Pancreatic Enzyme Supplementation in Patients with Atopic Dermatitis and Food Allergies: An Open-Label Pilot Study
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Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects both patients and their families. Current therapies often alleviate symptoms but do not prevent or eradicate the disease.
Our objective was to determine whether pancreatic enzyme supplementation is an effective and safe treatment in refractory pediatric AD associated with food allergies.
We conducted an open-label pilot study using a case–control design. Patients with severe AD and known food allergies refractory to conventional therapies and exclusion diets were recruited and treated for 6 weeks with oral supplementation of pancreatic enzymes. The primary endpoint was the severity of AD, using the Scoring Atopic Dermatitis (SCORAD) index. Secondary measures included markers of intestinal permeability (urinary sucrose and lactulose/mannitol excretion).
A total of 11 patients met all eligibility criteria and completed the trial. Significant improvement in AD was observed after 6 weeks of pancreatic enzyme supplementation (SCORAD index 52.3 ± 5.5 vs. 34.6 ± 7.6; p = 0.0008). Beneficial effect was observed in 9 of 11 patients, without adverse events. Fractional urinary sucrose excretion improved to a level comparable to that of age-matched controls (p < 0.05). However, urinary lactulose:mannitol ratios remained abnormally high compared with those of controls (p = 0.01).
Pancreatic enzyme supplementation was associated with improved AD and gastroduodenal permeability. Additional randomized placebo-controlled studies are required before this treatment can be recommended in this clinical setting.
The authors thank Dr. Michael McCann for his numerous contributions that stimulated this study.
Compliance with Ethical Standards
The study design and consent forms were approved by the research institution’s investigational review board, and the study was performed in accordance with the ethical standards of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study or their legal guardians.
Sanford Singer, Jonathan Meddings, Julie Powell, Anne Desroches, Ernest G. Seidman participated in the design and implementation of the study, data collection and interpretation, and manuscript preparation. Jamie Koenekoop participated in updating, revising, and preparing the manuscript. All authors approved the final version of the article.
This study was supported by an unrestricted grant from Solvay Pharma Canada. Dr. E. Seidman is supported by a Tier 1 Canada Research Chair in Immune-mediated Gastrointestinal Disorders and a Canadian Foundation for Innovation Grant. No sources of funding were used to prepare this manuscript.
Conflict of interest
S. Singer, J. Koenekoop, J. Meddings, J. Powell, A. Desroches, and E.G. Seidman have no conflicts of interest relevant to the contents of this manuscript.
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