Dermatitis In Preschool Children Research Articles

Association between preterm birth and asthma and atopic dermatitis in preschool children: a nationwide population-based study

Asthma and atopic dermatitis (AD) are representative chronic diseases in childhood. This study aimed to investigate the impact of preterm birth on the incidence and severity of asthma and AD in children, as well as to identify neonatal risk factors for asthma and AD. We used health claims data recorded between 2007 and 2014 in the Korean National Health Insurance Service database. We recruited 2,224,476 infants born between 2007 and 2014 and divided them into three groups: 3518 of extremely preterm (EP) infants (< 28 weeks of gestational age (GA)), 82,579 of other preterm (OP) infants (28–36 weeks of GA), and 2,138,379 of full-term (FT) infants (> 37 weeks of GA). We defined asthma as > 3 episodes of clinical visits in a year before 6 years of age, early asthma as onset at < 2 years of age, and severe asthma as > 1 event of status asthmaticus or admission to a hospital via an emergency room. AD was defined as ≥ 3 diagnoses in a year before 6 years of age, early AD as onset at < 2 years of age, and severe AD as prescription of high-potency topical steroids or immunosuppressants. An association of preterm birth with asthma and AD was assessed using inverse probability of treatment-weighted multivariable Cox regression analysis. Cardiorespiratory conditions, such as respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, and pulmonary hypertension, significantly increased the risk of asthma. Specifically, bronchopulmonary dysplasia emerged as a significant risk factor for both severe and early-onset asthma (odds ratio (OR) 1.36, 95% CI 1.21–1.37 for severe asthma; OR 1.55, 95% CI 1.30–1.85 for early asthma), while it was associated with a decreased risk of AD (OR 0.86, 95% CI 0.80–0.92). Neonatal sepsis, jaundice, and retinopathy of prematurity were also identified as significant risk factors for later asthma. A stepwise increase in the risk of asthma with an increasing degree of prematurity was observed, with the OP group showing an adjusted hazard ratio (aHR) of 1.24 (95% CI: 1.22–1.26) and the EP group showing an aHR of 1.51 (95% CI: 1.41–1.63). Conversely, preterm birth was inversely associated with the risk of AD, with aHRs of 0.73 (95% CI: 0.67–0.79) for the OP group and 0.88 (95% CI: 0.87–0.89) for the EP group. Conclusion Preterm children have a significantly higher risk of asthma and lower risk of AD, with cardiorespiratory conditions significantly increasing the risk of asthma. Thus, we highlight the need for targeted respiratory management strategies for this high-risk population.What is Known:•Asthma and atopic dermatitis are prevalent chronic diseases in childhood, reducing the quality of life of children.•Preterm birth was associated with an increased risk of asthma, but few large nationwide studies.•Research on the relationship between preterm birth and pediatric atopic dermatitis is controversial, with few large nationwide studies.What is New:• Preterm children, especially born before 28 weeks of gestational age, had a significantly higher risk of asthma and lower risk of atopic dermatitis.• Cardiorespiratory comorbidities such as RDS, BPD, PDA, and pulmonary hypertension in neonatal period are prominent risk factors for asthma.• Preterm children are vulnerable to both early-onset and severe asthma.

Docosahexaenoic Acid Effect on Prenatal Exposure to Arsenic and Atopic Dermatitis in Mexican Preschoolers.

Childhood atopic dermatitis (AD) is a chronic and recurrent health problem that involves multiple factors, particularly immunological and environmental. We evaluated the impact of docosahexaenoic acid (DHA) supplementation on prenatal arsenic exposure on the risk of atopic dermatitis in preschool children as part of the POSGRAD (Prenatal Omega-3 fatty acid Supplements, GRowth, And Development) clinical trial study in the city of Morelos, Mexico. Our study population included 300 healthy mother-child pairs. Of these, 146 were in the placebo group and 154 in the supplement group. Information on family history, health, and other variables was obtained through standardized questionnaires used during follow-up. Prenatal exposure to arsenic concentrations, which appear in maternal urine, was measured by inductively coupled plasma optical emission spectrometry. To assess the effect of prenatal arsenic exposure on AD risk, we ran a generalized estimating equation model for longitudinal data, adjusting for potential confounders, and testing for interaction by omega-3 fatty acid supplementation during pregnancy. The mean and SD (standard deviation) of arsenic concentration during pregnancy was 0.06mg/L, SD (0.04mg/L). We found a marginally significant association between prenatal arsenic exposure and AD (OR = 1.12, 95% CI: 0.99, 1.26); however, DHA supplementation during pregnancy modified the effect of arsenic on AD risk (p < 0.05). The results of this study strengthen the evidence that arsenic exposure during pregnancy increases the risk of atopic dermatitis early in life. However, supplementation with omega-e fatty acids during pregnancy could modify this association.

