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Published on: September 27, 2017
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.
Background:
Atopic dermatitis (AD) is commonly associated with asthma and other atopic disorders in childhood.
Objective:
To evaluate the natural history of AD and its association with other allergic outcomes in a high-risk cohort through the age of 7 years.
Methods:
A total of 373 high-risk infants, who had undergone a randomized controlled trial with intervention measures for primary prevention of asthma applied during the first year of life, were assessed for asthma, AD, and allergic sensitization at 1, 2, and 7 years.
Results:
The multifaceted intervention program did not reduce AD despite reducing the prevalence of asthma significantly. Sixty-two children (16.6%) had AD during the first 2 years (early-onset AD); of these, 26 continue to have AD at the age of 7 years (persistent), whereas 36 no longer had the disease (nonpersistent) at the age of 7 years. Twenty-three children (6.2%) developed AD only after the age of 2 years (late-onset AD). Early-onset AD, persistent or nonpersistent, was associated with increased risk of allergic sensitization to food allergens within the first 2 years of life and asthma diagnosis at year 7. However, only persistent AD was associated with an increased risk of other atopic diseases and allergic sensitization to food and aeroallergens at year 7. Late-onset AD was not associated with atopic diseases or allergic sensitization at year 7 with the exception of Alternaria alternans.
Conclusion:
In this cohort of infants at high risk of asthma, early-onset persistent AD, which was highly associated with atopic sensitization, increased the risk of atopic diseases in later childhood and thus appears to be part of the atopic march.
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