Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity

Abstract

Background Atopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea. Methods AD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed. The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites, treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschool-onset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups. Results A total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma ( P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group ( P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancy-onset group ( P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD ( P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life ( P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group. Conclusion This study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants. ...

Eczema in early childhood increases the risk of allergic multimorbidity

“…These findings agree with similar reports, showing eczema onset before 2 years of age to be associated with development of FA, asthma and hay fever. [20][21][22] Onset of eczema in the first 2 months has even been reported to have the strongest association with development of FA by age 3. 23 Taken together, our findings suggest that individuals with disease onset before 6 months and persistent eczema are at highest risk for developing allergic multimorbidity during childhood and adolescence.…”

“…Future investigations concerned with the effect of early-life eczema on allergic multimorbidity should consider the integration of disease severity for eczema, food allergies, asthma and hay fever, since it was repeatedly shown that eczema severity was associated with the development and severity of other allergic diseases. 13,18,21,40 Further, there seems to be a heterogenic association between eczema phenotypes and different allergenic foods. 22 This distinction could result in a more detailed understanding of the allergen specific associations present among comorbid allergic diseases, if applied to future studies.…”

Moderate to severe atopic dermatitis in children: focus on systemic Th2 cytokine receptor antagonists and Janus kinase inhibitors

“…The clinical AD phenotypes according to age at onset can be clearly defined. Generally, 4 types are classified: infantile (<2 years), early childhood (2–6 years), late childhood (6–12 years), and adolescence (12–18 years) [ 33 , 34 ].…”

“…A European birth cohort study revealed that the prevalence of asthma and FA by 6 years of age strongly increased among children with early phenotypes (aged <2 years), especially those with persistent symptoms [ 35 ]. Similarly, a recent Korean study of school-aged children and adolescents with AD found that comorbid FA, allergic rhinitis, and asthma as well as inhalant allergen sensitization were more prevalent in infancy-onset (<2 years of age) than childhood-onset AD (≥2 years of age) [ 34 ]. While a significant proportion of patients with the early-onset phenotype can reach complete remission before 2 years of age, another proportion, estimated at up to 40%, continues to suffer from the disease over a long period of time [ 11 ], and this category of patients may be at high risk for atopic march [ 36 ].…”

Kiwifruit’s Allergy in Children: What Do We Know?

“…Patient clinical history and examination are the first steps toward a diagnosis of kiwifruit allergy [34]. Other clinical diagnostic tools include skin prick test (SPT), enzymelinked immunosorbent assay (ELISA), component-resolved diagnosis (CRD), and doubleblind placebo-controlled food challenge (DBPCFC) [35]. DBPCFC is considered to be the gold standard test to detect a food allergy because it ensures an objective assessment of outcomes without operator-specific preconceptions or biases [36].…”