Risk Factors For Atopic Dermatitis Research Articles

Application of lipidomics to reveal differences of facial skin surface lipids between atopic dermatitis and healthy infants.

The current knowledge about potential risk factors for atopic dermatitis (AD) is primarily based on the structure and function of the stratum corneum, which is characterized by osmotic defects and abnormal antibacterial function. There are no studies on the difference between facial lipids in infants with AD and healthy infants. We sought to explore significantly different lipid markers for infants with AD presenting with lesions and healthy infants aged 0-2years to guide treatment strategies. Twenty-eight patient infants with AD and 32 healthy infants were recruited. Each infant received its surface skin lipids (SSL) on the right cheek. The components of skin lipids were measured by ultra-performance liquid chromatography-quadrupoletime-of-flight mass spectrometry (UPLC-Q-TOF-MS) to explore significantly different lipid markers by analyzing the detection results using orthogonal partial least squares analysis(OPLS-DA). There were clear distinctions in the components of SSL between the two groups. Twenty-nine significantly different lipid markers (P≤.05) were found. This study confirmed that there were significant differences in the components of the SSL between AD infants with lesions and healthy infants, but also found lipid types, lipid contents, and lipid structures as AD-related risks.

Prenatal Omega-3 and Omega-6 Polyunsaturated Fatty Acids and Childhood Atopic Dermatitis

Atopic dermatitis is a common childhood disease, potentially influenced by prenatal nutritional exposures such as polyunsaturated fatty acids (PUFAs). In a racially diverse cohort, we hypothesized that childhood atopic dermatitis would be associated with higher prenatal omega-6 (n-6) and lower omega-3 (n-3) PUFAs. We included mother-child dyads, births 2006 to 2011, enrolled in the University of Tennessee Health Sciences Center Conditions Affecting Neurocognitive Development in Early Childhood cohort. Primary exposures included second trimester plasma n-3 and n-6 PUFA status and the ratio of the two (n-6:n-3). We assessed child current atopic dermatitis symptoms in the previous 12 months at age approximately 4 to 6 years. We investigated the association between PUFA exposures and atopic dermatitis using multivariable logistic regression, adjusting for potential confounders. We assessed for effect modification by maternal prenatal smoking, atopic disease history, and child sex. Among 1131 women, 67% were African American and 42% had an atopic disease history; 17% of children had atopic dermatitis. Higher prenatal n-6 PUFAs were associated with increased relative odds of child atopic dermatitis (adjusted odds ratio: 1.25; confidence interval: 1.01-1.54 per interquartile range difference), and interaction models demonstrated that this association was seen in dyads in which the women had a history of atopic disease. Neither prenatal n-3 PUFAs nor n-6:n-3 were associated with child atopic dermatitis. In this racially diverse cohort, higher second trimester n-6 PUFAs were associated with atopic dermatitis in children of women with atopy. PUFAs may represent a modifiable risk factor for atopic dermatitis, particularly in individuals with a familial predisposition.

Factors Associated with Atopic Dermatitis and Allergic Rhinitis among Residents of Two Municipal Areas in South Korea.

Background and Objectives: The growing burden and deleterious health consequences of allergic diseases, especially of allergic rhinitis (AR) and atopic dermatitis (AD), in developed countries remains an important public health issue. The current study aimed to assess the prevalence and to identify the risk factors of atopic dermatitis and allergic rhinitis among residents of Pohang-Si and Yeongdeok-Gun, two municipal areas in South Korea. Materials and Methods: A cross-sectional study was conducted in both municipal areas between 12 November and 13 December 2017. A total of 302 subjects were recruited from 100 households (25 apartments and 25 houses in each municipality), by system extraction according to district code numbers. Data were collected using International Study of Asthma and Allergies in Childhood (ISAAC) Standard Questionnaires for children and a health questionnaire for adults. Risk factors were identified by multivariate logistic regression analysis. Results: Of the 302 study participants, 12.9% and 25.5% had AD and AR, respectively. The significant factors associated with AD by multivariate logistic regression analysis were age ≥19 years (aOR (adjusted odds ratio) 6.9; 95% CI (confidence interval) (2.9–16.37)), residence in Pohang-Si (aOR 2.5; 95% CI (1.18–5.53)), and family history of allergic disease (aOR 2.3; 95% CI (1.09–4.9)). Similarly, the significant factors associated with AR were male gender (aOR 2.3; 95% CI (1.24–4.42)), age ≥19 years (aOR 4.4; 95% CI (2.28–8.48)), residence in Pohang-Si (aOR 2.8; 95% CI (1.51–5.37)), and family history of allergic disease (aOR 6.7; 95% CI (3.50–12.82)). Conclusion: The present study shows that age ≥19 years, residence in Pohang-Si, and family history of allergic disease are risk factors for AD and AR, and that, additionally, male gender is a risk factor of AR. Understanding the risk factors of allergic diseases can aid the design and implementation of evidence-specific strategies to reduce the long-standing problems associated with allergic disease.

