1. 아토피피부염과 환경요인 성균관의과대학 삼성서울병원 소아청소년과 안 강 모

2. 아토피피부염

3. 전국 초등학생, 중학생의 아토피피부염 유병률 ( 한국 어린이 청소년의 알레르기질환에 관한 전국적 역학조사 : 대한 소아알레르기 호흡기학회 ) 아토피피부염으로 진단받은 적이 있는 경우 (%) 16.6%24.9% 7.3%12.8%

4. 서울지역 초등학생의 아토피피부염 유병률 ( 한국 어린이 청소년의 알레르기질환에 관한 전국적 역학조사 : 대한 소아알레르기 호흡기학회 ) (%) 19.7%27.5%29.2%9.3%13.5%14.5% 아토피피부염으로 진단 받은 적이 있는 경우 최근 12 개월동안 아토피피부 염으로 치료받은 적이 있는 경 우

6. 알레르기 질환의 발생 기전 유전적 요인환경적 요인 알레르기 질환

7. 위생가설 (Hygiene Hypothesis) (New Engl J Med 2002;347:911-20)

8. 알레르기 질환의 면역상태 Th1Th2

9. 알레르기 질환의 면역상태 Th1 Th2

10. 출생 전후의 Th2 면역 상태의 변화

11. 아토피질환은 유전적 요인과 환경적 요인에 의해 발생한다. 유전요인환경요인 아토피질환의 진행 및 악화 면역상태의 변화 IgE 감작 아토피질환의 발생 알레르겐에의 노출

12. 알레르기 행진 01248163264 나이 ( 세 ) 알레르기비염식품알레르기천식아토피피부염 증상 중증도

13. 아토피피부염의 경과 출생 아토피피부염 관해 천식 / 알레르기비염 지속 / 악화 요인 분석

14. Skin inflammation PruritusScratching Atopic dermatitis Dry skin Food allergen Infection Super-Ag stressirritants antihistamine Skin hydration /moisturizing antibiotics Steroid/ immunomodulation avoidance

15. Environment and Atopic Dermatitis Indoor environment Outdoor environment Allergens Irritants

16. Familiar and environmental factors influencing atopic dermatitis in the childhood J Eur Acad Dermatol Venereol 2006;20:418-22 Objectives –Family, birth weight (BW), home environment Methods –Case vs. control (461 : 343) in Hungary –Questionnaires (retrospective) Results –(+) : higher BW, small households, carpet, indoor pets –No : nursery, heating system, indoor smoking

17. Atopic eczema and the home environment Br J Dermatol 2001; 145:730-6 Objectives –To assess the home environmental factors Methods –Cross sectional case-control (1,350 : 1,056) in UK Results –(+) : dampness, radiator, synthetic pillow –(-) : frequent vacuuming

18. Early life risk factors for atopic dermatitis in Ethiopian children J Allergy Clin Immunol 2005 Objectives –To establish the risk factors in AD (parasite) Methods –Cross-sectional case-control study (ISAAC) –Case vs. control (306 : 426) Results –Prevalence rate = 4.2% –(+) : malaria, piped drinking water –No : parasite infection, family size, breast feeding

19. Risk factors and prevalence of asthma or atopic dermatitis in young children by a questionnaire Survey J Nippon Med Sci 2004 Objectives –Risk factors & prevalence of AD (altitude) Methods –24,631 children in Japan –ATS-DLD questionnaire Results –(+) : male, age↑, FHx(+), higher altitude

20. Factors influencing AD – A questionnaire survey of schoolchildren’s perceptions Br J Dermatol 2004 Objectives –To determine the exacerbating factors Methods –Questionnaire survey in UK ( 악화 / 호전 인자 ) –250 AD children Results – 악화 : sweating, wool, hot weather – 호전 : topical steroid, moisturizers, medicine –No effects of food on AD Sx (60%)

21. The incidence of AD in school entrants is associated with individual life style factors but not with local environmental factors in Hannover, Germany Br J Dermatol 2002;147:95-104 Objectives –To assess the life-style factors on AD Methods –4,219 AD children, Germany (questionnaire) Results –(+) : more privileged SES, German nationality, ↑paternal SES, ↑daily duration of father’s professional work, lack of paternal shift work –No : air pollution, urbanization

22. Environmental associations with eczema in early life Br J Dermatol 2001;144:795-802 Objectives –To investigate role of dietary & environmental factors ass. with development of AE Methods –Prospective cohort study in UK (n=624) Results –(+) : maternal education, maternal allergy Hx –(-) : crowded home

