The natural history of atopic dermatitis and its association with Atopic March

Atopic dermatitis (AD) is the first manifestation of Atopic March. The natural history of AD and predictive factors for Atopic March have not been widely studied in Asia.

To study the natural history and associated factors of disease remission and risk of respiratory allergy in Thai children with AD.

Medical records of AD patients attending Allergy clinic at Siriraj hospital from 2004-2014 were reviewed. Patients were further followed-up to obtain current symptoms and treatment.

One hundred and two AD patients (60.8% female) were followed for 10.2±4.7 years. The median age at diagnosis was 1.5 (0.1-12.0) years. The most common allergen sensitization was Dermatophagoides pteronyssinus and Dermatophagoides farinae. Forty-four percent of patients had complete remission at the median age of 6.3 (2.0-15.0) years. Forty-seven percent of early AD patients (onset < 2 years) had concomitant food allergy which egg and cow's milk were leading causes. The remission rate of AD was higher in early AD than later onset AD (p=0.02). Allergic rhinitis (AR) and asthma were diagnosed in 61.8% and 29.4% of the patients at the median age of 4.6 and 3.8 years, respectively. Early AD and food allergies were significantly associated with early asthma (onset < 3years) (OR=10.80, p< 0.01 and OR=8.70, p=0.01).

Almost half of AD children had complete remission at school age with a better prognosis in early AD. At preschool age, two-thirds and one-third developed AR and asthma, respectively. Early AD and food allergy were risk factors of early asthma.