Transient epidermal barrier deficiency and lowered allergic threshold in filaggrin-hornerin (FlgHrnr-/- ) double-deficient mice.

Filaggrin (Flg) and hornerin (Hrnr) share similar structural and functional features. Both proteins have been implicated as essential proteins for skin barrier maintenance. Loss-of-function mutations of these genes constitute a risk factor for atopic dermatitis and eczema-related asthma. Furthermore, both FLG and HRNR protein levels are downregulated in patients with atopic dermatitis. Thus, mice deficient for Flg and Hrnr provide a novel model to study skin barrier impairment and the susceptibility for cutaneous inflammation. By using appropriate targeting vectors and breeding strategies, we established a homozygous FlgHrnr double-deficient (FlgHrnr-/- ) mouse model lacking both genes including the intergenomic sequence. Neonates appeared normal, but developed a transient scaly phenotype with overall flaky appearance, but no overt skin phenotype in adulthood, thereby reflecting a subclinical barrier defect seen in humans. Structurally, FlgHrnr-/- mice displayed a markedly reduced granular layer and a condensed cornified layer. Functionally, FlgHrnr-/- mice showed permeability abnormalities and metabolic aberrations regarding the production of natural moisturizing factors (NMFs) in the stratum corneum. Surprisingly, although the immune system revealed no aberrations under steady-state conditions, FlgHrnr-/- mice are predisposed to mount an allergic contact dermatitis, especially at hapten threshold levels eliciting allergic reactions. Together, our FlgHrnr-/- mouse model nicely reflects the epicutaneous sensitization susceptibilities and inflammatory reactions to environmental insults in humans with impaired skin barrier functions.

Inflammatory dietary pattern and incident psoriasis, psoriatic arthritis, and atopic dermatitis in women: A cohort study

Diet is a modulator of inflammation that might impact inflammatory skin diseases. To assess the relationship between pro-inflammatory dietary patterns and incident psoriasis, psoriatic arthritis (PsA), and atopic dermatitis (AD). We conducted cohort studies among women in the Nurses' Health Study II. The Empirical Dietary Inflammatory Pattern (EDIP) score was calculated at baseline and every 4years. Incident psoriasis, PsA, and AD were assessed by validated self-report. We used multivariable-adjusted Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDIP quintiles and risk for psoriasis, PsA, and AD. We had 85,185 participants in the psoriasis analysis and 63,443 in the AD analysis. There were 1432 cases of psoriasis, 262 cases of PsA, and 403 cases of AD. Pro-inflammatory dietary patterns were not associated with the risk for outcomes in multivariable models (all P values for trend >.05). HRs comparing the highest to the lowest EDIP quintile were 0.99 (95% CI 0.83-1.18) for psoriasis, 1.22 (95% CI 0.81-1.83) for PsA, and 0.96 (95% CI 0.69-1.34) for AD. Recall and self-report. Our findings do not support dietary inflammatory potential as a risk factor for psoriasis, PsA, or AD.

Atopic dermatitis

Atopic dermatitis is a chronic inflammatory skin disease associated with pruritus that occurs most frecquently in children. A family history of atopy (eczema, asthma, or allergic rhinitis) and skin barrier abnormalities genetically determined are major risk factors for atopic dermatitis. The diagnosis of atopic dermatitis is clinical, based upon the history, onset, and morphology of skin lesions. The goals of treatment are to reduce symptoms, prevent exacerbations, to improve the quality of life and minimize therapeutic risks. The optimal management is based on the severity of the disease and involves the elimination of exacerbating factors, restoration of the skin barrier function, pharmacologic treatment of skin inflammation (topic and systemic agents), and patient education.

