Abstract
BackgroundEczema phenotypes based on eczema onset and persistence might better identify groups prone to allergic and respiratory conditions than a binary definition of eczema. We examined the associations of childhood eczema phenotypes with allergic sensitization, allergy, asthma and lung function at school age.MethodsThis study among 4277 children was embedded in a multi-ethnic population-based prospective cohort study. Five eczema phenotypes (never, early transient, mid-transient, late transient, persistent) based on parental-reported physician-diagnosed eczema from age 6 months until 10 years were identified. At age 10 years, allergic sensitization was measured by skin prick tests, physician-diagnosed allergy and asthma by parent-reported questionnaires, and lung function by spirometry. Adjusted linear, logistic and multinomial regression models were applied.ResultsCompared with never eczema, all eczema phenotypes were associated with increased risks of asthma (odds ratios (OR) range (95% confidence interval): 2.68 (1.58, 4.57) to 11.53 (6.65, 20.01)), food and inhalant allergic sensitization (1.72 (1.25, 2.36) to 12.64 (7.20, 22.18)), and physician-diagnosed inhalant allergy (1.92 (1.34, 2.74) to 11.91 (7.52, 18.86)). Strongest effect estimates were observed of early and persistent eczema with the risk of physician-diagnosed food allergy (OR 6.95 (3.76, 12.84) and 35.05 (18.33, 70.00), respectively) and combined asthma and physician-diagnosed allergy (7.11 (4.33, 11.67) and 29.03 (15.27, 55.22), respectively). Eczema phenotypes were not associated with lung function measures.ConclusionEczema phenotypes were differentially associated with risks of respiratory and allergic conditions in school-aged children. Children with early transient and persistent eczema might benefit from more intense follow-up for early identification and treatment of asthma and allergies.
Highlights
Eczema phenotypes based on eczema onset and persistence might better identify groups prone to allergic and respiratory conditions than a binary definition of eczema
Main results of loss-to-follow-up analysis showed that children not included in the analyses more often had mothers of younger age, multiparity, lower education and no history of eczema, allergy or asthma, and more often had lower birth weight, a male sex and a non-European ethnicity mostly of Moroccan, Turkish and Cape Verdean ethnicity (Additional file 1: Table S1)
We showed that children with early transient and persistent eczema phenotypes had both allergic sensitization and physician-diagnosed allergies, with the strongest effect estimates for food allergy at age 10 years
Summary
Eczema phenotypes based on eczema onset and persistence might better identify groups prone to allergic and respiratory conditions than a binary definition of eczema. We examined the associations of childhood eczema phenotypes with allergic sensitization, allergy, asthma and lung function at school age. Childhood eczema is a chronic disease with variable onset and persistence over time. It has been suggested that children with eczema and food allergies in early life develop asthma and allergic rhinitis in later life, which has been referred to as the atopic march [3]. Previous results of longitudinal cohorts only found a small proportion of children with eczema that follow this atopic march [4]. This might partly be explained by the definition of eczema used in these studies. Eczema phenotypes have been introduced in epidemiologic research to replace
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