Does improvement management of atopic dermatitis influence the appearance of respiratory allergic diseases? A follow-up study

Abstract

BackgroundAtopic dermatitis (AD) is often the prelude to allergic diseases. The aim of this study was 1) to evaluate if an integrated management regime could bring about a change in the evolution of the disease in comparison to the results of a previous study; 2) to determine whether the refinement of allergic investigations allowed to identify more promptly the risk factors of evolution into respiratory allergic diseases.MethodsThe study included 176 children affected by AD and previously evaluated between 1993 and 2002 at the age of 9-16 months, who underwent a telephonic interview by means of a semi-structured, pre-formed questionnaire after a mean follow-up time of 8 years. According to the SCORAD, at first evaluation children had mild AD in 23% of cases, moderate in 62%, severe in 15%.ResultsAD disappeared in 92 cases (52%), asthma appeared in 30 (17%) and rhinoconjunctivitis in 48 (27%). The factors significantly related to the appearance of asthma were: sensitization to food allergens with sIgE > 2 KU/L (cow's milk and hen's egg; P < 0.05); to inhalant allergens with sIgE > 0.35 KU/L (P < 0.05). Logistic regression analysis showed that inhalant sensitization was positively related to the occurrence of asthma (OR = 4.219). While AD showed similar rates of disappearance to those of our previous study, the incidence of asthma was reduced, at the same follow-up time, from 29% to 15% (P = 0.002), and the incidence of rhinoconjunctivitis from 35% to 24% (P = 0.02).ConclusionComparing the results with those of the previous study, integrated management of AD does not seem to influence its natural course. Nevertheless, the decrease in the percentage of children evolving towards respiratory allergic disease stresses the importance of early diagnosis and improvement management carried out by specialist centers. The presence of allergic sensitization at one year of age might predict the development of respiratory allergy.

Persistence of atopic dermatitis (AD): A systematic review and meta-analysis

“…17 One study found that children with AD at age 9 to 16 months who had moderate to severe compared with mild disease as judged by Scoring Atopic Dermatitis (SCORAD) were more likely to have persistent AD 6 to 12 years later (SCORAD 25-50: 51.8% and SCORAD[50: 53.8% vs SCORAD < 25: 32.5%). 40 Finally, a study found that children with AD onset within the first 3 years of life who had less than or equal to 1 or more than 1 night compared with 0 nights per week of being kept awake by their rash had higher rates of persistent AD 5 years later (52.9% and 66.7% vs 42.0%). 28 …”

“…After review of the titles and abstracts, 9326 were excluded; an additional 634 articles were excluded after full-text review. In total, 46 studies were included in the review, of which 44 had valid frequency data that could be pooled, 7 had valid data to assess the effects of gender, 6,23,28,31,44,45,48 6 for allergen sensitization, 6,17,23,36,40,45 and 3 for baseline AD severity 17,28,40 on disease persistence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram is presented in Fig 1. …”

Atopic march, food allergy and food hypersensitivity in children and adolescents suffering from atopic dermatitis

“…Many epidemiological investigations have suggested that food allergy is a risk factor for the appearance of other allergic disease in later childhood (Kijima et al, 2013;PenardMorand et al, 2005;Ricci et al, 2010) and the progression of atopic disorders from AD in infants to allergic rhinitis and asthma in children is usually described as atopic march (Burgess et al, 2007;Carlsten et al, 2013;Leynaert et al, 2004;Ricci et al, 2006). The most important factor that precipitates allergic march is now considered an impaired epidermal barrier.…”

Respiratory comorbidity in South African children with atopic dermatitis

“…better control of AD may reduce the risk of food allergy or asthma. An Italian study [20] suggested that early diagnosis and improved management of AD may lead to a reduction in the percentage of children evolving towards asthma from 29% to 15%. Integrated management of the allergic patient is therefore essential, treating each allergic manifestation well to try to reduce progression to or severity of associated allergic manifestations.…”