title: Alpine climate treatment of atopic dermatitis: a systematic review.
abstract: Climate therapy has been used for decades in the treatment of atopic dermatitis (AD), but evidence of its effectiveness has not yet been assessed systematically. A systematic literature search in Medline, Embase, and the Cochrane library was performed to identify all original studies concerning alpine climate treatment. The risk of bias of individual studies was assessed following the Cochrane Handbook, and level of evidence was rated using GRADE guidelines. Fifteen observational studies were included concerning 40 148 patients. Four studies concerning 2670 patients presented follow-up data over a period of 1 year. Disease activity decreased in the majority of patients during treatment (96% of n = 39 006) and 12-month follow-up (64% of n = 2670). Topical corticosteroid use could often be reduced or stopped during treatment (82% of n = 1178) and during 12-month follow-up (72% of n = 3008). Quality assessment showed serious study limitations, therefore resulting in a very low level of evidence for the described outcomes. Randomized controlled trials designed with a follow-up period including well-defined patient populations, detailed description and measurement of applied interventions during climate therapy and using validated outcomes including cost-effectiveness parameters, are required to improve the evidence for alpine climate therapy as an effective treatment for patients with AD.
authors.affiliation: Department of (Pediatric) Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands; High Altitude Clinic Merem Dutch Asthma Center Davos, Davos, Switzerland.
authors.forename: K B
authors.initials: KB
authors.lastname: Fieten
authors.forename: A C G
authors.initials: AC
authors.lastname: Weststrate
authors.forename: E J
authors.initials: EJ
authors.lastname: van Zuuren
authors.forename: C A
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: S G M A
authors.initials: SG
authors.lastname: Pasmans
mesh_terms: D018926:Anti-Allergic Agents / Q000627:therapeutic use; D002980:Climate; D013790:Climatotherapy; D003131:Combined Modality Therapy; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D018926:Anti-Allergic Agents
keywords: alpine; atopic dermatitis; climate; high altitude; systematic review