EARLY CHILDHOOD ATOPIC PHENOTYPES AND THE DEVELOPMENT OF ALLERGIC RESPIRATORY DISEASE

Abstract

<h3>Introduction</h3> Pediatric atopic dermatitis (AD) is associated with risk of respiratory allergic disorders. The "atopic march" doesn't fit all subjects, and atopic phenotypes may better predict progression. We hypothesize that AD by age 2 modifies the association between various allergic factors (2-year food/aeroallergen sensitization, 3–5-year food allergy), and the risk of developing allergic respiratory disease (ARD: allergic rhinitis, asthma) by age 10. <h3>Methods</h3> Sensitization to 10 common food and aeroallergens from the WHEALS birth cohort was assessed at age 2. Food allergy (3-5 years) was assessed by physician panel. AD (age 2 and 10), asthma and allergic rhinitis (age 10) were physician-assessed. Risk ratios were calculated using Poisson regression with robust error variance and were adjusted for several factors. <h3>Results</h3> Two-year AD significantly modified the association between food allergy at 3-5 years and the risk of ever having asthma by age 10 (p=0.027). In the absence of AD, food allergy was associated with an increased risk of ever having asthma (aRR=3.36(1.71, 6.58), p<0.001), while no difference was observed in the presence of AD (aRR= 1.24(0.57, 2.68), p=0.99). Food sensitization in the absence of AD was associated with increased risk of ever asthma (aRR 2.04(1.03, 4.05), p=0.038). Food sensitization in the presence of AD was not associated with ever asthma (aRR 0.89(0.45,1.78), p=0.99) or ever allergic rhinitis (aRR 1.45(0.97-2.16), p=0.078). Sensitization to at least one aeroallergen at age 2 didn't result in significantly different risk of ARD in either AD subgroup. <h3>Conclusion</h3> Identifying early atopic phenotypes may help identify later ARD risk.