Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations.

Journal

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
ISSN: 1534-4436
Titre abrégé: Ann Allergy Asthma Immunol
Pays: United States
ID NLM: 9503580

Informations de publication

Date de publication:
15 Dec 2023
Historique:
received: 23 10 2023
revised: 08 11 2023
accepted: 09 11 2023
medline: 18 12 2023
pubmed: 18 12 2023
entrez: 18 12 2023
Statut: aheadofprint

Résumé

Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).

Sections du résumé

BACKGROUND BACKGROUND
Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.
OBJECTIVE OBJECTIVE
To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.
METHODS METHODS
A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles.
RESULTS RESULTS
The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts.
CONCLUSION CONCLUSIONS
These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).

Identifiants

DOI: 10.1016/j.anai.2023.11.009 PMID: 38108679
pubmed: 38108679
pii: S1081-1206(23)01455-2
doi: 10.1016/j.anai.2023.11.009
pii:
doi:

Types de publication

Practice Guideline

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Disclosures Detailed in the Methods and eAppendix, the Guidelines followed JTFPP policies and international standards for addressing potential conflicts of interest. All JTFPP members’ COI are available publicly at https://www.allergyparameters.org.

Auteurs

Derek K Chu (DK)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada. Electronic address: chudk@mcmaster.ca.

Lynda Schneider (L)

Division of Immunology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: Lynda.Schneider@childrens.harvard.edu.

Rachel Netahe Asiniwasis (RN)

Department of Dermatology, University of Saskatchewan, Regina, Canada.

Mark Boguniewicz (M)

Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado.

Anna De Benedetto (A)

Department of Dermatology, University of Rochester Medical Center, Rochester, New York.

Kathy Ellison (K)

Westerville, Ohio.

Winfred T Frazier (WT)

Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania.

Matthew Greenhawt (M)

Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado.

Joey Huynh (J)

Sepulveda VA Medical Center, North Hills, California.

Elaine Kim (E)

Toronto, Canada.

Jennifer LeBovidge (J)

Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

Mary Laura Lind (ML)

School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona.

Peter Lio (P)

Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Stephen A Martin (SA)

University of Massachusetts Chan Medical School, Worcester, Massachusetts.

Monica O'Brien (M)

Tufts University School of Medicine, Boston, Massachusetts.

Peck Y Ong (PY)

Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California.

Jonathan I Silverberg (JI)

Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.

Jonathan M Spergel (JM)

Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Julie Wang (J)

Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York.

Kathryn E Wheeler (KE)

Department of Pediatrics, University of Florida, Gainesville, Florida.

Gordon H Guyatt (GH)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

Korey Capozza (K)

Global Parents for Eczema Research, Santa Barbara, California.

Wendy Smith Begolka (WS)

National Eczema Association, Novato, California.

Alexandro W L Chu (AWL)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

Irene X Zhao (IX)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

Lina Chen (L)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

Paul Oykhman (P)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

Layla Bakaa (L)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

David Golden (D)

Johns Hopkins University School of Medicine, Baltimore, Maryland.

Marcus Shaker (M)

Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire.

Jonathan A Bernstein (JA)

University of Cincinnati, Cincinnati and Columbus, Ohio.

Matthew Greenhawt (M)

Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado.

Caroline C Horner (CC)

Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.

Jay Lieberman (J)

University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee.

David Stukus (D)

Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio.

Matthew A Rank (MA)

Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona.

Julie Wang (J)

Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York.

Anne Ellis (A)

Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Elissa Abrams (E)

Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.

Dennis Ledford (D)

Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida.

Derek K Chu (DK)

Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.

Classifications MeSH