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

Low Interleukin 10 Production at Birth Is a Risk Factor for Atopic Dermatitis in Neonates with Bifidobacterium Colonization

Background: Altered regulatory immune responses to microbial stimuli and intestinal colonization of beneficial bacteria early in life may contribute to the development of allergic diseases (e.g., atopic dermatitis [AD]). However, few reports have investigated these factors simultaneously. The purpose of this study was to analyze neonatal immune responses to microbial stimuli as well as intestinal colonization of beneficial bacteria, in relation to the development of AD in a birth cohort. Methods: Pregnant women were recruited, and their infants were followed up until 7 months of age. Levels of interleukin (IL)-10 released from cord-blood mononuclear cells (CBMCs) stimulated with heat-killed gram-positive bacteria (Bifidobacterium bifidum and Lactobacillus rhamnosus GG) and Lactobacillus-derived peptidoglycan were measured. Fecal Bifidobacterium counts at 4 days and 1 month were quantified using real-time polymerase chain reaction. The development of AD was determined by means of a questionnaire at 7 months of age. Results: The levels of released IL-10 were significantly lower in infants with AD (n = 17) than in infants without AD (n = 53) for all stimuli. In infants with fecal Bifidobacterium, the incidence of AD was inversely associated with the release of IL-10 from cord blood mononuclear cells. Conclusion: Our findings suggest that impaired IL-10 production in response to microbial stimuli at birth may be associated with an increased risk of developing infantile AD, even in infants with early colonization of intestinal bifidobacteria.

Factors that predict disease severity in atopic dermatitis: The role of serum basal tryptase

Increased numbers of mast cells that contain tryptase are found in lesional atopic dermatitis (AD) skin. The association of serum basal tryptase (sBT) with anaphylactic reactions and mast cell diseases has recently been shown in children with venom and food allergy. We aimed to identify the risk factors that predict the severity of AD and the association of sBT levels with AD and disease severity. AD diagnosis was made according to Hanifin and Rajka criteria. Disease severity was scored by the objective scoring atopic dermatitis (SCORAD) index. The sBT levels were measured. Skin-prick testing, total immunoglobulin E, eosinophil percentages and counts, and a questionnaire concerning the history of atopic diseases and the risk factors of AD were applied. The children, ages 0.5 to 3.0 years, with AD (n = 85) were analyzed in two groups according to the presence (AD+/atopy+ [n = 55]) or absence (AD+/atopy- [n = 30]) of skin-prick test positivity. The comparisons were made with an age- and sex-matched control group (n = 82). The median (interquartile range) sBT in the AD+/atopy+, AD+/atopy-, and control groups were 5.01 ng/mL (2.75-6.79 ng/mL), 3.02 ng/mL (1.67-4.44 ng/mL), and 2.63 ng/mL (1.31-4.49 ng/mL), respectively (p = 0.003). The median (interquartile range) sBT levels were higher in patients with moderate-severe objective SCORAD index scores compared with the those with mild disease (3.85 ng/mL [2.04-5.91 ng/mL] versus 2.80 ng/mL [1.83-3.48 ng/mL]; p = 0.038). Multivariate logistic regression analysis showed that an sBT level of ≥3.9 ng/mL (odds ratio 8.77 [95% confidence interval, 1.87-41.18]; p = 0.006) was independently associated with an increased risk of moderate-severe AD (objective SCORAD index). To our knowledge, this was the first study that indicated that sBT levels may be important in the AD disease process and associated with the disease severity and atopy.

Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring

Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring

Risk factors of Atopic dermatitis in 1- to 4-Years Old Children in Al-Bayda city, Libya

may be an important factor in children with atopic eczema under 4 years. Our objective was to assess the extent and characteristics of confirmed and unconfirmed diagnoses of AD in 112 children who were diagnosed by Pediatric Allergy Clinic at El-Beyda’s hospital with a high possibility of having AD at some point in their lifetimes. Sera from the patients were analyzed for specific IgE antibodies to 20 allergens. About 95% of children with AD have IgE-mediated clinical reactivity. The prevalence of positive cases with food allergens ranged from 19-20%, and environmental factors ranged from 11-14% for boys and girls respectively. Positive cases of environmental factors in this population were recorded against some species of plants. As a result, a combined sensitization to food and environmental allergens not only has an additive increase in serum IgE antibody production, but also increases the risk of developing allergic diseases such as asthma during childhood. An evaluation for AD should be considered to these children.