Early Life Domestic Pet Ownership, and the Risk of Pet Sensitization and Atopic Dermatitis in Preschool Children: A Prospective Birth Cohort in Shanghai.

Background: Although domestic pet ownership is on the rise, the impact of early life pet ownership on children's pet sensitization and atopic dermatitis (AD) remains controversial.Methods: Shanghai Allergy Cohort is an ongoing prospective study followed up to the age of 5 years. Pregnant mothers were recruited and their offspring were followed up every year by a group of pediatricians. Information on furred pet ownership was collected by the questionnaire. AD was diagnosed by dermatologists according to disease history and Williams criteria at 5 years ± 1 months. Skin prick test (SPT) was performed to determine sensitization to specific allergens. Multiple logistic regression models were used to evaluate the associations between pet ownership and AD, dog/cat sensitization.Results: In the 538 children at preschool age, 112 (20.82%) were diagnosed with AD. Dermatophagoides pteronyssinus and Dermatophagoides farina were the most common allergens, and almost 10% of children were positive to dog and cat. The percentage of positive SPT reactors at 5-year old was 65.28% in the group of children with AD, higher than that in non-AD group (44.57%). Domestic pet ownership at both infant and preschool period was positively associated with an increased risk of sensitization to dog (OR adjusted = 2.85 [95% CI: 1.08–7.50 for infant exposure], OR adjusted = 2.73 [95% CI: 1.33–5.61] for preschool exposure), and interestingly, pet ownership at infant period negatively associated with higher risk of AD at 5-year old (OR adjusted = 0.33 [95% CI: 0.12–0.88]).Conclusion: This is the first prospective birth cohort study in Shanghai that found half of preschool children had positive allergen sensitization even in the non-AD children. Although early life exposure to dog may increase the risk of dog sensitization, it significantly decreased the risk of AD. The underlying mechanisms warrant further investigations.

Effect of prenatal particulate matter exposure on atopic dermatitis in preschool children modified by cord blood vitamin D: COCOA study

Effect of prenatal particulate matter exposure on atopic dermatitis in preschool children modified by cord blood vitamin D: COCOA study

Atopic dermatitis in preschool children: prevalence, clinical and allergic characteristics and risk factors

Background. Information on atopic dermatitis (AD) epidemiology in preschool children is scarce. Objectives. To estimate the prevalence, clinical, allergological characteristics and risk factors of AD in preschool children. Materials and methods. 5156 children aged 3-6 years old living in the Altai Territory participated in the study. The study included a screening and clinical phases. At the screening stage of the study the prevalence of AD was evaluated using the Russian version of the ISAAC questionnaire, risk factors were evaluated using the additional questionnaire. At the clinical stage diagnosis of AD was verified by allergists. Results. The prevalence of atopic dermatitis was 9,9%. 73,8% of children had mild AD; 58,5% of children were sensitized: 25 (15,6%) to food allergens - 12 (7,2%) to egg, 12 (7,2%) to cow’s milk, 6 (3,6%) to wheat flour and 8 (4,9%) to fish. The most important inhaled allergens were house dust mites, the sensitivity to them was diagnosed in 44 (26,8%) children. The family anamnesis of allergic diseases increases risk of development of AD by 5 times (OR=5,7; 95% CI=4,1-7,9; p

Phthalate metabolites in urine and asthma, allergic rhinoconjunctivitis and atopic dermatitis in preschool children

