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Clinical features of atopic dermatitis at two years of age: a prospective, population-based case-control study
1Department of Dermatology, Karolinska Hospital and Institute, Stockholm, Sweden. Maria.Bohme@ood.ki.se
Insights
Most young children with atopic dermatitis (AD) develop it within the first year. By age two, 71% still had eczema, with higher rates of allergic rhinoconjunctivitis in affected children.
Area of Science:
- Pediatrics
- Dermatology
- Allergology
Background:
- Atopic dermatitis (AD) is a common skin condition often starting in infancy.
- Prospective studies on early-onset AD in young children are limited.
- Understanding the phenotype and progression of AD in early childhood is crucial.
Purpose of the Study:
- To prospectively characterize young children with atopic dermatitis (AD).
- To evaluate the phenotypic presentation and progression of AD up to two years of age.
- To assess atopic sensitization and associated allergic conditions in this cohort.
Main Methods:
- A prospective birth cohort study followed 221 children with AD and 99 controls to age two.
- Children were re-examined, and screened for atopic sensitization using skin-prick tests for foods and Phadiatop.
- Data on eczema severity, asthma, and allergic rhinoconjunctivitis were collected.
Main Results:
- AD onset occurred within the first year in 88% of cases.
- At two years, 71% of children had ongoing eczema (45% mild, 53% moderate, 2% severe).
- Allergic rhinoconjunctivitis was significantly more common in children with AD (5%) compared to controls (0%).
- Food allergen sensitization was positive in 27% of AD cases; Phadiatop was positive in 15%.
- Boys showed higher rates of ongoing AD and positive Phadiatop results compared to girls.
- Eczema severity did not correlate with sensitization status.
Conclusions:
- Atopic dermatitis frequently persists into early childhood, with a significant proportion experiencing ongoing eczema at age two.
- While asthma prevalence was similar between groups, allergic rhinoconjunctivitis was more common in children with AD.
- Atopic sensitization, particularly to inhalant allergens, is present in a subset of young children with AD, with a notable gender difference in prevalence.
- Further research is needed to understand the long-term implications of early-onset AD and associated atopic conditions.
Abstract:
While atopic dermatitis (AD) usually presents early in life, few prospective studies focus on young children with AD. The objective of this study was to characterize, phenotypically and prospectively, young children with AD. From a community birth cohort of 2,256 children, consecutive children with AD (n = 221) were followed to 2 years of age, when they were re-examined and screened for atopic sensitization (skin-prick test to foods; Phadiatop). Ninety-nine controls were also examined. AD debuted during the first year in 88% of cases. At the 2-year examination, when the children had already undergone topical treatment, 157/221 (71%) had ongoing eczema ranging among mild (45%), moderate (53%) and severe (2%). Airway problems indicating asthma had occurred in 9% of cases and 6% of controls (not significant), and allergic rhinoconjunctivitis in 5% and 0%, respectively (p<0.05). The skin-prick test to common food allergens was positive in 27% of cases and Phadiatop was positive in 15%. In 67% both tests were negative. Eczema severity did not differ between sensitized and non-sensitized children. Positive Phadiatop was more common in boys than in girls with ongoing AD (22% vs 3%, p<0.01), and more boys than girls had ongoing AD (82% vs 59%, p<0.001); otherwise, no differences attributable to gender were found.