The Natural History of Atopic Dermatitis and Its Association with Atopic March

Abstract

RationaleAtopic dermatitis (AD) is the first manifestation of atopic march. The natural history of AD and predictive factors for atopic march were not widely studied in Asia.MethodsMedical records of AD patients attending Pediatric Allergy clinic at Siriraj hospital prior to 15 years of age were reviewed. Patients were further interviewed to obtain the current symptoms and treatment.ResultsFifty AD patients (68% female) were followed for 9.9 years. Median age at AD diagnosis was 1.2 years with the AD severity being mild (76%), moderate (16%) and severe (8%). Fifty percent of patients had complete remission at the median age of 8 years. The most common allergen sensitization was Dermatophagoides pteronyssinus and Dermatophagoides farinae (65.9%). Patients with early AD (onset ≤2 years) was found to have concomitant food allergy in 58% with egg white and cow’s milk as the leading causes (91%). Sixty-four percent of early AD had complete remission at the median age of 6.1 years. Food allergy was more prevalent in early AD compared with later onset AD (OR=12.19, 95% CI; 1.43-100, p=0.008). Allergic rhinitis (AR) and asthma was diagnosed in 60% and 34% of the patients with the median age of 4 and 3 years, respectively. Family history of atopy was associated with the development of asthma (OR=5.53, 95% CI; 1.08-28.18, p=0.028).ConclusionsHalf of AD children had a complete remission at school age with a better prognosis in early AD. Two-third and one-third developed AR and asthma, respectively. Family history of atopy is a predictor of asthma. RationaleAtopic dermatitis (AD) is the first manifestation of atopic march. The natural history of AD and predictive factors for atopic march were not widely studied in Asia. Atopic dermatitis (AD) is the first manifestation of atopic march. The natural history of AD and predictive factors for atopic march were not widely studied in Asia. MethodsMedical records of AD patients attending Pediatric Allergy clinic at Siriraj hospital prior to 15 years of age were reviewed. Patients were further interviewed to obtain the current symptoms and treatment. Medical records of AD patients attending Pediatric Allergy clinic at Siriraj hospital prior to 15 years of age were reviewed. Patients were further interviewed to obtain the current symptoms and treatment. ResultsFifty AD patients (68% female) were followed for 9.9 years. Median age at AD diagnosis was 1.2 years with the AD severity being mild (76%), moderate (16%) and severe (8%). Fifty percent of patients had complete remission at the median age of 8 years. The most common allergen sensitization was Dermatophagoides pteronyssinus and Dermatophagoides farinae (65.9%). Patients with early AD (onset ≤2 years) was found to have concomitant food allergy in 58% with egg white and cow’s milk as the leading causes (91%). Sixty-four percent of early AD had complete remission at the median age of 6.1 years. Food allergy was more prevalent in early AD compared with later onset AD (OR=12.19, 95% CI; 1.43-100, p=0.008). Allergic rhinitis (AR) and asthma was diagnosed in 60% and 34% of the patients with the median age of 4 and 3 years, respectively. Family history of atopy was associated with the development of asthma (OR=5.53, 95% CI; 1.08-28.18, p=0.028). Fifty AD patients (68% female) were followed for 9.9 years. Median age at AD diagnosis was 1.2 years with the AD severity being mild (76%), moderate (16%) and severe (8%). Fifty percent of patients had complete remission at the median age of 8 years. The most common allergen sensitization was Dermatophagoides pteronyssinus and Dermatophagoides farinae (65.9%). Patients with early AD (onset ≤2 years) was found to have concomitant food allergy in 58% with egg white and cow’s milk as the leading causes (91%). Sixty-four percent of early AD had complete remission at the median age of 6.1 years. Food allergy was more prevalent in early AD compared with later onset AD (OR=12.19, 95% CI; 1.43-100, p=0.008). Allergic rhinitis (AR) and asthma was diagnosed in 60% and 34% of the patients with the median age of 4 and 3 years, respectively. Family history of atopy was associated with the development of asthma (OR=5.53, 95% CI; 1.08-28.18, p=0.028). ConclusionsHalf of AD children had a complete remission at school age with a better prognosis in early AD. Two-third and one-third developed AR and asthma, respectively. Family history of atopy is a predictor of asthma. Half of AD children had a complete remission at school age with a better prognosis in early AD. Two-third and one-third developed AR and asthma, respectively. Family history of atopy is a predictor of asthma.