uncertain. This randomised controlled trial evaluates the effect of excluding egg from the diet in young children with atopic eczema and sensitivity to eggs. Fifty-five such children were randomised either to a 4-week regimen, in which mothers were given general advice on care of eczema and additional specific advice from a dietician about an egg exclusion diet (diet group), or to a control group in which general advice only was given. Both groups continued conventional topical treatment. Disease activity was assessed by estimates of the surface area affected by eczema and by an arbitrary severity score. Possible egg sensitivity was identified by RAST before randomisation and after the trial by double-blind placebo-controlled egg challenge. RESULTS: The mean reduction in surface area affected by eczema was significantly greater (p = 0.02) in the group receiving dietary advice (from 19.6% to 10.9% area affected) than in the control group (from 21.9% to 18.9%). A significant improvement also occurred in severity score (p = 0.04): from 33.9 to 24.0 units for the diet group compared with a decrease from 36.7 to 33.5 in the control group. The study suggests that advice on the dietary exclusion of eggs is useful as part of the overall management of young children with atopic eczema and sensitivity to eggs.
http://www.ncbi.nlm.nih.gov/pubmed?t...20C%2C%20Waugh
4. Atherton D J, Sewall M, Soothill J F, Wells R S, Chilvers C E D. A double-blind controlled cross-over trial of an antigen-avoidance diet in atopic eczema. Lancet 1978;25:401–403.
Abstract.
20 out of 36 children (aged two to eight years) with atopic eczema completed a twelve-week, double-blind, controlled, crossover trial of an egg and cows' milk exclusion diet. During the first and third four-week periods, patients on an egg and cows' milk exclusion diet received a soya-based milk substitute (trial period) or an egg and cows' milk preparation (control period). Response was assessed in terms of eczema activity, number of areas affected, pruritus, sleeplessness, and antihistamine usage while on the two diets. During the middle period patients resumed their normal diet to minimise any carry-over effect. 14 patients responded more favourably to the antigen-avoidance diet than to the control diet, whereas only 1 responded more favourably to the control diet than the trial diet. Patients experienced more benefit during the first diet period than the second, whatever the nature of the diet. There was no correlation between a positive prick test to egg and cows' milk antigen and response to the trial diet.
http://www.ncbi.nlm.nih.gov/pubmed?term=75438

5. Neild V S, Marsden R A, Bailes J A, Bland J M. Egg and milk exclusion diets in atopic eczema. Br J Dermatol 1986;114:117–123.
Abstract.
Fifty-three patients with atopic eczema took part in a double blind controlled cross-over trial of an egg and cow's milk exclusion diet. Response to the diet was assessed in terms of areas affected, day and night time itch, and topical steroid usage. Twenty-five percent of the patients failed to comply adequately with the trial regime and were excluded from the analysis. Of the remaining 40 patients, ten appeared to benefit from the diet and were advised to continue egg and milk avoidance. This response rate to the diet was not statistically significant.
http://www.ncbi.nlm.nih.gov/pubmed?t...0A%2C%20Bailes
6. Cant A J, Bailes J A, Marsden R A, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies. BMJ Clin Res Ed 1986;293:231–233.
Abstract.
Thirty seven breast fed infants with eczema were studied to see whether changes in their mothers' diets affected their skin condition. Nineteen mothers and babies took part in a double blind crossover trial of exclusion of egg and cows' milk, and 18 took part in open exclusion of 11 foods followed by double blind challenge to those mothers whose infants seemed to respond. Babies were examined at the beginning and end of each dietary period, and the extent and severity of the rash were given a numerical score. The eczema improved in six infants when their mothers avoided egg and cows' milk and worsened again when these were reintroduced. Two infants suffered gastrointestinal reactions after maternal ingestion of egg and cows' milk, one developing colitis. Maternal dietary exclusion seems to benefit some breast fed babies with eczema.
http://www.ncbi.nlm.nih.gov/pubmed/3089466
7. Kramer M S, Kakuma R. Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child. The Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000133. McGill University, Faculty of Medicine, 1020 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A2. michael.kramer@mcgill.ca
Update in:
Cochrane Database Syst Rev. 2006;3:CD000133.
Update of:
Cochrane Database Syst Rev. 2000;(2):CD000133.
Abstract.
BACKGROUND: Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.
OBJECTIVES: To assess the effects of prescribing an antigen avoidance diet during pregnancy and/or lactation on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2002) and contacted researchers in the field.
SELECTION CRITERIA: All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of nondietary aspects of the infant's environment.
