Li Wei, chief physician of the Department of Dermatology of Huashan Hospital, said that |: Why are allergic diseases that are not fatal and often repeated, and that afflict hundreds of millions of people, difficult to treat?

Allergies, which have become the sixth most chronic disease in the world, are very common in our lives, such as atopic dermatitis on the skin, urticaria, pollen-induced asthma, various food allergies, etc. According to the World Allergy Organization (WAO), the incidence of allergic diseases has increased at least threefold in the past 30 years, and the total global prevalence of allergies has reached 22%, and hundreds of millions of patients are deeply affected by allergies.

Especially in the middle of summer, many patients are plagued by allergic diseases, and the number of patients who have recently gone to the dermatology department of the hospital for diagnosis and treatment is increasing. A variety of dermatological diseases are closely related to allergies, and the common atopic dermatitis caused by type 2 inflammatory reactions is considered to be the first disease of the allergic process, which not only affects the patient's normal life and work, but also brings both physical and psychological torture to the patient and the family. Summer is also the peak of the incidence of atopic dermatitis, and patients need to pay attention to food, clothing, housing, washing and other aspects, so as to help smoothly spend the summer.

Today (July 8) is the 17th World Allergic Diseases Day, in order to enhance the public's understanding of allergic diseases, the 21st Century Business Herald "Famous Doctors Say" column interviewed Professor Li Wei, deputy director of the Shanghai Institute of Dermatology and chief physician of the Department of Dermatology of Huashan Hospital affiliated to Fudan University, and asked him to introduce us to how to prevent and treat allergic diseases.

21st Century: What are the causes of the global high incidence of allergic diseases? About how many patients in our country suffer from allergies?

Li Wei: In the past 30 years, the incidence of allergic diseases has increased significantly nationwide, mainly related to the deepening of industrialization, westernization of lifestyles, increased mental stress and environmental pollution. In recent years, more and more studies have also shown that genetic factors, allergens and environmental factors are important causes of allergic reactions. It should be noted that in allergic diseases, atopic dermatitis has a genetic probability of 30%-50%, and from the perspective of predisposing factors, if parents have atopic dermatitis, the risk of the disease in children is generally higher. Therefore, in the daily outpatient clinic, we also routinely ask the patient for a family history of the disease when diagnosing atopic dermatitis.

21st Century: Allergy is a systemic disease that belongs to type 2 inflammation. So, what is a type 2 inflammatory disease? Why is there a higher risk of comorbidities in type 2 inflammatory diseases?

Li Wei: Type 2 inflammatory disease is based on type 2 inflammation as the mechanism of occurrence, mainly c2 cytokines and cells involved in the disease, such as interleukin 4, 13, 5, etc., cells mainly include TH2 T cells, mast cells, eosinophils, basophils, these cells and factors dominate the inflammation is type 2 inflammation, including a series of allergy-related diseases.

Type 2 inflammation is at the heart of the occurrence of allergic diseases, and type 2 inflammatory factor disorders are the root cause of the onset of type 2 inflammatory disease. Type 2 inflammatory disease does not exist independently, and patients often have other comorbidities. Taking atopic dermatitis as an example, patients are at higher risk of other type 2 inflammation-related diseases such as allergic rhinitis and asthma in the future, and 70% of patients with atopic dermatitis have a family history of genetic allergies such as allergies, asthma or allergic rhinitis.

"21st Century": Why is atopic dermatitis worthy of attention in allergic diseases, and what is the difference between atopic dermatitis and ordinary eczema dermatitis?

Li Wei: Moderate to severe atopic dermatitis (AD), mainly caused by type 2 inflammatory reactions, is a refractory systemic immune disease with recurrent episodes of severe itching and eczema-like dermatitis as the main clinical manifestations, and is the first disease of the "skin-gastrointestinal-respiratory tract" allergic process.

Atopic dermatitis ranks first in the disease burden of non-fatal skin diseases, and patients are in a long-term physical and psychological double torture, which seriously affects the quality of life of patients. According to the "Survey Report on the Survival Status of Patients with Atopic Dermatitis in China", 50%-63% of patients with atopic dermatitis are plagued by itching for more than 12 hours a day, unable to study, work and sleep like ordinary people, and 44% of patients are accompanied by severe anxiety/depression, and the risk of suicidal thoughts is increased.

Atopic dermatitis in the past and daily eczema overlaps to a large extent, the main symptoms of eczema include eczematous dermatitis, itching, and atopic dermatitis patients more emphasis on genetic allergy family history, patients with itching, there are also particularities at the site of the onset, this is a special type of eczema.

"21st Century": What are the main treatments for atopic dermatitis? What is the biggest difficulty in our current treatment of atopic dermatitis?

