Table 4.
Results regarding treatment and follow-up of patients with AD.
| Item | Consensus (%) | Majority (%) | Discrepancy (%) |
|---|---|---|---|
| Substances that should be avoided | |||
| (i) When the prick test is positive for any allergen with suspicion of clinical involvement, avoidance of these allergens as far as possible may be a useful complementary measure | 83.8 | ||
| (ii) Patients with moderate-to-severe AD should follow a diet that does not include foods testing positive in the prick test or prick-prick test and that are clinically relevant for the patient | 91.4 | ||
|
| |||
| Topical and anti-inflammatory treatment | |||
| (i) The use of wet wraps increases the effect of topical corticosteroids | 90.4 | ||
| (ii) Proactive “treatment”, for example, application for two times per week in long-term follow-up, can help reduce new flares | 85.6 | ||
| (iii) Proactive “treatment” with application of tacrolimus ointment two times per week can help reduce new flares | 91.2 | ||
| (iv) Simultaneous combination on the same location of topical glucocorticoids and topical calcineurin inhibitors does not seem to be useful | 72.4 | ||
| (v) Based on results of clinical trials of crisaborole, this is not the treatment of choice for severe AD | 92.4 | ||
|
| |||
| Antipruritic treatment | |||
| (i) There are no sufficient bibliographic references supporting the general use of first- and second-generation antihistamines for treating pruritus in AD | 85.7 | ||
| (ii) First- and second-generation antihistamines, in general, are not useful for systemic treatment of AD | 64.8 | ||
|
| |||
| Allergen-specific immunotherapy (allergen-SIT) | |||
| (i) Allergen-SIT has positive effects in some sensitized patients with AD | 76.2 | ||
| (ii) AD is not a contraindication for the use of immunotherapy in patients with allergic respiratory diseases (allergic rhinoconjunctivitis, allergic bronchial asthma) | 92.4 | ||
|
| |||
| Systemic treatments | |||
| (i) With the current immune response modifiers, the therapeutic needs of patients with severe AD are not sufficiently covered | 97.6 | ||
| (ii) In the treatment of severe AD, cyclosporine has an adequate risk-benefit ratio | 80.0 | ||
| (iii)With phototherapy, the therapeutic needs of patients with severe AD are not sufficiently covered | 92.8 | ||
| (iv) In the treatment of severe AD, phototherapy has an adequate risk-benefit ratio | 69.5 | ||
|
| |||
| New systemic treatments | |||
| (i) Treatment with biologic drugs should be considered in patients with severe AD not controlled with conventional systemic and topical treatment | 93.6 | ||
| (ii) The objectives of these new biologic drugs should be targeting mainly cytokines involved in Th2 allergic inflammation such as IL-4, IL-5, IL-13, and IL-31 | 92.0 | ||
| (iii) Dupilumab has the potential to become the new first-line reference treatment for patients with moderate-to-severe AD who are candidates for systemic treatment (with or without topical treatment) | 90.4 | ||
| (iv) According to results of phase II studies, JAK inhibitors will be a future treatment of AD | 60.0∗ | ||
AD: atopic dermatitis; SIT: specific immunotherapy; IL: interleukin; JAK : Janus kinase. ∗60.0% neither agree nor disagree.