Phthalate esters are among the most ubiquitous of indoor pollutants and have been associated with various adverse health effects. In the present study we assessed the cross-sectional association between eight different phthalate metabolites in urine and allergic disease in young children. As part of the Danish Indoor Environment and Children's Health study, urine samples were collected from 440 children aged 3-5 years, of whom 222 were healthy controls, 68 were clinically diagnosed with asthma, 76 with rhinoconjunctivitis and 81 with atopic dermatitis (disease subgroups are not mutually exclusive; some children had more than one disease). There were no statistically significant differences in the urine concentrations of phthalate metabolites between cases and healthy controls with the exception of MnBP and MECPP, which were higher in healthy controls compared with the asthma case group. In the crude analysis MnBP and MiBP were negatively associated with asthma. In the analysis adjusted for multiple factors, only a weak positive association between MEP in urine and atopic dermatitis was found; there were no positive associations between any phthalate metabolites in urine and either asthma or rhinoconjunctivitis. These findings appear to contradict earlier studies. Differences may be due to higher exposures to certain phthalates (e.g., BBzP) via non-dietary pathways in earlier studies, phthalates serving as surrogates for an agent associated with asthma (e.g., PVC flooring) in previous studies but not the present study or altered cleaning habits and the use of "allergy friendly" products by parents of children with allergic disease in the current study in contrast to studies conducted earlier.

Associations between selected allergens, phthalates, nicotine, polycyclic aromatic hydrocarbons, and bedroom ventilation and clinically confirmed asthma, rhinoconjunctivitis, and atopic dermatitis in preschool children

Previous studies, often using data from questionnaires, have reported associations between various characteristics of indoor environments and allergic disease. The aim of this study has been to investigate possible associations between objectively assessed indoor environmental factors and clinically confirmed asthma, rhinoconjunctivitis, and atopic dermatitis. The study is a cross-sectional case-control study of 500 children aged 3-5years from Odense, Denmark. The 200 cases had at least two parentally reported allergic diseases, while the 300 controls were randomly selected from 2835 participating families. A single physician conducted clinical examinations of all 500 children. Children from the initially random control group with clinically confirmed allergic disease were subsequently excluded from the control group and admitted in the case group, leaving 242 in the healthy control group. For most children, specific IgE's against various allergens were determined. In parallel, dust samples were collected and air change rates were measured in the children's bedrooms. The dust samples were analyzed for phthalate esters, polycyclic aromatic hydrocarbons (PAH), nicotine, and various allergens. Among children diagnosed with asthma, concentrations of nicotine were higher (P<0.05) and cat allergens were lower (P<0.05) compared with the healthy controls; air change rates were lower for those sensitized (specific IgE+) compared with those not sensitized (specific IgE-, P<0.05); and dust mite allergens were higher for specific IgE+ cases compared with healthy controls (P<0.05). When disease status was based solely on questionnaire responses (as opposed to physician diagnosis), significant associations were found between di(2-ethylhexyl) phthalate (DEHP) and dog allergens in dust and current wheeze.

Analysis of the Prevalence of and Risk Factors for Atopic Dermatitis Using an ISAAC Questionnaire in 8,750 Korean Children

Background: Since 1995, epidemiologic studies of atopic disorders using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire have been performed in many countries, including the Republic of Korea. The prevalence, burden and risk factors of atopic dermatitis were surveyed in these studies, which helped to enhance their comparability among different areas and age groups, as well as to clarify the nature of atopic dermatitis and other atopic disorders. Methods: From 21 facilities, 8,750 children were enrolled in this cross-sectional study. The data were collected via the Internet using a questionnaire based on the Korean-language version of the ISAAC study format. Results: The prevalence of atopic dermatitis over the previous 12 months was 14.4%. The prevalence in preschool children was significantly higher than in elementary school children. Family history of atopic diseases, diagnosis of allergic conjunctivitis and diagnosis of food allergy were positively associated with atopic dermatitis in both preschool and elementary school children. In addition, raising pets was positively associated with atopic dermatitis in preschool children. In elementary school children, female gender, secondhand smoking, breastfeeding, changing the parents' house to a newly built one during the first year of life, diagnosis of asthma and diagnosis of allergic rhinitis were positively associated with atopic dermatitis. Conclusion: The prevalence of atopic dermatitis in preschool and elementary school children in Korea is similar to that of children in other developing countries. The risk factors for atopic dermatitis are different in preschool and elementary school children. More detailed strategies will be necessary to reduce atopic dermatitis in both age groups.

