Risk Factors for Moderate-Severe Asthma in Children Ages 5-11 Years With Early-Onset Atopic Dermatitis

Area of Science:

• Pediatric Allergy and Immunology
• Respiratory Medicine
• Epidemiology

Background:

• Identifying early childhood risk factors for persistent asthma is crucial for timely intervention.
• Early-onset atopic dermatitis (AD) is a known precursor to other atopic diseases, including asthma.

Purpose of the Study:

• To identify risk factors for developing moderate-severe persistent asthma (MS-Asthma) between ages 5-11 in children with early-onset AD.
• To develop predictive risk models for MS-Asthma using early childhood and maternal data.

Main Methods:

• A birth cohort of 10,688 children with AD onset before 36 months was analyzed using electronic health records up to age 11.
• MS-Asthma was defined as GINA step care level ≥3 for ≥4 years between ages 5-11.
• Robust Poisson regression was used to determine risk ratios for MS-Asthma.

Main Results:

• Children who developed MS-Asthma were more likely to be male, non-Hispanic Black, preterm, and not exclusively breastfed for one month.
• Significant risk factors included perinatal respiratory disorders, infections, food allergy, allergic rhinitis, asthma, sensitization, and elevated eosinophils.
• Maternal comorbidities, antibiotic use, and fewer pre-existing diabetes cases were associated with increased MS-Asthma risk. Protective factors included exclusive breastfeeding and maternal diabetes.

Conclusions:

• Risk models for later childhood MS-Asthma can be developed using early childhood and maternal factors from administrative data.
• Early identification of at-risk children with AD can facilitate targeted prevention and management strategies.