Health Economics and Nutrition: Atopic Dermatitis

Editor(s): Jörg Spieldenner, Lausanne Sibylle Koletzko, Munich Annales Nestlé Vol.72 / 3,  2015


The last few decades have witnessed a considerable increase in atopic diseases, including asthma, allergic rhinitis and atopic dermatitis or eczema according to the new nomenclature, which collectively affect an estimated 20% of the world’s population – particularly children [1–3] . This increase in atopic disorders is not confined to industrialized countries but also affects developing nations. At first glance, atopic diseases appear to be a group of heterogeneous, unrelated disorders that share some risk factors. Indeed, the complex nature and etiology of these diseases have made it difficult to develop a unifying hypothesis to explain their steeply increasing prevalence worldwide. If two or more allergic diseases (asthma, eczema and allergic rhinitis) occur within one child, the question is whether this occurs purely by chance due to the high prevalence of these disorders or whether there are other factors at play. Furthermore, can the presence of atopy (defined as being positive for a specific IgE) contribute to the excess comorbidity frequently seen with these conditions? Pooled data from different European birth cohort studies including data from more than 10,000 children with information on underlying diseases and sensitization at 4 and 8 years of age showed that IgE sensitization is associated with the presence of excess comorbidity, irrespective of preexisting diseases [4] . However, the level of comorbidity is even higher in children with no sensitization. The authors concluded that the presence of sensitization accounted for <40% of comorbidity, suggesting that IgE sensitization can no longer be considered the dominating causal mechanism of allergic comorbidity.

  • Focus: Cost-Effectiveness of Partially Hydrolyzed Whey Protein Formula in the Primary Prevention of Atopic Dermatitis in High-Risk Urban Infants in Southeast Asia

    Author(s): M. Botteman and P. Detzel

    Proteins found in standard cow’s milk formula have been associated with an increased risk of atopic dermatitis, especially in infants with a familial predisposition towards atopy. Compared to standard cow’s milk formula, partially or extensively hydrolyzed formulas are alternative protein sources that may reduce the risk of atopic dermatitis and other allergic disorders when used in high-risk infants. This study compared the long-term (i.e. 6 years) economic impact of using a partially hydrolyzed whey-based formula instead of a standard cow’s milk formula in the first 17 weeks of life in nonexclusively breastfed infants who are at high risk of developing atopic dermatitis in Malaysia, Singapore, and the Philippines.

    The analysis was based on the 6-year results of the German Infant Nutritional Intervention (GINI) study, a large randomized clinical trial comparing the risk of atopic dermatitis in following feeding with standard cow’s milk formula versus partially hydrolyzed whey-based formula.

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