Role of Psychological Stress on Interferon-Gamma (IFN-γ) in Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease, with itching predominant symptom, which usually develope in infancy and associated with an increase in serum IgE and history of atopies, such as allergic rhinitis or bronchial asthma. The etiology of AD remains unclear. However, there are many predisposing factors, such as genetic, immunological disorders, infections, foods, irritants, and psychological stress. Many research has conclude that stress is one of the risk factor for AD, but the current understanding for the underlying mechanism remain unclear. Recent research shows that stress can suppress interferon gamma (IFN-γ), which plays an important role in the pathogenesis of AD. This study aims to determine the role of stress and serum levels of IFN-γ to AD. Study design using a case-control study with a sample consisting of 31 cases and 28 controls. Stress indexes were measured using Holmes & Rahe Stress Scale and serum IFN-γ levels were examined. Statistical analysis was performed to determine the differences between the mean stress index and serum IFN-γ level between cases and controls, the magnitude of psychological stress as a risk factor for AD, and the correlation between psychological stress and serum IFN-γ level against the severity of AD. This study concluded that stress is a risk factor for AD with an odds ratio of 5.3, and the stress index is positively correlated with the severity of AD. Serum IFN-γ levels were significantly lower in cases group. There was a strong negative correlation between IFN-γ with the severity of AD (r = -0.905; p <0.05). Current study conclude that psychological stress is a risk factor for AD and stress can suppress serum IFN-γ levels.

The prevalence and risk factors of atopic dermatitis in 6–8 year-old first graders in Taipei

BackgroundDespite the advance in the understanding of etiology, pathophysiology and diagnosis of atopic dermatitis (AD), its prevalence has increased annually in Taiwan. PurposesThe purpose of this study is to explore the prevalence, and personal and environmental risk factors of AD. MethodsA cross-sectional survey was conducted via health centers of elementary schools in Taipei city. We used the Chinese version of ISAAC questionnaire to examine possible personal and environmental risk factors of AD. Questionnaires were completed by parents or guardians of first graders (6–8 year-old) who agreed to participate in this study. Logistic regression was conducted to examine possible personal and environmental factors related to AD (in early life and currently). ResultsThe 12-month prevalence of AD (in the past 12 months) was 10.7% (2683/24,999) among 6- to 8-year-old first graders in Taipei. Forty-five percent of first graders with AD had their first episode of AD symptoms before the age of two. Children with asthma history were 1.65 times (95% CI: 1.51–1.79, p < 0.001) and children with rhinitis were 2.57 times (95% CI: 2.34–2.84, p < 0.001) more likely to have AD than those without the conditions. Compare to their counterarts, children who used antibiotics during their first year of life (OR = 1.37, 95% CI: 1.22–1.53, p < 0.001) and who had bronchiolitis before the age of two (OR = 1.47, 95% CI: 1.33–1.63, p < 0.001) had a higher chance to have AD during the last 12 months of the study. However, receiving breastfeeding for less than 4 months (OR = 0.75, 95% CI: 0.67–0.83, p < 0.001) and having older siblings (OR = 0.83, 95% CI: 0.76–0.92, p < 0.001) had 25% and 17% reduced risks for AD in the 12 months before this study, respectively. ConclusionOur study verified personal and environmental risk factors of AD in children in Taiwan. Based on the results, we propose that avoiding bronchiolitis before the age of two, using antibiotics properly in babies, and providing diet counseling for breastfeeding mothers may be good prevention strategies of AD.

Bifurcation analysis of a mathematical model of atopic dermatitis to determine patient-specific effects of treatments on dynamic phenotypes

Atopic dermatitis (AD) is a common inflammatory skin disease, whose incidence is currently increasing worldwide. AD has a complex etiology, involving genetic, environmental, immunological, and epidermal factors, and its pathogenic mechanisms have not yet been fully elucidated. Identification of AD risk factors and systematic understanding of their interactions are required for exploring effective prevention and treatment strategies for AD. We recently developed a mathematical model for AD pathogenesis to clarify mechanisms underlying AD onset and progression. This model describes a dynamic interplay between skin barrier, immune regulation, and environmental stress, and reproduced four types of dynamic behaviour typically observed in AD patients in response to environmental triggers. Here, we analyse bifurcations of the model to identify mathematical conditions for the system to demonstrate transitions between different types of dynamic behaviour that reflect respective severity of AD symptoms. By mathematically modelling effects of topical application of antibiotics, emollients, corticosteroids, and their combinations with different application schedules and doses, bifurcation analysis allows us to mathematically evaluate effects of the treatments on improving AD symptoms in terms of the patients’ dynamic behaviour. The mathematical method developed in this study can be used to explore and improve patient-specific personalised treatment strategies to control AD symptoms.

