Risa Mineoka

BACKGROUND: The Prevention of Allergy via Cutaneous Intervention (PACI) randomized controlled trial (RCT) demonstrated that early enhanced topical corticosteroid (TCS) therapy modestly reduced food allergy (FA) at 28 weeks of age. The present prospective follow-up study (PACI-ON) evaluated whether these effects persisted to age 3 years. METHODS: Participants were randomized in infancy to early enhanced (proactive) or early conventional (reactive) TCS treatment (1:1) for atopic dermatitis (AD) until 28 weeks. A total of 590 (91%) children who completed the PACI RCT were followed to age 3 years. During follow-up, no protocolized interventions were given; all participants received usual care. Main outcomes included physician-diagnosed FA, AD severity (EASI, POEM), sensitization profiles, allergic comorbidities, and growth parameters as safety outcomes. RESULTS: At age 3 years, the prevalence of any FA remained lower in the early enhanced group than in the conventional group (47.4% vs. 58.8%, p = 0.006), mainly driven by a reduced prevalence of raw egg allergy (30.4% vs. 40.5%, p = 0.013). No between-group differences were observed for wheeze, asthma, or rhinitis. Japanese cedar sensitization at age 2 was lower in the enhanced group (6.1% vs. 12.2%, p = 0.02 6) but not at age 3. AD control and quality of life were well maintained and similar across groups, with > 90% achieving mild or less disease. Early growth suppression at 1 year resolved by age 3. CONCLUSION: Early enhanced AD intervention was associated with a sustained modest reduction in its planned primary follow-up outcome of FA and safety (growth) up to age 3. Although most differences were small and may reflect early diagnosis and good overall management in both groups, the findings support early AD treatment as a potential strategy to modify allergic disease trajectories.

BACKGROUND AND OBJECTIVE: The increasing prevalence of atopic dermatitis (AD) has raised concerns about whether individuals with AD require specific cardiovascular disease (CVD) prevention strategies. This study investigated the association between AD and CVD among middle-aged adults. METHODS: We conducted a nested case-control study using data from the Kyoto Claim Database (April 2013-March 2023) among individuals aged 40-59 years who were followed for ≥ 3 years. Cases were patients with first-onset CVD (hospitalization for ischemic heart disease or stroke), whereas controls had no history of CVD. AD was defined by an ICD-10 code (L20) plus a topical corticosteroid (TCS) prescription. For each case, 10 controls were matched on age, sex, index month, hypertension, diabetes, dyslipidemia, hyperuricemia, and use of anticoagulant or antiplatelet agents. Logistic regression was used to assess associations between CVD and AD prevalence or severity. RESULTS: We identified 2,757 CVD cases, including 1,247 with ischemic heart disease and 1,563 with stroke (median age 53 years [interquartile range, 49-56]; 2,031 [73.7%] male). Comorbidities included hypertension in 1,430 (51.9%), diabetes in 583 (21.1%), dyslipidemia in 1,018 (36.9%), hyperuricemia in 307 (11.1%), and anticoagulant or antiplatelet prescriptions in 377 (13.7%). The median follow-up period was 60 months. After matching, 2,672 cases and 26,720 controls were compared. AD was diagnosed in 66 cases (2.5%) and 728 controls (2.7%), with no significant association between AD and CVD (odds ratio [OR], 0.90; 95% confidence interval, 0.69-1.16). Regarding AD severity, 3 cases (0.1%) and 76 controls (0.3%) were in the top 10% of average monthly TCS dose (≥37.8 g/month); 28 cases (1.0%) and 352 controls (1.3%) received class 1 TCS; and 14 cases (0.5%) and 144 controls (0.5%) received systemic treatment (immunosuppressants or biologics). AD severity was not associated with CVD risk (ORs: 0.39 [0.10-1.05], 0.79 [0.53-1.15], and 0.97 [0.53-1.62], respectively). A limitation of this study was potential misclassification of AD status due to the nature of claims data. CONCLUSION: Among adults aged 40-59 years, AD was not significantly associated with an increased risk of CVD onset, even in severe cases. Targeted CVD screening for patients with AD may not be necessary; however, comprehensive management of standard CVD risk factors remains essential, as in the general population.