Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood

Abstract

and the PASTURE study group IMPORTANCE Atopic dermatitis is an inflammatory, pruritic skin disease that often occurs in early infancy with a chronic course. However, a specific description of subtypes of atopic dermatitis depending on the timing of onset and progression of the disease in childhood is lacking.OBJECTIVE To identify different phenotypes of atopic dermatitis using a definition based on symptoms before age 6 years and to determine whether some subtypes are more at risk for developing other allergic diseases. DESIGN, SETTING, AND PARTICIPANTSThe Protection Against Allergy Study in Rural Environments (PASTURE) is a European birth cohort where pregnant women were recruited between August 2002 and March 2005 and divided in 2 groups dependent on whether they lived on a farm. Children from this cohort with data on atopic dermatitis from birth to 6 years of age were included.EXPOSURES Atopic dermatitis, defined as an itchy rash on typical locations from birth to 6 years. MAIN OUTCOMES AND MEASURESThe latent class analysis was used to identify subtypes of atopic dermatitis in childhood based on the course of symptoms. Multivariable logistic regressions were used to analyze the association between atopic dermatitis phenotypes and other allergic diseases. RESULTSWe included 1038 children; of these, 506 were girls. The latent class analysis model with the best fit to PASTURE data separated 4 phenotypes of atopic dermatitis in childhood: 2 early phenotypes with onset before age 2 years (early transient [n = 96; 9.2%] and early persistent [n = 67; 6.5%]), the late phenotype with onset at age 2 years or older (n = 50; 4.8%), and the never/infrequent phenotype (n = 825; 79.5%), defined as children with no atopic dermatitis. Children with both parents with history of allergies were 5 times more at risk to develop atopic dermatitis with an early-persistent phenotype compared with children with parents with no history of allergies. Both early phenotypes were strongly associated with food allergy. The risk of developing asthma was significantly increased among the early-persistent phenotype (adjusted odds ratio, 2.87; 95% CI, 1.31-6.31). The late phenotype was only positively associated with allergic rhinitis. CONCLUSIONS AND RELEVANCEUsing latent class analysis, 4 phenotypes of atopic dermatitis were identified depending on the onset and course of the disease. The prevalence of asthma and food allergy by 6 years of age was strongly increased among children with early phenotypes (within age 2 years), especially with persistent symptoms. These findings are important for the development of strategies in allergy prevention.

Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019

“…In a European birth cohort study, the prevalence of AD symptoms was between 11.4 and 16.9% during the first 6 years of age [2]. Children with an early onset (age <2 years) of AD, especially those with persistent symptoms, had a significantly higher risk of associated food allergy and asthma, while the late-onset phenotype (age >2 years) was associated with allergic rhinitis [2].…”

“…Children with an early onset (age <2 years) of AD, especially those with persistent symptoms, had a significantly higher risk of associated food allergy and asthma, while the late-onset phenotype (age >2 years) was associated with allergic rhinitis [2]. In Europe, as shown for Bavaria/Germany, the AD prevalences of 12.4% in 1995 and 11.1% in 2002 have remained stable over the last decade, whereas a significant increase in eczema prevalence has been observed in Africa (i.e., 11.8% in 1995 vs. 19.4% in 2002) [20].…”

“…AD affects approximately 20% of all children at age 6 years and 5% of adults in Western industrialized countries [1, 2]. The development of AD is based on a genetic predisposition that determines both the skin barrier function and the predominant T-helper-2 (Th2)-type inflammatory reaction.…”

Allergic Eye Diseases in Children. Modern View on Pathogenesis and Treatment

“…Многолетние клинико-эпидемиологические исследо-вания, проведенные в течение последних десятилетий, установили, что распространение аллергических забо-леваний в разных регионах России колеблется от 15 до 35%, причем среди заболевших увеличивается число де-тей раннего возраста. Нередко у детей атопический дер-матит, начавшийся в младенческом возрасте, может пе-рерасти в «аллергический марш» -пищевую аллергию, вслед за которой формируется аллергический ринит, аллергический конъюнктивит и другие аллергические заболевания [7,8]. В свою очередь, аллергические забо-левания существенно снижают качество жизни ребенка и способствуют физической и эмоциональной дезадап-тации как пациента, так и членов его семьи [9].…”

Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria‐based assessment

“…Atopic dermatitis/eczema (AD) affects 15%‐20% of children worldwide. The risk for progression to more severe allergic diseases varies depending on the trajectories of AD; those whose AD persisted from age 1 year were more likely to develop asthma and allergic rhinitis than those with a later onset . Currently, reliable criteria for distinguishing between transitory rashes and AD in infancy are not well established.…”