DATA COLLECTION AND ANALYSIS: We extracted data from published reports, supplemented by additional information received from the trialists we contacted.
MAIN RESULTS: The evidence from 4 trials involving approximately 451 participants does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 12 to 18 months of life. Data on allergic rhinitis/conjunctivitis and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a nonsignificantly higher risk of preterm birth, and a nonsignificant reduction in mean birthweight.The evidence from 3 trials involving approximately 210 participants suggests a protective effect of maternal antigen avoidance during lactation on the incidence and severity of atopic eczema during the first 12 to 18 months, but methodologic shortcomings argue for caution in interpretation.One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a nonsignificant reduction in eczema severity.
REVIEWER'S CONCLUSIONS: Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal and/or fetal nutrition. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.
http://www.ncbi.nlm.nih.gov/pubmed/14583912
Есть и продолжение этого исследования, не указанное в библиографии.
Cochrane Database Syst Rev. 2006 Jul 19;3:CD000133.
Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.
Kramer MS, Kakuma R.
McGill University, Faculty of Medicine, 1020 Pine Avenue West, Montreal, Quebec, Canada H3A 1A2. michael.kramer@mcgill.ca
Update of:
Cochrane Database Syst Rev. 2003;(4):CD000133.
Abstract.
BACKGROUND: Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.
OBJECTIVES: To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2006) and contacted researchers in the field.
SELECTION CRITERIA: All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of nondietary aspects of the infant's environment.
DATA COLLECTION AND ANALYSIS: We extracted data from published reports, supplemented by additional information received from the trialists we contacted.
MAIN RESULTS: The evidence from four trials, involving 334 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a nonsignificantly higher risk of preterm birth, and a nonsignificant reduction in mean birthweight.The evidence from one trial, involving 26 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months.One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a nonsignificant reduction in eczema severity.
AUTHORS' CONCLUSIONS: Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.
http://www.ncbi.nlm.nih.gov/pubmed/16855951
8. Osborn D A, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003741.
Update in:
Cochrane Database Syst Rev. 2006;(4):CD003741.
Abstract.
BACKGROUND: Allergies and food reactions in infants and children are common and may be associated with foods including adapted cow's milk formulas. Soy based formulas have been used to treat infants with allergy or food intolerance. However, it is unclear whether they can be advocated for the prevention of allergy and food intolerance in infants without clinical evidence of allergy or food intolerance.
OBJECTIVES: In infants without clinical evidence of allergy or food intolerance, to determine whether feeding them an adapted soy formula compared to human milk, cow's milk formula or a hydrolysed protein formula prevents allergy or food intolerance.
SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used including searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2003), MEDLINE (1966 - January 2004), EMBASE (1980 - January 2004), CINAHL (1982 - December 2003) and previous reviews including cross references.
SELECTION CRITERIA: Randomised and quasi-randomised trials that compare the use of an adapted soy formula to human milk, an adapted cow's milk or a hydrolysed protein formula for infant feeding in the first 6 months. Only trials with > 80% follow up of participants and reported in group of assignment were eligible for inclusion.
DATA COLLECTION AND ANALYSIS: Eligibility of studies for inclusion, methodological quality and data extraction were assessed independently by each reviewer. Primary outcomes included clinical allergy, specific allergies and food intolerance. Meta-analysis was conducted using a fixed effects model where no heterogeneity of treatment effect existed, and a random effects model when heterogeneity was found.
MAIN RESULTS: Five eligible studies were found, all enrolling infants at high risk of allergy on the basis of a family history of allergy in a first degree relative. All studies compared use of a soy to a cow's milk formula. Two studies also included a group fed a formula containing hydrolysed protein. No eligible study enrolled infants fed human milk. No study examined the effect of early, short term soy formula feeding. Three studies were of good methodology and did not have unbalanced allergy-preventing co-interventions in the treatment groups. Comparing soy to cow's milk formula, one study with unclear allocation concealment and 19.5% losses to follow up reported a reduction in cumulative incidence of childhood allergy, asthma and allergic rhinitis. No other study reported a significant benefit for any allergy or food intolerance. Analysis found no significant difference in allergy cumulative incidence in infancy (one study: RR 1.02, 95% CI 0.69, 1.49) or childhood (3 studies: typical RR 0.73, 95% CI 0.37, 1.44) and no significant difference in cumulative incidence or period prevalence of any specific allergy or food intolerance in infancy or childhood. Analysis of studies comparing soy to a hydrolysed formula found a significant increase in infant (one study: RR 1.67, 95% CI 1.03, 2.69) and childhood allergy cumulative incidence (one study: RR 1.55, 95% CI 1.02, 2.35), infant eczema cumulative incidence (2 studies: typical RR 2.34, 95% CI 1.51, 3.62) and childhood food allergy period prevalence (one study: RR 1.81, 95% CI 1.09, 3.02).
