Atopic dermatitis caused by ascariasis and cured with nitazoxanide
Streszczenie
Introduction: Ascariasis is mostly studied from the epidemiolog ical, public health and gastrointestinal perspective. In consequence, there are currently hardly any reports that associate ascariasis with atopic diseases and what is more, most of the available studies are either inconclusive or contradictory.
Case study: We report a case of chronic atopic dermatitis caused by Ascaris lumbricoides infestation that was cured with nitazoxanide. The studied patient was a 1.5 year boy that suffered from refractory atopic dermatitis. No improvement was observed during prior to nitazoxanide standard treatment including topic steroids, oral antihistaminics and eliminatory diet. After nitazoxanide treatment, all atopic dermatitis symptoms vanished.
Conclusions: Patients with ascariasis may present atopic dermatitis as the main symptom. The treatment should include antihelmintic medicines. In childr en < 24 months of age nitazoxanide is considered as a safe and effective drug.
Słowa kluczowe: ascariasisascaris lumbricoidesatopic dermatitisnitazoxanide
Referencje
- Santos AB, Rocha GM, Oliver C, et al. Cross-reactive IgE antibody responses to tropomyosins from Ascaris lumbricoides and cockroach. J Allergy Clin Immunol. 2008; 121(4): 1040–1046.
- Barreto ML, Genser B, Strina A, et al. Impact of a citywide sanitation program in Northeast Brazil on intestinal parasites infection in young children. Environ Health Perspect. 2010; 118(11): 1637–1642.
- Thygarajan A, Burks AW. American Academy of Pediatrics recommendations on the effects of early nutritional interventions on the development of atopic disease. Curr Opin Pediatr. 2008; 20(6): 698–702.
- von Mutius E. The rising trends in asthma and allergic disease. Clin Exp Allergy. 1998; 28 Suppl 5: 45–49.
- Pinelli E, Willers SM, Hoek D, et al. Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study. Eur J Clin Microbiol Infect Dis. 2009; 28(11): 1327–1334.
- Scrivener S, Yemaneberhan H, Zebenigus M, et al. Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study. Lancet. 2001; 358(9292): 1493–1499.
- Cooper PJ, Chico ME, Rodrigues LC, et al. Risk factors for atopy among school children in a rural area of Latin America. Clin Exp Allergy. 2004; 34(6): 845–852.
- Palmer LJ, Celedón JC, Weiss ST, et al. Ascaris lumbricoides infection is associated with increased risk of childhood asthma and atopy in rural China. Am J Respir Crit Care Med. 2002; 165(11): 1489–1493.
- Sharghi N, Schantz PM, Caramico L, et al. Environmental exposure to Toxocara as a possible risk factor for asthma: a clinic-based case-control study. Clin Infect Dis. 2001; 32(7): E111–E116.
- Cooper PJ, Chico ME, Vaca MG, et al. Effect of albendazole treatments on the prevalence of atopy in children living in communities endemic for geohelminth parasites: a cluster-randomised trial. Lancet. 2006; 367(9522): 1598–1603.
- Maizels RM, McSorley HJ, Smyth DJ. Helminths in the hygiene hypothesis: sooner or later? Clin Exp Immunol. 2014; 177(1): 38–46.
- Strachan DP. Family size, infection and atopy: the first decade of the "hygiene hypothesis". Thorax. 2000; 55 Suppl 1: S2–10.
- Rook GAW. Review series on helminths, immune modulation and the hygiene hypothesis: the broader implications of the hygiene hypothesis. Immunology. 2009; 126(1): 3–11.
- Osada Y, Kanazawa T. Parasitic helminths: new weapons against immunological disorders. J Biomed Biotechnol. 2010; 2010: 743758.
- Hopkin J. Immune and genetic aspects of asthma, allergy and parasitic worm infections: evolutionary links. Parasite Immunol. 2009; 31(5): 267–273.
- Kamal SM, El Sayed Khalifa K. Immune modulation by helminthic infections: worms and viral infections. Parasite Immunol. 2006; 28(10): 483–496.
- Smits HH, Yazdanbakhsh M. Chronic helminth infections modulate allergen-specific immune responses: Protection against development of allergic disorders? Ann Med. 2007; 39(6): 428–439.
- Hawlader MDH, Ma E, Noguchi E, et al. Ascaris lumbricoids Infection as a Risk Factor for Asthma and Atopy in Rural Bangladeshi Children. Trop Med Health. 2014; 42(2): 77–85.
- Dold S, Heinrich J, Wichmann HE, et al. Ascaris-specific IgE and allergic sensitization in a cohort of school children in the former East Germany. J Allergy Clin Immunol. 1998; 102(3): 414–420.
- Obihara CC, Beyers N, Gie RP, et al. Respiratory atopic disease, Ascaris-immunoglobulin E and tuberculin testing in urban South African children. Clin Exp Allergy. 2006; 36(5): 640–648.
- Rook GAW. 99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: darwinian medicine and the 'hygiene' or 'old friends' hypothesis. Clin Exp Immunol. 2010; 160(1): 70–79.
- Filippi CM, von Herrath MG. Viral trigger for type 1 diabetes: pros and cons. Diabetes. 2008; 57(11): 2863–2871.
- Rook GAW. Hygiene hypothesis and autoimmune diseases. Clin Rev Allergy Immunol. 2012; 42(1): 5–15.
