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Atopic dermatitis in early infancy predicts allergic airway disease at 5 years
R L Bergmann1, G Edenharter, K E Bergmann
1Department of Paediatrics of the Humboldt University, Charité-Virchow Hospitals, Berlin, Germany.
Insights
Early atopic dermatitis in infants, especially with a family history, predicts aeroallergen sensitization by age 5. This finding supports early intervention for respiratory allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Epidemiology of Allergic Diseases
- Early Childhood Development
Background:
- Newborn screening for atopy risk has limited predictive power.
- Identifying early atopic symptoms could enable secondary prevention strategies.
- This study investigates early atopic dermatitis as a predictor for later allergic disorders.
Purpose of the Study:
- To assess if early atopic dermatitis predicts aeroallergen sensitization at age 5.
- To determine if early atopic dermatitis predicts respiratory atopic disorders at age 5.
- To evaluate the role of family history in these predictions.
Main Methods:
- A prospective birth cohort study (MAS-90) followed 1314 German children from birth to 5 years.
- Atopic dermatitis, asthma, and rhinoconjunctivitis were diagnosed via clinical examinations and parental interviews.
- Aeroallergen sensitization was determined by specific IgE levels at ages 1, 2, 3, and 5.
Main Results:
- Early atopic dermatitis (first 3 months) was a significant risk factor for aeroallergen sensitization at 5 years.
- A positive family history of atopy amplified this risk; 77% of children with two atopic parents and early dermatitis were sensitized.
- Risk factors were associated with allergic airway disease, with a 50% positive predictive value at age 5.
Conclusions:
- Infants exhibiting very early atopic dermatitis signs and a positive family history are prime candidates for early intervention.
- These findings highlight the potential for predicting and preventing respiratory allergies in high-risk infants.
- Early identification can guide preventative strategies against the development of allergic airway diseases.
Background:
Screening tests for atopy risk in newborns have a low predictive value. If early atopic symptoms and signs could be used as predictors for the next expected atopic disorder then secondary prevention could be employed. The aim of this study was to evaluate the capacity of early atopic dermatitis to predict aeroallergen sensitization and the manifestation of respiratory atopic disorders at 5 years of age.
Methods:
1314 children of a German prospective birth cohort study MAS-90 were followed from birth up to 5 years of age. Atopic dermatitis, asthma and rhinoconjunctivitis were diagnosed from symptoms and signs at physical examinations and by interviews of the parents. Blood was drawn at 1, 2, 3, and 5 years of age. Aeroallergen sensitization was diagnosed by a specific IgE value of at least 0.35 kU/L (CAP class > or = 1) against any of five respiratory allergens (mite, cat, dog, birch, grass).
Results:
Atopic dermatitis in the first 3 months was a risk factor for aeroallergen sensitization at 5 years. The risk increased with a positive family history for atopic diseases. Seventy-seven per cent of children with two atopic parents and early atopic dermatitis were sensitized against aeroallergens at 5 years, i.e. could have been predicted in early infancy without any laboratory tests. Although these risk factors were also significantly associated with the manifestation of allergic airway disease, the positive predictive value for this outcome at age 5 years was not yet as high, i.e. 50%.
Conclusion:
Infants with very early signs of atopic dermatitis and a positive family history are candidates for early intervention measures against respiratory allergies.