REVIEWERS' CONCLUSIONS: Feeding with a soy formula should not be recommended for the prevention of allergy or food intolerance in infants at high risk of allergy or food intolerance.
http://www.ncbi.nlm.nih.gov/pubmed/15266499
Есть и продолжение этого исследования, не указанное в библиографии.
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003741.
Soy formula for prevention of allergy and food intolerance in infants.
Osborn DA, Sinn J.
Westmead Hospital, Neonatal Unit, Hawkesbury Road, Westmead, New South Wales, Australia.
Update of:
Cochrane Database Syst Rev. 2004;(3):CD003741.
Abstract.
BACKGROUND: Allergies and food reactions in infants and children are common and may be associated with a variety of foods including adapted cow's milk formula. Soy based formulas have been used to treat infants with allergy or food intolerance. However, it is unclear whether they can help prevent allergy and food intolerance in infants without clinical evidence of allergy or food intolerance.
OBJECTIVES: To determine the effect of feeding adapted soy formula compared to human milk, cow's milk formula or a hydrolysed protein formula on preventing allergy or food intolerance in infants without clinical evidence of allergy or food intolerance.
SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. Updated searches were performed of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966-March 2006), EMBASE (1980-March 2006), CINAHL (1982-March 2006) and previous reviews including cross references.
SELECTION CRITERIA: Randomised and quasi-randomised trials that compare the use of an adapted soy formula to human milk, an adapted cow's milk or a hydrolysed protein formula for feeding infants without clinical allergy or food intolerance in the first six months of life. Only trials with > 80% follow up of participants and reported in group of assignment were eligible for inclusion.
DATA COLLECTION AND ANALYSIS: Eligibility of studies for inclusion, methodological quality and data extraction were assessed independently by each review author. Primary outcomes included clinical allergy, specific allergies and food intolerance. Where no heterogeneity of treatment effect was found, the fixed effect model was used for meta-analysis. Where significant or apparent heterogeneity was found, results were reported using the random effects model and potential causes of the heterogeneity were sought.
MAIN RESULTS: Three eligible studies enrolling high risk infants with a history of allergy in a first degree relative were included. No eligible study enrolled infants fed human milk. No study examined the effect of early, short term soy formula feeding. All compared prolonged soy formula to cow's milk formula feeding. One study was of adequate methodology and without unbalanced allergy preventing co-interventions in treatment groups. One study with unclear allocation concealment and 19.5% losses reported a significant reduction in infant allergy, asthma and allergic rhinitis. However, no other study reported any significant benefits from the use of a soy formula. Meta-analysis found no significant difference in childhood allergy incidence (2 studies; typical RR 0.73, 95% CI 0.37, 1.44). No significant difference was reported in one study in infant asthma (RR 1.10, 95% CI 0.86, 1.40), infant eczema (RR 1.20, 95% CI 0.95, 1.52), childhood eczema prevalence (RR 1.10, 95% CI 0.73, 1.68), infant rhinitis (RR 0.94, 95% CI 0.76, 1.16) or childhood rhinitis prevalence (RR 1.20, 95% CI 0.73, 2.00). Meta-analysis found no significant difference in childhood asthma incidence (3 studies, 728 infants; typical RR 0.71, 95% CI 0.26, 1.92), childhood eczema incidence (2 studies, 283 infants; typical RR 1.57, 95% CI 0.90, 2.75) or childhood rhinitis incidence (2 studies, 283 infants; typical RR 0.69, 95% CI 0.06, 8.00). One study reported no significant difference in infant CMPI (RR 1.09, 95% CI 0.45, 2.62), infant CMA (RR 1.09, 95% CI 0.24, 4.86), childhood soy protein allergy incidence (RR 3.26, 95% CI 0.36, 29.17) and urticaria. No study compared soy formula to hydrolysed protein formula.
AUTHORS' CONCLUSIONS: Feeding with a soy formula cannot be recommended for prevention of allergy or food intolerance in infants at high risk of allergy or food intolerance. Further research may be warranted to determine the role of soy formulas for prevention of allergy or food intolerance in infants unable to be breast fed with a strong family history of allergy or cow's milk protein intolerance.
http://www.ncbi.nlm.nih.gov/pubmed/17054183