Effect of Prenatal Maternal Trait Anxiety on Atopic Dermatitis and Immunoglobulin E Level: Cocoa Study

Abstract

U E S D A Y 855 Phenotypes of Atopic Dermatitis in School Children Eun Lee, Si Hyeon Lee, Ji-Won Kwon, Song I. Yang, MD, Young Ho Jung, MD, Hyung-Young Kim, Ju-Hee Seo, MD, Byoung-Ju Kim, MD, PhD, Hyo-Bin Kim, MD, PhD, So Yeon Lee, MD, PhD, HoJang Kwon, MD PhD, Soo-Jong Hong, MD, PhD; Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Asan Institute for Life Sciences, University of ulsan College of Medicine, Department of Pediatrics, Bundang CHA Medical Center, CHA University College of Medicine, Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Department of Pediatrics, Korea Cancer Center Hospital, Seoul, South Korea, Department of Pediatrics, Hae-undae Paik Hospital, Inje University College of Medicine, Busan, South Korea, Department of Pediatrics,Inje University Sanggye Paik Hospital, Seoul, South Korea, Department of Pediatrics, Hallym University College of Medicine, Seoul, South Korea, Dankook University, Cheonan. RATIONALE: Atopic dermatitis (AD) develops from a complex interplay between environmental and immunologic factors incomplete understanding of its pathophysiology. AD is characterized by heterogeneous features in its onset and severity. The aim was to define the distinct phenotypes of AD children aged 6 to 13 years. METHODS: 242 children diagnosed with AD ever and AD symptoms during the last 12 months were included from the first survey of Children’s Health and Environmental Research survey (n52491). Variables such as personal characteristics, age at onset of AD, treatment during the last 12 months, number of positive skin prick tests (SPTs), total serum IgE levels and eosinophil were included. After 4 years, lung function tests, methacholine provocation tests, and blood test including IgE and eosinophil were performed. RESULTS: We identified 4 AD phenotypes. Class types were characterized as ‘‘early onset with low atopy’’ (26.4% of sample, Group 1), ‘‘early onset with high atopy’’ (48.3%, Group 2), ‘‘late onset with low atopy’’ (9.9%, Group 3), ‘‘intermediate onset with high atopy’’ (15.3%, Group 4). At 4 year follow-up, although group 2 and 4 showed persistently elevated IgE levels, only group 2 showed persistently elevated eosinophil level, increased prevalence of new onset of bronchial hyper-responsiveness (BHR) (13.5%) and new diagnosis of asthma (8.5%), and higher positive SPTs, compared to group 4. CONCLUSIONS: The LCA revealed four distinct AD phenotypes in school children. Cluster analysis of ADmay lead to a better understanding of the pathophysiology of AD, a better prediction of the prognosis, and furthermore, an ideal application of personalized therapy in future.