Food allergy, dermatologic diseases, and anaphylaxis
Patient perspectives on the management of atopic dermatitis

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Background

Atopic dermatitis (AD) is increasingly common, with a point prevalence of more than 30% in some countries, and is characterized by visible skin lesions and intense itching.

Objective

The International Study of Life with Atopic Eczema (ISOLATE) is the first large-scale study to assess the effect of AD on the lives of patients and society, how patients and caregivers manage the condition, and how well patients and caregivers currently believe that AD is controlled.

Methods

Two thousand two patients (>13 years) and caregivers of children (2-13 years) with moderate-to-severe AD randomly selected from 8 countries underwent standardized telephone interviews using questions developed in collaboration with national eczema patient groups and physicians.

Results

During each year, patients spend, on average, 1 of 3 days in flare. The majority of patients receive prescription topical corticosteroids to treat flares; however, 49% of respondents are concerned about using these agents. On average, patients and caregivers delay initiating treatment for 7 days after onset of a flare. Only 24% of patients and caregivers feel confident they can manage AD flares adequately. Seventy-five percent of caregivers and patients feel that being able to effectively control AD would be the single most important improvement to their or their child's quality of life. The avoidable secondary economic cost of AD is estimated at €2 billion per year across the European Union.

Conclusion

ISOLATE highlights the need to improve patients' control of AD to reduce the significant effect this condition has on the patient and society.

Clinical implications

ISOLATE shows that patients with AD are untreated for half the time they are in flare, and thus there is an urgent need for physicians to ensure that the patients are educated and confident in using medication as prescribed to gain disease control.

Section snippets

Methods

The study was conducted in 8 countries between July and September 2004 (see Table E1 in the Online Repository at www.jacionline.org). Patients (>13 years) and caregivers (of children 2-13 years old) with moderate to severe AD as defined by their treating physician underwent in-depth telephone interviews apart from those in the United States and the United Kingdom, where interviews were conducted face to face to enable the EQ-5D15 questionnaire to be administered. The results of the EQ-5D will

Patient characteristics

A total of 2002 patients and caregivers from 8 countries took part in ISOLATE (see Table E1 in the Online Repository at www.jacionline.org). Sixty percent of the respondents were patients (>13 years), and 40% were caregivers looking after children (2-13 years). Table II shows that the distribution of patients by age, sex, and disease characteristics is similar to that of other published AD surveys.21 The proportion of patients with moderate-to-severe AD is also in line with the caseload of the

Discussion

The results of ISOLATE highlight AD as a condition that still has a significant physical and emotional effect on patients and caregivers despite the availability of effective treatment strategies and sources of patient support. Less than optimal disease control results in patients experiencing sleep deprivation, lack of concentration, and impaired school-work productivity. The resulting stigma of AD can also affect the patient's self-esteem, mood, self-confidence, and ability to establish and

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This study was supported by an unrestricted educational grant from Novartis Pharma AG.

Disclosure of potential conflict of interest: T. Zuberbier has consultant arrangements with and is on the speakers' bureau for Novartis. S. Orlow has consultant arrangements with and is on the speakers' bureau for Novartis and Astellas. A. Paller has speaker and consultant arrangements with Novartis. A. Taïeb has consultant arrangements with and has received a travel grant from Novartis. R. Allen is on the speakers' bureau for Novartis. J. Ocampo-Candiani has received a travel grant from Novartis. M. Cox works for the National Eczema Society, which works closely with the pharmaceutical industry. J. Langeraar works for the Nation Eczema Association for Science and Education, which has received financial support from Astellas and Novartis. J. Simon has consultant arrangements with and is on the speakers' bureau for Novartis.

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