23. Association between indoor renovation activities and eczema in early childhood Int J Hyg Environ Health 2006;209:241-7 Objective : to evaluate the effect of exposure to risk factors such as indoor air pollution during early childhood Methods : - birth cohort comprising of 2536 children in epidemiologic study (LISS: Leipzig infection, allergy and airway diseases sutdy among school starters) - redecoration activities (painting, floor covering, new furniture) before birth and in the first year of life

26. Body burden of mercury is associated with acute atopic eczema and total IgE in children from southern Germany J Allergy Clin Immunol 2004;114:457-9 Objective : to investigate the associations of body burdens of (heavy) metals with AE Methods : - cross-sectional study with all school beginners in Augsburg, Bavaria in 1996 (n=1673) - recruitment : 164 children with AE (76 with acute symptoms and 98 without acute symptoms), 213 controls - concentration of arsenic, cadmium and mercury in morning urine by atopic absorption spectrometry

28. Sublingual immunotherapy in mite-sensitized children with atopic dermatitis J Allergy Clin Immunol 2007;120:164-70 Objective : to assess the effect of sublingual IT in children with AD Methods : - a randomized, double-blind, placebo-controlled study - 56 children with AD (5-16 years) who are sensitized to dust mite alone - 28 with IT, 28 without IT - IT for 18 months

32. Meteorological influence on NaOH irritation varies with body site Arch Dermatol Res 2005 Objectives –To assess the dry air & cold weather on AD Methods –544 occupational dermatitis –SMART (Swift Modified Alkaline Resistance Test) –Local ambient temperature, absolute humidity Results –(+) : low temperature & humidity (esp. ≤6 ℃, ≤8 mg/L)

33. An exploratory prospective observational study of environmental factors exacerbating AE in children Br J Dermatol 2006 Objectives –To assess trigger factors in AD Methods –25 AD children in Ireland & UK –Using diary over 4 wk (prospective study) Results –Stress, damp & hot weather  scratch scores.

34. Influence of weather and climate on subjective symptom intensity in atopic eczema Int J Biometerol 2000 Objectives –To assess the meteorological factors Methods –7-year investigation (1983-1989) in Swiss –2,106 AD(15 meteorological variables on itch) Results –No : gender, age, atopic respiratory disease –(-) : air temperature, pressure, H 2 O pressure, duration of sunshine –(+) : snowfall, fog, thunderstorm

35. Concentrations and determinants of NO 2 in homes of Ashford, UK and Barcelona and Menorca, Spain Indoor air 2004 Objectives –To assess indoor NO 2 & gas combustion, ETS Methods –1,421 home of AD (using filter for 7~15 days) –Cohort study Results –NO 2 : Barcelona > Ashford & Menorca –Sources of NO 2 : heating/cooking fuel, parental smoking

36. Trends of prevalence of AD in schoolchildren : A longitudinal study in Osaka prefecture, Japan from 1985 to 1997 Br J Dermatol 2001 Objectives –To assess the relationship between prevalence and environmental factors Methods –4,000,000 Japan primary school (1985-1997) Results –Increment of AD prevalence stopped in 1993. –(+) : air pollution↓, income index↑

37. Allergy trigger-free room 대기 / 실내공기 / 물 / 음식 등의 알레르겐 및 오염물질 제거 환자의 증상 악화를 유발하는 환경적 요인들을 조절 중증도와 관련된 환경적인 요인 분석 중증환자들을 화학 ( 생물 ) 적으로 청정한 병실 입원 치료 / 연구

38. Allergy trigger-free room 의 설치 조건 온 · 습도 조절 장치 에어 샤워 시설 오존 증기 부하 시스템 ( 벽재 등의 부착 가스 제거 효과 ) 실내공기청정기 - 향균필터 ( 극미세먼지 2um 이하 제어 ) 친환경 건축 및 인테리어 자재 사용 - 바닥재 : 온돌마루, 황토바닥재, 참숯바닥재, 항균타일, 참숯몰탈 등 - 페인트 : 무공해 수용성페인트, 천연페인트, 규조토, 액상 참숯페인트 - 벽지 : 참숯, 쑥, 녹차를 첨가한 천연벽지, 천연한지 - 조명기구 : 항균 탈취 조명기구 - 유리 : 향균 유리 병실침구 및 환자복 ( 환자용품 ): 향균탈취 재질

39. Allergy trigger-free room 일본 사가미하라 국립병원 임상연구센터

40. Allergy trigger-free room