Increased Risk of Atopic Dermatitis in Preschool Children with Kawasaki Disease: A Population-Based Study in Taiwan

Kawasaki disease (KD) is an acute febrile systemic vasculitis and has been reported to be associated with allergic disease. The risk of atopic dermatitis (AD) in preschool children with KD has not been investigated. The study was to determine the longitudinal risk of the development of AD in preschool children with KD. A nationwide 5-year population-based study was performed using data from the National Health Insurance Database in Taiwan between 1999 and 2003. The risk factors for AD were compared between the 2 study groups during the follow-up period using the Cox proportional hazards model. In addition, plasma interleukin (IL)-5 levels were analyzed in normal subjects and KD patients. Among the 1440 subjects included, 21.6% developed AD during the 5-year follow-up period, of which 30.3% and 18.7% belonged to the study cohort and the comparison group, respectively. Children with KD were 1.25 times more likely to have AD than those in controls (P = 0.04). Levels of IL-5 and IgE were significantly higher in KD patients. Children with KD had a higher risk of developing AD during the 5-year follow-up period than the control group. Increased IL-5 and IgE levels may be key factors contributing to the risk of AD.

Gene-environment interaction between Toll-like receptor 4 and mold exposure in the development of atopic dermatitis in preschool children

Purpose: Genetic factors and environmental exposures are recognized as important risk factors for atopic dermatitis (AD) in children. Inflammatory responses by molds can be mediated via Toll-like receptor 4 (TLR4). The aims of this study were to investigate mold as risk factor of AD and gene-environment interaction on AD in preschool children. Methods: We undertook a cross-sectional survey with 986 preschool children. We investigated five mold exposure measures (dampness stain, dampness damage, visible mold, mold odor, and house repair). The TLR4 polymorphism (rs1927911) was genotyped by TaqMan assay. Results: The prevalence of AD was as follows: AD diagnosis by questionnaire, 35.1%; current AD (lifetime diagnosis together with symptoms in the last 12 months), 21.5%. When children with parental history of AD were exposed to mold odor during infancy and house repair during the last 12 months, the risk for current AD (adjusted odds ratio [aOR], 6.826; 95% confidence interval [CI], 2.511 to 18.554 vs. aOR, 6.143; 95% CI, 2.348 to 16.074) was further increased than only with parental history of AD. In children with the CC genotype of TLR4 polymorphism, the risk of AD was increased by mold exposure. Conclusion: This investigation identified that mold exposure is potential risk factor for AD in preschool children. Parental history of AD and mold exposure during infancy and the last 12 months had synergistic effect on high prevalence of AD. We identified that mold exposure and TLR4 polymorphism have an effect on the development of atopic dermatitis. (Allergy Asthma Respir Dis 2013;1:129-137)

343 Gene-environment Interactions on the Development of Atopic Dermatitis in Preschool Children

BackgroundGenetic factor and environmental exposure are recognized risk factors for atopic dermatitis (AD) in children. It is known that fungus is the representative environmental factor of AD. However, the relative and the overall contributions of fungal exposure remain unexplored.MethodsDuring July to August 2010 population-based cross-sectional survey, we investigate 986 preschool children from 16 kindergartens of Seoul and Gyeonggi-do province in Korea using a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We investigated 5 mold exposure items (dampness stain, dampness damage, visible mold, mold odor, house repair) in this survey. Multivariate regression analysis was applied to determine impact of mold exposure as risk factor for AD.ResultsThe prevalence of AD was as follows: lifetime symptoms, 28.0%; symptoms in the past 12 months, 28.7%; lifetime diagnosis by questionnaire, 35.1%; treatment in the past 12 months, 16.6%; current AD (which was defined as lifetime diagnosis by questionnaire together with symptoms in the past 12 months), 21.5%; and diagnosis by doctor's examination on the spot, 14.6%. A parental history of AD and mold exposure and environmental factors were independent risk factors for AD in preschool children. The coexistence of a parental history of AD and mold exposure together was synergistically related to AD prevalence. When children with a parental history of AD were exposed to mold (ex. mold odor), the risk for AD prevalence increased up to 7 times. (OR 6.956, 95% CI, 2.599-18.615)ConclusionsThis investigation provides a high prevalence of AD and a close relationship with mold. High prevalence of AD was detected by the combined effect parental history of AD and mold exposure at infancy. These findings suggest that early avoidance from mold exposure is important to prevent the development of AD especially in the susceptible children.

