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Biomedical subjects

T J David

Publications and source records attributed to T J David.

At least 19 recordsLinked to original sources
PubMed1995

Controlled trial of a few foods diet in severe atopic dermatitis.

Eighty five children (median age 2.3 years, range 0.3 to 13.3 years) with refractory atopic dermatitis affecting more than 12% of the body surface area, were randomly allocated to receive a few foods diet (eliminating all but five to eight foods) supplemented with either a whey hydrolysate (n = 27) or a casein hydrolysate formula (n = 32), or to remain on their usual diet and act as controls (n = 26), for a six week period. Thirty five patients who received the diet and four controls had to be withdrawn because of non-compliance with the diet or intercurrent illness. The change in dermatitis severity was evaluated by a blinded observer who estimated the extent and severity of the dermatitis, using a skin severity score. After six weeks, there was a significant reduction in all three groups in the percentage of surface area involved (controls, median reduction (MR) = 4.9% (95% confidence interval 1.5%, 11.9%); whey hydrolysate group, MR = 17.8% (8.3%, 23.0%); casein hydrolysate group, MR = 5% (1.6%, 21.2%), and skin severity score (controls, MR = 15.9 (5.0, 22.5); whey hydrolysate group, MR = 21.8 (12.8, 30.2); casein hydrolysate group, MR = 13.5 (3.4, 38.0). Sixteen (73%) of the 22 controls and 15 (58%) of the 24 who received the diet showed a greater than 20% improvement in the skin severity score. This study failed to show benefit from a few foods diet.

Adolescent↗
PubMed1995

Nutritional content of few foods diet in atopic dermatitis.

The nutritional content of a few foods diet, supplemented with a casein hydrolysate formula (n = 24) or a whey hydrolysate formula (n = 21), was studied in 45 children with atopic dermatitis. The six day weighed food inventory record method was used to estimate the mean daily intake of energy, protein, calcium, iron, zinc, folate, and vitamin C on normal diet and on the few foods diet. The diet was associated with a significant reduction in protein and calcium intake in both groups, and in energy intake in the casein hydrolysate group. The median daily volume of hydrolysate milk taken was 10.5 ml/day (range 0-840 ml/day) for the casein hydrolysate group and 267 ml/day (range 0-1300 ml/day) for the whey hydrolysate group. Whey hydrolysate appears to be more palatable than casein hydrolysate, which is a potential advantage in the maintenance of an adequate intake in children on a few foods diet.

Calcium, Dietary↗
PubMed1992

Controlled study of Pseudomonas cepacia and Pseudomonas maltophilia in cystic fibrosis.

In a retrospective study, children with cystic fibrosis who were colonised with Pseudomonas cepacia were compared with a control group who were colonised with Pseudomonas maltophilia. Out of 216 children with cystic fibrosis seen between 1983 and 1990, P cepacia was recovered from 13 (median age at colonisation 12.2 years) and P maltophilia from 23 (median age at first colonisation 6.1 years), and both organisms were recovered in five cases. With the exception of two patients with P cepacia in whom no other pathogens were found, all the patients with P cepacia or P maltophilia had co-colonisation with Pseudomonas aeruginosa. The lack of spread of P cepacia to siblings with cystic fibrosis, and the relative lack of inpatient contact between colonised and uncolonised patients suggest that cross infection is not the sole route whereby patients with cystic fibrosis become infected, but the possibility of cross infection cannot be excluded from our data. Three patients with P cepacia died, but two of these had shown appreciable respiratory deterioration before colonisation with P cepacia; there was no evidence of unexpected deterioration in the remainder or in the controls with P maltophilia. By 1990, the prevalence of P cepacia was 9/133 (7%) and that of P maltophilia was 13/133 (10%), but it was impossible to determine to what extent this increase was due to the introduction of the routine use of selective media. Further studies are required to establish whether patients with and without P cepacia should be segregated.

Adolescent↗
PubMed1992

Tartrazine in atopic eczema.