A short period of breastfeeding in infancy, excessive house cleaning, absence of older sibling, and passive smoking are related to more severe atopic dermatitis in children.

Atopic dermatitis (AD) is one of the most common, chronic or chronically relapsing inflammatory skin diseases that affect children. Multiple genetic and environmental factors appear to regulate the pathogenesis of AD. Our aim was to investigate the possible association between family, social, dieting, atopic and environmental factors and the severity of AD evaluated by SCORAD scores in children. The study group included 100 children with AD who attended a paediatric dermatology outpatient clinic with a median age of 18.5 months. The diagnosis of AD was established on the basis of the clinical criteria according to the American Dermatology Society, while the SCORAD score was used to evaluate disease severity. Multivariate linear regression analysis disclosed that excessive cleanliness (p<0.001), RAST level greater than 0.7KU/l (p<0.001), breastfeeding for less than two months (p=0.001), and the absence of an older sibling (p=0.049) were statistically significant independent determinants for high SCORAD scores. Multivariate logistic regression analysis showed that excessive cleanliness (p<0.001) was the strongest independent risk factor for severe AD (SCORAD>36) (aOR: 59.4; 95%CI: 10.9-322.6). RAST level greater than 0.7KU/l (aOR: 7.9; 95%CI: 1.5-41.0; p=0.014) and severe passive smoking (aOR: 4.6; 95%CI: 1.0-22.1; p=0.050) also showed a significant independent, but clearly weaker, association with severe AD. A short duration of breastfeeding, absence of older siblings, parental passive smoking, food allergens along with aeroallergens, and excessive cleanliness should be considered as negative prognostic factors, leading to a higher SCORAD score in children with AD.

The Prevalence and Risk Factors of Atopic Dermatitis and Clinical Characteristics according to Disease Onset in 19-Year-Old Korean Male Subjects.

BackgroundThe natural course of atopic dermatitis (AD) in infancy, childhood, and adolescence is not yet completely known.ObjectiveTo investigate the prevalence and risk factors of atopic dermatits among 19-year-old Korean male subjects.MethodsAll 19-year-old Korean males must undergo medical examination for conscription. We precisely evaluated the prevalence of AD in three Korean provinces using the information from this physical checkup. AD was diagnosed by experienced dermatologists according to the Hanifin and Rajka criteria. The disease severity was assessed by the scoring of atopic dermatitis (SCORAD) index. In order to investigate the risk factors for AD, a questionnaire was administered to all subjects regarding parental atopic history, geographical characteristics of past habitation, past economic status, number of siblings, parental occupation, etc.ResultsThe point prevalence in the Korean provinces ranged from 1.15% to 1.44%. In multivariable analysis, a parental history of AD was a significant risk factor in all 3 disease-onset groups (infancy, childhood, and adolescent onset). In the infancy-onset group, low economic status was also a significant risk factor for AD. The SCORAD index was significantly higher in AD subjects with early onset and those living in small-sized habitations. Moreover, erythema, edema, lichenification, dryness of skin, and sleep loss appeared to be more severe in early-onset cases.ConclusionThe younger the age of disease onset, the more severe the clinical outcomes in 19-year-old male subjects. In addition, active AD treatment at younger ages might affect the prevalence and the severity of AD in adulthood.