The Relationship between Atopic Dermatitis, Thymus and Activation-Regulated Chemokine/CCL17, Quality of Life, and Attention Deficit-Hyperactivity Disorder in Preschool Children

Purpose : Atopic dermatitis may impair quality of life and lead to attention deficit-hyperactivity disorder (ADHD). Thymus and activation-regulated chemokine (TARC)/CCL17 may serve as a new biomarker for atopic dermatitis. We investigated the relationship between TARC and the severity of atopic dermatitis, quality of life, and ADHD. Methods : A total of 249 preschool children who had atopic dermatitis were enrolled. Parents of the patients filled out a questionnaire on the past history of allergic diseases, quality of life, and ADHD. In each patient, total immunoglobulin (Ig) E and specific IgE to nine foods and inhalant allergens, total eosinophil counts, and TARC levels were measured. We evaluated the severity of atopic dermatitis by using the scoring atopic dermatitis (SCORAD) score and divided the patients into three groups; mild ( 40). Results : In a total of 249 children, 222 children (89.2%) had a history of atopic dermatitis. Children with allergic sensitization had a higher SCORAD score, total IgE levels, and total eosinophil counts, but not TARC levels. Three groups by the SCORAD score showed significant differences in quality of life index and TARC levels but not in ADHD index. TARC level was correlated with the SCORAD score, but not with the quality of life index and ADHD index. The SCORAD score was correlated with the quality of life index but not with the ADHD index. Conclusion : Serum TARC levels may be associated with the severity of atopic dermatitis but not with the degree of quality of life and ADHD. Disease severity of atopic dermatitis in preschool children may be associated with the degree of quality of life but not with the level of ADHD. [Pediatr Allergy Respir Dis(Korea) 2011;21:215-225]

Probiotic Supplement Reduces Atopic Dermatitis in Preschool Children

The role of probiotics in the treatment of atopic dermatitis (AD) remains controversial. A recent systematic review of the available evidence called for further clinical trials with new probiotic formulations. To assess the clinical efficacy and impact of Lactobacillus acidophilus DDS-1, Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide on peripheral blood lymphocyte subsets in preschool children with moderate-to-severe AD. Randomized, double-blind, placebo-controlled, prospective trial of 90 children aged 1-3 years with moderate-to-severe AD who were treated with a mixture of L. acidophilus DDS-1, B. lactis UABLA-12 with fructo-oligosaccharide at a dosage of 5 billion colony-forming units twice daily for 8 weeks versus placebo. The primary outcome measure was the percentage change in Scoring of Atopic Dermatitis (SCORAD) value. Other outcome measures were changes in Infant Dermatitis Quality Of Life (IDQOL) and Dermatitis Family Impact (DFI) scores, frequency and amount of topical corticosteroid used, and lymphocyte subsets in peripheral blood measured by laser flow cytometry. At the final visit, the percentage decrease in SCORAD was 33.7% in the probiotic group compared with 19.4% in the placebo group (p = 0.001). Children receiving probiotic showed a greater decrease in the mean [SD] SCORAD score than did children from the placebo group at week 8 (-14.2 [9.9] vs -7.8 [7.7], respectively; p = 0.001). IDQOL and DFI scores decreased significantly from baseline by 33.0% and 35.2% in the probiotic group and by 19.0% and 23.8% in the placebo group, respectively (p = 0.013, p = 0.010). Use of topical corticosteroids during the 8-week trial period averaged 7.7 g less in probiotic patients (p = 0.006). CD3, CD16, and CD22 lymphocyte subsets remained unchanged, whereas the percentage of CD4, and the percentage and absolute count of CD25 decreased, and the percentage and absolute count of CD8 increased in the probiotic group at week 8 (p < 0.007 vs placebo). There was a significant correlation between CD4 percentage, CD25 percentage, CD25 absolute count, and SCORAD values (r = 0.642, r = 0.746, r = 0.733, respectively; p < 0.05) in the probiotic group at week 8. The administration of a probiotic mixture containing L. acidophilus DDS-1, B. lactis UABLA-12, and fructo-oligosaccharide was associated with significant clinical improvement in children with AD, with corresponding lymphocyte subset changes in peripheral blood. The efficacy of probiotic therapy in adults with AD requires further investigation.