Multiple double blind placebo controlled challenges with tartrazine 50 mg (three challenges) and glucose placebo (three challenges) were performed in 12 children with atopic eczema aged 1 to 6 years. The children were selected on the basis of severity (regular clinic attenders) and a parental history that tartrazine provoked worsening of the eczema. In only one patient did the three tartrazine challenge periods correspond with the highest symptom scores or the highest physician observer scores, and the probability of this occurring by chance in one or more patients out of 12 was 0.46. In this sample we were unable to confirm intolerance to tartrazine in 11 out of 12 patients.

Child↗
PubMed1992

Extreme dietary measures in the management of atopic dermatitis in childhood.

Of 63 children with severe atopic dermatitis who were treated with a diet eliminating all but 6 foods for a 6-week period, 9 (14%) abandoned the diet, 21 (33%) completed the diet but did not benefit, and in 33 (52%) there was significant benefit. However, the outcome at 12 months was the same regardless of the response to the diet because of the tendency for dermatitis to markedly improve in all three groups. Of 37 children with exceptionally severe atopic dermatitis treated with an antigen avoidance regimen comprising hospitalization, exclusive feeding with an elemental formula for a median duration of 30 days, and measures to reduce exposure to pet animal and dust mite antigens at home, 10 (27%) either failed to respond to the regimen or relapsed within 12 months, and sustained improvement was seen in 27 (73%) patients. A few-food diet or a strict anti avoidance regimen may be associated with improvement of atopic eczema where conventional treatments have failed.

Adolescent↗
PubMed1991

Elemental diet for refractory atopic eczema.

A total of 37 children with refractory wide-spread atopic eczema were treated with an antigen avoidance regimen comprising hospitalisation, exclusive feeding with an elemental formula for a median duration of 30 days, and measures to reduce exposure to pet and dust mite antigens at home. After the initial period of food exclusion, food challenges were performed at intervals of seven days, and the patients followed up for at least 12 months. Ten of the children (27%) either failed to respond to the regimen or relapsed within 12 months. Improvement in the eczema was seen in 27/37 (73%) patients, by discharge from hospital their disease severity score had fallen to a median of 27% of the pretreatment figure, and only 3/27 required topical corticosteroids. There were no clinical or laboratory findings which could be used to predict the outcome. Drawbacks to the regimen were prolonged hospitalisation (median 70 days), a fall in body weight and serum albumin concentration, and a risk of anaphylactic shock (4/37 cases). A strict antigen avoidance regimen may be associated with improvement of atopic eczema where conventional treatments have failed.

Animals↗
PubMed1991

Holidays and atopic eczema.

Information was collected by telephone about 300 holidays taken over a three year period by 126 children with severe atopic eczema. During the holidays, improvement in eczema occurred more frequently (112/300, 37%) than deterioration (63/300, 21%). There was a significant correlation between improvement and a more southerly holiday location: improvement was common in holidays taken in the Mediterranean or further south (63/92, 69%), but holidays in northern Britain were more likely to be associated with deterioration (27/100, 27%) than improvement (13/100, 13%). Changes in eczema were correlated with changes in asthma in 231 holidays taken by children with both conditions, but improvement was not significantly associated with pet ownership. All patients returned to their preholiday state, usually within two weeks of return home. The causes of changes in eczema while on holiday have not been identified.

Adolescent↗
PubMed1991

Six food diet for childhood atopic dermatitis.

Sixty-three children with severe atopic dermatitis aged 0.4 to 14.8 years, were treated with a diet eliminating all but six foods for a 6-week period. Nine (14%) abandoned the diet before 6 weeks had elapsed. Twenty-one (33%) completed the diet but did not benefit. Thirty-three (52%) patients obtained greater than or equal to 20% improvement in the disease severity score at 6 weeks, and for these patients, foods were reintroduced singly at weekly intervals. The outcome at 12 months was the same for the group who responded to the diet, the group who failed to respond, and the group who failed to comply, because of the tendency for dermatitis to improve markedly in all three groups. Although dietary elimination of this type may be associated with immediate improvement, the long term outcome appears to be unaffected by dietary success or failure.