Atopic dermatitis in children aged 1 - 7 years in Shenzhen city: an epidemiological study

Objective To investigate the prevalence of and influencing factors for atopic dermatitis (AD) in children aged 1 - 7 years in Shenzhen city, and to analyze difference in diagnostic results between two diagnostic criteria. Methods From December 1st 2013 to March 1st 2014, a questionnaire survey and physical examination were conducted to investigate the prevalence of AD in children aged 1 - 7 years in Shenzhen city. Results A total of 1 504 children were enrolled into this study, including 716 males and 788 females. Based on the clinical diagnosis by experienced dermatologists, the prevalence of AD was 11.84% (178/1 504) in total, 11.73% (84/716) and 11.93% (94/788) in males and females, respectively, and there was no significant difference in the prevalence of AD between males and females (χ2 = 0.01, P > 0.05) . Based on the Williams′ diagnostic criteria, the prevalence of AD was 3.92% (59/1 504) in total, and 4.05% (29/716) and 3.81% (30/788) in males and females, respectively. Premature birth was a risk factor for the occurrence of AD (χ2 = 5.43, P < 0.05) . Conclusions The prevalence of AD is evidently increased among children aged 1 - 7 years in Shenzhen city, and premature birth is a risk factor for AD. Missed diagnosis will be reduced based on clinical diagnosis by experienced dermatologists. Key words: Dermatitis, atopic; Child; Prevalence; Population characteristics

Identification of atopic dermatitis subgroups in children from 2 longitudinal birth cohorts

BackgroundAtopic dermatitis (AD) is a prevalent disease with variable natural history. Longitudinal birth cohort studies provide an opportunity to define subgroups on the basis of disease trajectories, which may represent different genetic and environmental pathomechanisms.ObjectivesWe sought to investigate the existence of distinct longitudinal phenotypes of AD and test whether these findings are reproducible in 2 independent cohorts.MethodsThe presence of AD was examined in 2 birth cohort studies including 9894 children from the United Kingdom (ALSPAC) and 3652 from the Netherlands (PIAMA). AD was defined by parental report of a typical itchy and/or flexural rash. Longitudinal latent class analysis was used to investigate patterns of AD from birth to the age of 11 to 16 years. We investigated associations with known AD risk factors, including FLG null mutations, 23 other established AD-genetic risk variants, and atopic comorbidity.ResultsSix latent classes were identified, representing subphenotypes of AD, with remarkable consistency between the 2 cohorts. The most prevalent class was early-onset-early-resolving AD, which was associated with male sex. Two classes of persistent disease were identified (early-onset-persistent and early-onset-late-resolving); these were most strongly associated with the AD-genetic risk score as well as personal and parental history of atopic disease. A yet unrecognized class of mid-onset-resolving AD, not associated with FLG mutations, but strongly associated with asthma, was identified.ConclusionsSix classes based on temporal trajectories of rash were consistently identified in 2 population-based cohorts. The differing risk factor profiles and diverse prognoses demonstrate the potential importance of a stratified medicine approach for AD.

Maternal sensitivity and social support protect against childhood atopic dermatitis

BackgroundMany studies have identified associations between qualities of maternal–child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal–infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors.MethodsWe conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age.ResultsHigher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD.ConclusionsLow maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal–infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.

Filaggrin loss-of-function mutations, atopic dermatitis and risk of actinic keratosis: results from two cross-sectional studies.

Common loss-of-function mutations in filaggrin gene (FLG) represent a strong genetic risk factor for atopic dermatitis (AD). Homozygous mutation carriers typically display ichthyosis vulgaris (IV) and many have concomitant AD. Previously, homozygous, but not heterozygous, filaggrin gene mutations have been associated with squamous cell carcinomas. The first objective was to examine the association between FLG mutations and actinic keratosis (AK). The second objective was to investigate the occurrence of AK in patients with IV and AD, respectively. FLG mutation status in patients with AK was compared with controls from the general population. Furthermore, based on nationwide data from Danish registers, we compared the risk of AK in patients with IV, AD and psoriasis, respectively. The prevalence of homozygous FLG mutations was significantly higher in the AK group (n = 4, 0.8%) in comparison with the control group (n = 18, 0.2%), whereas the prevalence of heterozygous FLG mutations was lower. In hospital registry data, patients with AD exhibited an increased risk of AK than did psoriasis controls (adjusted OR 1.46; [95% CI 1.12-1.90]), whereas no difference in risk was observed between patients with IV and AD. This study indicates an increased susceptibility to AK in individuals with homozygous, but not heterozygous, FLG mutations and in patients with AD compared to psoriasis. Whether a reduction or absence of epidermal filaggrin could contribute to the susceptibility to AK in patients with IV and AD is unknown and additional research is needed to further explore this relationship.