창원시 학동 전기 소아들의 아토피 피부염 유병률과 그 원인에 관한 연구

In the past decade there has been increasing concern about the atopic dermatitis (AD) associated with environmental diseases. AD has been increased in the last decade and known as one of the multifactoral diseases, which has the genetic background and environmental factors at the same time. The purposes of this study were to investigate the prevalence rate and etiologic risk factors of atopic dermatitis in preschool children in Changwon, which is a one of the Korean cities and has a large industrial complex. We reviewed and analyzed the statistical data, obtained from Korea National Health Insurance Corporation, related to prevalence rate by age and administrative district. A cross-sectional questionnaire survey, based on ISAAC (International Study of Allergy and Asthma in Childhood), was conducted on random samples of preschool children (5 to 8 years old) of large sized kindergartens in Changwon. The lifetime and last one years prevalence of AD in preschool children in Changwon was increased from 1998 to 2008. The prevalence rate of AD in the preschool children in Changwon city was 9.6%. The prevalence rate in boys was 9.7% and that in girls was 9.4%. The one year prevalence of AD was ranked as middle among other provincial cities in Korea in 2008. This study showed that the prevalence rate of the atopic disease in Changwon was 9% in 2008, which was increased especially compare to 2000. More active governmental approaches for control and prevention of atopic dermatitis for children are recommended. Further studies are needed for more accurate estimation of the prevalence of AD in Korea including different regional and age population.

Prevalence and risk factors for atopic dermatitis in preschool children

Atopic dermatitis (AD) is a common condition in infancy which usually disappears by 3 years of age in a significant proportion of children. The prognosis is mostly determined by severity and presence of atopic sensitization. To investigate prevalence of AD, comorbidities and risk factors in a population of preschool children aged 3-5 years. Children in kindergartens were evaluated. The International Study of Asthma and Allergies in Childhood written questionnaire (WQ) was used, with additional questions on risk factors. Atopy was investigated by skin prick tests. One thousand, four hundred and two valid WQs (92% response rate) were returned for evaluation. The prevalence of AD symptoms in the last 12 months in the whole population was 18.1% (254 cases). Seventy-two per cent of these children presented AD-specific localizations. The prevalence of eczema as a doctor's diagnosis in the total population was 15.4%. Positive atopic sensitization was present in 18.6% of the total and in 32.2% of the AD study population, respectively. Multiple sensitivities were observed in 58.2% of sensitized children. The prevalence of sensitization demonstrated that the most common sensitizing allergens in children with AD were mites and grass pollen. Rhinitis symptoms and wheezing were present in 32.2% and 24.2%, respectively, of children with AD. Allergic sensitization to egg, cat, grass pollen and mites, as well as the presence of symptoms of rhinitis, and a positive family history of atopy were all significant risk factors for AD. The study demonstrates a high prevalence of AD and a close relationship with rhinitis symptoms. Significant risk factors for AD were sensitization to food or inhalant allergens as well as parental history of atopy.

What is the cost of atopic dermatitis in preschool children?

Atopic dermatitis (AD) is the most common inflammatory skin disorder and an important cause of morbidity in young children in the U.K. Such disability produces significant economic burden reflected in direct medical costs associated with health service utilization, direct family care costs such as transport costs, indirect costs associated with loss of productivity of carers, and intangible costs associated with the psychological effects of the disease. In order to evaluate this economic burden we conducted a cross-sectional survey of children aged 1-5 years in the Nottingham area in 1995-96. We sent a postal questionnaire to parents of all children aged 1-5 years with questions to identify those with AD; a second questionnaire was sent to parents of identified children regarding costs and utilization of medical services. Intangible costs were not evaluated. The 12-month period prevalence of AD according to a dermatologist's diagnosis in 1761 children was 16.5% (95% confidence interval 14.7-18.2%). Total mean disease costs were estimated to be pound79.59 per child over the 12-month period of the study. The most significant costs were due to costs to the state for National Health Service (NHS) consultations ( pound28.62 mean annual cost) and prescriptions ( pound22.03). Consultations with general practitioners accounted for the significant bulk of consultation costs, with only 6% of children being seen in secondary care (17 of 290). Most prescribing costs (76%) were due to emollients and bath preparations. Family care costs ( pound28.94 mean annual cost) accounted for 36% of total disease costs and were associated with changes to the home environment, purchase of over-the-counter medicines, transport costs, visits to homoeopaths and salary loss. The results signify that AD is an important cause of economic burden both to the NHS and to the families of affected children. Using population census data and the results in this study, we estimated that the annual U.K. cost of AD in children aged 1-5 years in 1995-96 was pound47 million.