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Published on: August 7, 2017
Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years
Marie Ekbäck1, Michaela Tedner2, Irene Devenney1
1Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University and Department of Pediatrics, County Council of Östergötland, Linköping, Sweden.
Insights
Infant eczema with high severity scores increases asthma risk by age 10. Early allergic rhinoconjunctivitis (ARC) and eczema in infancy predict more severe allergic disease and later asthma development.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Pulmonology
Background:
- Infant eczema is often linked to subsequent allergic conditions like asthma.
- The concept of the 'atopic march' is debated due to complex atopic disorder relationships.
Purpose of the Study:
- To prospectively follow children with eczema from infancy to age 10.
- To investigate allergen sensitization, eczema severity, and allergic airway symptom development.
- To assess the relationship between early eczema and later allergic diseases.
Main Methods:
- Recruited 123 infants with eczema, assessing severity using Hanifin-Rajka criteria and SCORAD index.
- Collected data on wheezing, skin prick tests, IgE levels, and questionnaires.
- Repeated assessments at 4.5 and 10 years, including specific tests for allergic rhinoconjunctivitis (ARC) and asthma.
Main Results:
- High SCORAD scores in infancy correlated with increased risk for ARC (B=9.86, P=0.01) and asthma (B=10.17, P=0.01).
- Infants with eczema and wheezing had an OR of 4.05 (P=0.01) for developing asthma.
- ARC at 4.5 years predicted asthma development by age 10 with an OR of 11.28 (P=0.00).
Conclusions:
- Infant eczema severity (high SCORAD) is a significant risk factor for childhood asthma.
- Wheezing in infancy alongside eczema increases the likelihood of developing asthma.
- Early-onset ARC combined with infant eczema suggests a more severe allergic trajectory, supporting the 'atopic march' concept in severe cases.
Background:
Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march" has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another.
Objective:
In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age.
Methods:
On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma.
Results:
94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01) and asthma, (B = 10.17, P = 0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00) for asthma development at 10 years.
Conclusion:
This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march", at least in more severe allergic disease.
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