The natural course of early-onset atopic dermatitis in Taiwan: a population-based cohort study

Abstract

Summary Background Atopic dermatitis (AD) often manifests in early childhood and has variable disease course among individual patients. Previous studies regarding the natural course of AD have usually been of small sample size and were not based on nationwide populations. Objectives We aimed to find out the disease duration and remission rate of children with early‐onset AD (onset in the first 2 years of life) in Taiwan, and to determine whether the presence of allergic rhinitis (AR) or asthma affects the disease course. Methods The patients with early‐onset AD in a nationally representative cohort were selected using the National Health Insurance Research Database of Taiwan and were followed from birth to 10 years of age. Kaplan–Meier survival analysis was carried out to analyse the disease duration and remission of AD. Between‐group analysis using the log‐rank test was carried out to analyse the influence of risk factors on the disease course. Results Of the 1404 children with early‐onset AD, 19·4% had disease duration < 1 year and 48·7% had disease duration < 4 years. During the follow‐up, 69·8% of the patients went into remission. Sex, onset age, presence of AR, presence of asthma and presence of respiratory atopy (either AR or asthma) did not show statistically significant influence on disease course. Conclusions Children in Taiwan with early‐onset AD had disease of variable natural course, and the median disease duration was 4·2 years. About 70% of the patients went into remission eventually. The presence of AR or asthma did not affect the disease course of AD.

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

“…6,23,28,31,44,45,48 The duration of AD persistence was significantly higher in females (median: 9.0 years; mean ± SE: 12.7 ± 0.2 years) compared with males (median: 7.0 years; mean±SE: 11.7 ± 0.2 years) (HR 1.15; 95% CI 1.04-1.27; P = .006) (Fig 2, E).…”

“…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. …”

Biomarkers for atopic dermatitis

“…Birth cohort studies have suggested that, in up to 70% of cases, AD greatly improves or resolves until late childhood. 107,108 One could speculate that resolving childhood AD may represent an independent endotype of AD. However, several birth cohort studies have shown that severity is one of the strongest risk factor for a non resolving AD.…”

“…However, several birth cohort studies have shown that severity is one of the strongest risk factor for a non resolving AD. 107,108 Therefore, it could also be the case that endotypes do not differ between adults and children with AD, but that children with resolving disease suffer from a milder form of AD, irrespective the endotype they belong to. This theory would be in agreement with our findings in chapter 7, in which we showed that disease severity does not influence cluster membership of adult AD patients.…”

Effects of Intramuscular Injection of Autologous Immunoglobulin on Clinical Severity and Serum IgE Concentration in Patients with Atopic Dermatitis

“…An interesting puzzle regarding the nature of AD is that a significant number of children with AD (up to 70%) experience natural remission of their disease before puberty [5]. The natural remission observed in children with AD might be due to a natural induction of immune tolerance.…”