Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors

Chris Carlsten1, Helen Dimich-Ward, Alexander Ferguson

  • 1Chan-Yeung Centre for Occupational and Environmental Lung Disease Unit, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. carlsten@mail.ubc.ca

Insights

Early-onset persistent atopic dermatitis (AD) in high-risk infants predicts later allergic diseases, highlighting its role in the atopic march. The intervention did not prevent AD but impacted asthma outcomes.

Area of Science:

  • Pediatric Allergy and Immunology
  • Dermatology
  • Epidemiology

Background:

  • Atopic dermatitis (AD) is frequently linked with asthma and other allergic conditions in children.
  • Understanding the natural history of AD is crucial for managing allergic disease progression.

Purpose of the Study:

  • To investigate the long-term course of atopic dermatitis (AD) and its association with other allergic outcomes up to age 7 in a high-risk infant cohort.
  • To evaluate the impact of a primary asthma prevention intervention on AD development.

Main Methods:

  • A cohort of 373 high-risk infants, initially part of an asthma prevention trial, were monitored for asthma, AD, and allergic sensitization at ages 1, 2, and 7.
  • Data collection included clinical assessments and allergy testing.

Main Results:

  • The intervention effectively reduced asthma prevalence but did not impact AD rates.
  • Early-onset AD (by age 2) was linked to increased food allergen sensitization and later asthma diagnosis.
  • Persistent AD (continuing to age 7) was significantly associated with other atopic diseases and sensitization to both food and aeroallergens.

Conclusions:

  • Early-onset persistent atopic dermatitis (AD) in high-risk infants is a significant predictor of subsequent atopic diseases, confirming its role in the "atopic march."
  • Late-onset AD showed limited associations with allergic outcomes, except for Alternaria alternans sensitization.
Abstract

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