Virginia Layng Millonig, PhD, RN, CPNP President, Health Leadership Associates

Potomac, Md

w Atopic Dermatitis: Clinical Relevance of Food Hypersensitivity Reactions Burks, A. W., Mallory, S. B., Williams, L. W., & Shirrell, M. A. (1988). The journal of Pediatrics, 7 73, 447451.

T he role of dietary factors in atopic dermatitis has been the subject of debate for several decades. One of the most important unanswered questions with regard to food allergy as a cause of atopic dermatitis is the prevalence of clinically relevant hypersensitiv- ity. Previous research has shown that food hypersen- sitivity plays a pathogenic role in some children who have atopic dermatitis and that appropriate diagnosis and exclusionary diets can lead to significant im- provement in their skin symptoms.

Forty-six patients with atopic dermatitis, ranging from mild to severe, were evaluated for food hy- persensitivity with double-blind placebo-controlled food challenges. Twenty-eight patients had positive prick skin reaction to one of the foods tested. Sixty- five food challenges were performed; 27 were inter- preted as positive in 15 patients. Egg, milk, and pea- nut accounted for 78% of the positive reactions. These studies indicate that children who have atopic dermatitis unresponsive to routine therapy or who continue to need daily treatment after several months would benefit from evaluation for food hypersensi- tivity.

n Amoxicillin and Diaper Dermatitis Honig, P. J., Gribetz, B., Leyden, J. J., McGinley, K. J., & Burke, L. A. (1988). journal of the American Academy of Dermatology, 19, 275-279.

T here is controversy in the literature regarding the role the gastrointestinal reservoir of Ca&Zu albicans plays in diaper dermatitis. Several studies suggest a correlation between the severity of diaper dermatitis and the quantity of C. albicans in the feces. Other reports, however, have concluded that the elimina- tion of C. albicans from the gastrointestinal tract does not influence therapeutic outcome and, therefore, the reservoir of C. afbtins in that location is not im- portant in the development of diaper dermatitis.

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Although it is generally agreed that broad- spectrum oral antibiotic therapy is an associated risk factor for the development of C. a&zan~ diaper der- matitis, there are no prospective longitudinal studies in which this presumed association has been dem- onstrated. The purposes of this study were to inves- tigate the effect of systemic amoxicillin therapy on the emergence of C. al&iEans in the gastrointestinal tract and to correlate any change with the incidence of diaper dermatitis caused by this organism.

Infants receiving oral amoxicillin therapy for otitis media were identified as a suitable study population. Data from this study support the conclusion that treatment with amoxicillin is associated with an in- creased incidence of positive cultures and density of C. a&cans in the gastrointestinal tract. This change is associated with an increased incidence of diaper dermatitis. Systemic antibiotic therapy (i.e., amoxi- cillin) is an important risk factor in the development of diaper dermatitis.

n Randomized Study of Six Umbilical Cord Care Regimens: Comparing length of Attachment, Microbial Control, and Satisfaction Gladstone, I. M., Clapper, L., Thorp, J. W., & Wright, D. I. (1988). Clinical Pediatrics, 27, 127-l 29.

T wo hundred seventy-one infants were enrolled in a study to compare six Merent methods of treating the umbilical cord. Antimicrobial control was equal for all methods. Repeated triple-dye application was considered least acceptable by staff and parents and had the longest attachment time. Povidone-iodine was associated with the shortest attachment time and was most liked. According to these authors, if there is no special need to treat a specific nosocomial out- break, duration of cord attachment satisfaction of staff and parents can help clinicians decide on a cord care regimen. Treatments evaluated in this study were equally effective for infection control, as measured by the incidence of colonization of the umbilicus and by the fact that omphalitis or other infections did not develop in any of the study infants.

JOURNAL OF PEDIATRIC HEALTH CARE