Summary
Atopic dermatitis is a common skin disease in children from western countries. Its pathogenesis is complex and involves genetic and environmental factors. The relevant genes need to be in the relevant environment (allergens, adjuvant factors). The increase in prevalence of atopic dermatitis underlines the role of environmental factors and has led to attempts to prevent atopic dermatitis. A considerable number of risk factors have been implicated in the development of atopic dermatitis. This field of research is characterised by many claims and few confirmations. Preventive measures focus on the reduction of allergen exposure during the first months of life. However, passive smoking is an important risk factor that should be addressed in a prophylactic program. Dietary intervention during the first 4 to 6 months has been documented to result in temporary reduction in incidence of food allergy and atopic dermatitis. Promising results have been obtained in a study combining dietary and environmental measures. As there is insufficient information on the efficacy of such measures, it is too early to advise them on a large scale. Other measures like breast-feeding and stopping passive smoking, potentially preventing atopic dermatitis, can be advised anyway due to general health considerations.
Samenvatting
Atopisch eczeem heeft een hoge prevalentie bij kinderen in Westerse landen. De pathogenese is complex en resulteert uit interacties tussen genetische aanleg en omgevingsfactoren (allergenen, adjuvante factoren). De toename van de prevalentie van atopisch eczeem onderstreept het belang van omgevingsfactoren voor de pathogenese ervan. Een groot aantal risicofactoren wordt in verband gebracht met het ontstaan van atopisch eczeem. Bij preventieve maatregelen ligt de nadruk op de vermindering van blootstelling aan allergenen (voedingsmiddelen, huisstofmijt, huisdieren). Passief roken mag als risicofactor niet worden vergeten. Er zijn aanwijzingen dat diëtaire maatregelen gedurende de eerste 4 à 6 maanden resulteren in een tijdelijke vermindering van voedselallergie en atopisch eczeem. Veelbelovend zijn de resultaten van een studie waarin een combinatie van maatregelen gebruikt werd (dieet, reductie van huisstofmijt). De effectiviteit hiervan staat echter nog niet vast, zodat het nog te vroeg is om adviezen voor de preventie van atopisch eczeem hierop te baseren. Hoewel van adviezen als niet roken in het bijzijn van het kind of in de zwangerschap en het geven van borstvoeding het preventief effect niet bewezen is, zijn zij mede gezien de algemene voordelen ervan zeker nastrevenswaardig.
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Afdeling Dermato-venereologie, Academisch Ziekenhuis Rotterdam.Correspondent: A. Wolkerstorfer, kinderdermatoloog, afd. Dermatologie-Venereologie, Academisch Ziekenhuis Rotterdam / Sophia Kinderziekenhuis, dr. Molewaterplein 60, 3015 gj Rotterdam.
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Wolkerstorfer, A., Oranje, A.P. Preventie van atopisch eczeem. KIND 68, 179–182 (2000). https://doi.org/10.1007/BF03061305
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DOI: https://doi.org/10.1007/BF03061305