Increasing Severity of Early-onset Atopic Dermatitis, but Not Late-onset, Associates With Development of Aeroallergen Sensitization and Allergic Rhinitis in Childhood

Abstract

To investigate if there is an association between severity and time of onset of atopic dermatitis and the later development of aeroallergen sensitization or allergic rhinitis.The study included 368 children from the Copenhagan Prospective Studies on Asthma in Childhood (COPSAC) at-risk mother-child cohort. Inclusion criteria included children born between August 1998 and December 2001 to mothers with a history of asthma. The study population was followed from birth until 12 years of age.The study was a single-center, prospective trial. Study participants had planned clinic visits, arranged acute care visits for allergy-related flare ups, and were examined by a COPSAC research physician with dermatology training. Atopic dermatitis was diagnosed according to Hanifin and Rajka criteria and severity was scored using the SCORAD index. Aeroallergen sensitization assessment was conducted via specific-IgE (sIgE) levels at age 6 and 12 years, and sensitization was defined as ≥0.35 kUA/L. Allergic rhinitis assessment at age 7 and 12 years was conducted via parental interview on history of symptoms and congruence with allergy testing (positive sIgE or skin prick test).At 6 years of age, aeroallergen sensitization was noted in 29 of 84 (35%) children with early onset atopic dermatitis versus 45 of 207 (22%) children without. At 12 years of age, aeroallergen sensitization was noted in 48 of 89 (54%) children with early onset atopic dermatitis versus 92 of 215 (43%) children without. Among children with early onset atopic dermatitis and aeroallergen sensitization, a 1 point increase in SCORAD had an odds ratio (OR) = 1.08 (1.03–1.14), P < .01 at 6 years and OR = 1.08 (1.03–1.14), P < .01 at 12 years. In contrast, in children with late onset atopic dermatitis, SCORAD had no significant association with aeroallergen sensitization. In children with early onset atopic dermatitis, allergic rhinitis was noted in 17 of 83 (20%) children at 7 years of age, whereas at 12 years of age it was noted in 38 of 98 (38%) children. The same could be seen with severity of SCORAD and association with development of allergic rhinitis. Additionally, these observations had a stronger association in children with filaggrin mutation. Adjusting for sex, older siblings, parental allergic rhinitis, breastfeeding, and smoking did not significantly alter results.More severe early onset atopic dermatitis was found to be associated with aeroallergen sensitization and allergic rhinitis.Atopic dermatitis is a very common childhood disorder and this study demonstrates that earlier and better control of atopic dermatitis may prevent the development of allergic rhinitis. This suggests that an infant’s skin barrier may be more permeable to aeroallergen penetration and/or that early onset versus late onset atopic dermatitis represent different endotypes. This study emphasizes the need for eczema control in atopic infants.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1111/all.15108