Li Wei: The difficulty in the treatment of atopic dermatitis mainly lies in the patient's compliance and cooperation. Currently, in terms of drug selection, patients can be treated with glucocorticoids, immunosuppressants, targeted biologics, etc. From 2020, targeted biologics enter the Chinese market, and the main indication is moderate to severe atopic dermatitis in adults. Before targeted biologics were marketed, there were theoretically no systematic therapeutic drugs that were both safe and effective, and targeted biologics greatly changed the quality of life of patients. It should be reminded that patients can only effectively control the disease if they regularly and standardize treatment. However, at present, many patients will not take medication until they have to, so treatment will be delayed.

"21st Century": What are the misunderstandings of patients with atopic dermatitis in diagnosis and treatment and disease management?

Li Wei: Although the number of people with skin allergies is gradually increasing, "not serious, not urgent, not fatal" has become an excuse for many patients to ignore and delay treatment, when there are related allergy symptoms, we must seek professional advice from professional doctors.

At present, patients have two misunderstandings about drug use: on the one hand, talking about "hormone" discoloration, especially worried about hormone side effects, whether it is oral or external use is very worried, resulting in a mentality of not daring to use drugs. When a new drug appears, patients are also extremely concerned about drug side effects. In fact, for drug side effects can be reasonably concerned, do not have to worry too much, as long as the rational use of drugs, many side effects are also very controllable. On the other hand, many patients think that allergies are caused by the body is too dirty, so they will choose to take a bath often, even seven or eight times a day. In fact, this is not advisable, and frequent bathing will make the skin more and more dry, and even aggravate the degree of disease.

"21st Century": The heritability rate of atopic dermatitis is as high as 50%, so is it possible to block the inheritance of diseases?

Li Wei: The occurrence of many diseases is caused by the combination of genes and the environment, as long as there is a pathogenic gene, the patient has the possibility of onset. And can it be onset, when, and in what form? Microorganisms in the environment are considered to be one of the more important influencing factors. In addition, plasticizers, detergents, exhaust gases, interior decoration and smog PM2.5 can all be involved in the occurrence of diseases to varying degrees, so at present, atopic dermatitis cannot be blocked regularly and clearly.

"21st Century": Allergic diseases are a chronic disease, chronic diseases involve long-term chronic disease management, so timely and standardized treatment and long-term management of diseases. What good advice do you have for patients in long-term disease management? What advanced experiences can Huashan Hospital share?

Li Wei: In March this year, Shanghai's first atopic dermatitis diagnosis and treatment center was established in Shanghai Dermatology Hospital, which can provide standardized diagnosis and treatment for more patients with atopic dermatitis, and strengthen the public's awareness and standardized treatment rate of atopic dermatitis diseases.

However, due to the very large patient group, there are many patients who come to Huashan Hospital every day, the outpatient volume of the hospital is very large, and patients still need to make breakthroughs in many aspects of disease management. At present, there are two aspects of what we can do: on the one hand, at the hospital level, try to collect patient information and clinical characteristics, find out the law of the disease, let us better understand allergic diseases, and provide services for patients; on the other hand, through the WeChat platform for patient education, 1 to 1 to achieve communication between doctors and patients, but due to the limited resources of doctors, we can only do 1 to many models now, we also hope that more professional doctors will join to help patients achieve more refined disease management.

"21st Century": July 8 is the Day of Allergic Diseases, what are your recommendations for the protection of allergic patients in terms of diet, housing and travel?

Li Wei: World Allergy Day is coming, for allergic patients such as atopic dermatitis, it is recommended to scientifically protect against allergic diseases from seven aspects of clothing, food, housing, and washing:

First, reduce skin irritation: wear loose clothing, use fragrance-free, dye-free laundry detergent, and cut short fingernails;

Second, bathe with warm water: shower for 5 minutes, pat dry after bathing, and immediately apply ointment and moisturizer to wet skin;

Third, the house is kept ventilated, breathable, clean and hygienic: the living temperature is suitable, and the dust is minimized;

Fourth, insist on emollient: wet compress treatment is best carried out after bathing in the evening;

Fifth, in terms of diet: avoiding food must have clear evidence, and whether the patient is allergic to a certain food through medical history;

Sixth, go out to do a good job of protection, avoid possible sensitization of the environment: spring and summer out, it is recommended to wear a mask, do a good job of personal protection, while paying attention to sunscreen, to resist ultraviolet rays on the skin irritation;

Seventh, carry out formal treatment to reduce or avoid recurrence: it is necessary to seek medical treatment in time, scientific diagnosis and treatment, and avoid aggravation of the disease.

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