Adolescent↗
PubMed1991

Nocturnal growth hormone release in children with short stature and atopic dermatitis.

This study was designed to test the hypothesis that children with atopic dermatitis and short stature fail to release growth hormone after falling asleep. Peak serum growth hormone response to arginine was compared with peak growth hormone concentration during sleep in 6 children with atopic dermatitis and short stature (greater than 3 SD below the mean) aged 7 to 12 years, and 5 control children aged 9 to 12 years without atopic dermatitis or asthma but with unexplained short stature (greater than 3 SD below the mean). All 5 control children achieved normal levels of growth hormone after falling asleep, whereas 3 of the 6 children with dermatitis did not. All patients with dermatitis were capable of releasing growth hormone after arginine stimulation. The results suggest that in some prepubertal children with atopic dermatitis and short stature there may be an impairment of growth hormone release during stage 4 sleep.

Arginine↗
PubMed1991

Failure of oral zinc supplementation in atopic eczema.

An eight week double-blind placebo-controlled trial of oral zinc sulphate 185.4 mg per day was undertaken in 50 children with atopic eczema aged 1-16 years. In those receiving zinc there was no significant improvement in disease severity as assessed by surface area affected and degree of erythema, symptom scores of itch, sleep disturbance and redness of skin, or weight of emollient or topical steroid use.

Administration, Oral↗
PubMed1991

Atopic and seborrheic dermatitis: practical management.

Atopic dermatitis is common and causes sleep loss, a disfiguring appearance, an unpleasant odour, teasing, short stature and restriction of career choice in severe cases. There are no drugs which control the scratching; distraction, keeping the nails short and smooth, and the use of mittens at night are all helpful. The sedative action of the older H1 antihistamines makes them useful if scratching prevents a child from falling asleep. Emollients are useful for the associated skin dryness. The least potent topical steroids should be used sparingly to avoid the main hazards of skin atrophy, systemic absorption and growth stunting. Bacterial skin infection with Staphylococcus aureus and sometimes beta-haemolytic streptococci is common and is best treated with oral antibiotics. Herpes simplex virus skin infection is also common; the initial infection occasionally causes a lethal (if untreated) illness. Allergy to house dust mites, pet animals, pollen and food can worsen dermatitis in some cases. There is no test however, which can be used to predict those patients who will respond to avoidance measures, so that management tends to be based on empirical trials of antigen avoidance. Seborrheic dermatitis is a common disorder that usually occurs in the first months of infancy. Findings consist of greasy yellow scales on the scalp (most simply treated with an emollient) and well-demarcated erythematous patches in the diaper area that spread to other areas such as the axillae and neck (usually requiring topical steroids). Some cases go on to develop atopic dermatitis, but many others, although florid, resolve spontaneously.

Administration, Cutaneous↗
PubMed1991

Childhood food intolerance.

Food intolerance can arise as a result of a variety of mechanisms, and is common in childhood. The diagnosis is confirmed by response to food avoidance and challenge, and treatment is by specific food avoidance, with dietetic supervision to ensure nutritional adequacy of the diet.

Animals↗
PubMed1991

Recent developments in the treatment of childhood atopic eczema.

Even with the most careful application of conventional treatment, atopic eczema can be a disabling handicap in severely affected children. In refractory cases the conventional therapeutic options--potent topical steroids or the use of systemic steroids--are potentially hazardous and associated with relapse after therapy has been discontinued. The main drawbacks to recent experimental approaches, such as oral cyclosporin, photochemotherapy or interferon-gamma, are relapse after cessation of therapy and potentially serious side-effects. Avoidance of certain foods, pets and house dust mites is an option, the major drawbacks being the lack of tests to identify triggers or predict response, and the possible nutritional or psychological hazards of elimination diets. Difficulties with these approaches emphasis the need for close attention to the details of conventional treatment.

Administration, Topical↗