Establishing subclasses of childhood eczema, their risk factors and prognosis

Abstract

Background The heterogeneity of development and progression of eczema suggests multiple underlying subclasses for which aetiology and prognosis may vary. A better understanding may provide a comprehensive overview of eczema development and progression in childhood. Thus, we aimed to determine longitudinal eczema subclasses based on assessments and identify their associations with risk factors and allergic outcomes. Methods A total of 619 participants with a family history of allergic disease were assessed at 24 time‐points from birth to 12 years. At each time, eczema was defined as the report of current rash treated with topical steroid‐based preparations. Longitudinal latent class analysis was used to determine eczema subclasses. Subsequent analyses using regression models assessed the associations between eczema subclasses and potential risk factors and allergic outcomes at 18‐ and 25‐year follow‐ups (eczema, allergic rhinitis, asthma and allergic sensitization). Results We identified five eczema subclasses ‘early‐onset persistent’, ‘early‐onset resolving’, ‘mid‐onset persistent’, ‘mid‐onset resolving’ and ‘minimal eczema’. Filaggrin null mutations were associated with the early‐onset persistent (OR = 2.58 [1.09–6.08]) and mid‐onset persistent class (OR = 2.58 [1.32–5.06]). Compared with ‘minimal eczema’, participants from early‐onset persistent class had higher odds of eczema (OR = 11.8 [5.20–26.6]) and allergic rhinitis (OR = 3.13 [1.43–6.85]) at 18 and at 25 years eczema (OR = 9.37 [3.17–27.65]), allergic rhinitis (OR = 3.26 [1.07–9.93]) and asthma (OR = 2.91 [1.14–7.43]). Likewise, mid‐onset persistent class had higher odds of eczema (OR = 2.59 [1.31–5.14]), allergic rhinitis (OR = 1.70 [1.00–2.89]) and asthma (OR = 2.00 [1.10–3.63]) at 18 and at 25 years eczema (OR = 6.75 [3.11–14–65]), allergic rhinitis (OR = 2.74 [1.28–5.88]) and asthma (OR = 2.50 [1.25–5.00]). Allergic and food sensitization in early life was more common in those in the persistent eczema subclasses. Conclusion We identified five distinct eczema subclasses. These classes were differentially associated with risk factors, suggesting differences in aetiology, and also with the development of allergic outcomes, highlighting their potential to identify high‐risk groups for close monitoring and intervention.

Self reported prevalence of eczema and associated risk factors among under five children in Northern Saudi Arabia: A population based cross sectional study

“…An interesting RCT conducted in China in 2020 by(Cheng et al, 2020) reported that paternal education through nurses could improve the management of atopic dermatitis among children. In contrast to this study,(Lopez et al, 2022) reported different findings.Children with a family history of atopic sensitization, such as bronchial asthma, allergic rhinitis, and eczema, could be significant factors, and this will help the health care workers to provide focused health education. Our research reported that family history of bronchial asthma (OR [95% CI] = 0.71 [0.58 -0.93], p = 0.013), and family history of eczema (OR [95% CI] = 4.32 [2.61 -6.96], p= 0.001).…”

Eczema in early childhood increases the risk of allergic multimorbidity

“…Other studies also reported that persistent eczema was associated with the development of FA 19 as well as asthma and hay fever. 8,20 Further, our results suggest that, the age at eczema onset plays an important role in allergic multimorbidity. Earlier onset of eczema showed a stronger association with FA, asthma and hay fever presence, with "Very early onset" showing higher aOR's (adjusted Odds Ratio) than "Early onset" and "Late onset".…”

“…Typically, these disease phenotypes are being stratified according to age of onset, persistence and severity of AD. [7][8][9][10] Differences in underlying pathophysiological pathways which might cause this heterogeneity of AD are yet to be described. 8 However, pinpointing the phenotype at highest risk for developing allergic multimorbidity and identifying phenotype-specific risk factors is needed for developing personalized prevention and treatment strategies for children with AD.…”

Current state and prospects of artificial intelligence in allergy

“…170,171 Similarly, over the past 5 years, longitudinal data on eczema were clustered using data-driven approaches. [172][173][174][175][176][177][178][179] There were notable differences in the estimated prevalence of each phenotype, and inconsistent associations with the filaggrin (FLG) genotype.…”