1) Weill-Cornell Medical College,
2) Section of Pediatric Allergy Immunology, Hamad Medical Corporation, Doha, Qatar.
3) Section of Pediatric Endocrinology, Alexandria University, Alexandria , Egypt.
Introduction: Skin barrier defects play central role in the pathogenesis of atopic dermatitis (AD) affecting local immunity and skin hydration. Severe AD is seen in 1-15% of cases and its effects on growth and nutrition are not known.
Objectives: to 1) determine frequency and severity of hypoalbuminemia and hypoproteinemia in severe AD its relationship with AD severity 2) to study effect of hypoalbuminemia and hypoproteinemia on the growth of these children.
Methods: A retrospective study of 135 records of all children (<14 years) seen at Ped Allergy-Immunology clinics of Hamad General Hospital during Jun 2014-2015 with severe AD with serum albumin and protein tests. We also reviewed demographic data and lab. tests (CBC with differential, IgE, IgG, IgA, IgM, serum zinc, food allergens tests of SPT or specific IgE). SCORAD and anthropometric data were collected.
Results: They were 42 month old with 78 (57.8%) males and 57(42.2%) females. Other allergies were found in 40 patients (29.6%) and positive family history of allergy in 105 patients (77.8%). Majority (77%) tested positive to one food. SCORAD was 61.3 ±22.3, and body mass index (BMI) was 14.6%. WBC were 11,827 ±3,992.3 cells/ul, eosinophils 955±946.1 cells/ul, and total IgE 3,2598,708.6 ku/L. Hypoproteinemia was present in 78 patients (57.8%), and hypoalbuminemia in 56 patients (41.5%). 26 hypoalbuminemic patients had low BMI 11.2±2 % compared to 26 normoalbuminemic patients who had BMI 19.1±38.1%. Hypoproteinemic patients had BMI of 11.2±1.2% compared to normoproteinemic patients who had BMI 22.5±11.8%. SCORAD was higher in hypoalbuminemic-low-BMI patients compared to normoalbuminemic-normal-BMI patients (67.9±22.1 vs 58.3±22.5), and in hypoproteinemic-low-BMI patients compared to normoproteinemic-normal-BMI patients (73±21.1 vs 59.9±20.5)
Conclusions: In patients with severe atopic dermatitis, 58% of patients had hypoproteinemia and 42% hypoalbuminemia that were associated with low BMI denoting a significant effect on growth. These were related to AD severity. It is important to closely monitor growth, nutrition and biochemical makers in the management of severe AD.