This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Acta Derm Venereol 2020; 100: adv00160 Centenary theme section: ATOPIC DERMATITIS SIGNIFICANCEAtopic dermatitis is common, and is often burdensome for the individual. An overview of how often AD occurs is therefore necessary. A systematic review was performed, which included more than 7,000 articles with data from all continents, on children and adults. Each year, up to 17.1% of adults and 22.6% of children were diagnosed with AD; with as many as 9.6% new cases of AD in children. Surprisingly, in adults, studies on new cases were from the 20 th century. The results will be useful for patient organizations, physicians, scientists and healthcare planning, especially as new therapies are emerging.The primary objective of this study was to systematically review and analyse epidemiological studies of the prevalence and incidence of atopic dermatitis (AD) during childhood and adulthood, focusing on data from the 21 st century. A systematic search of PubMed, EMBASE and Google (manual search) was performed in June 2019, followed by data abstraction and study quality assessment (Newcastle-Ottawa Scale). Cross-sectional and longitudinal epidemiological studies of individuals with AD (doctor-diagnosed or standardized definition) were included. Of 7,207 references reviewed, 378 moderate/good-quality studies were included: 352 on prevalence of AD and 26 on incidence of AD. In the 21 st century, the 1-year prevalence of doctor-diagnosed AD ranged from 1.2% in Asia to 17.1% in Europe in adults, and 0.96% to 22.6% in children in Asia. The 1-year incidence ranged from 10.2 (95% confidence interval (95% CI) 9.9-10.6) in Italy to 95.6 (95% CI 93.4-97.9) per 1,000 person-years in children in Scotland. There were few recent studies on incidence of AD in the 21 st century and no studies on adults only; most studies were conducted in Europe and the USA. Epidemiological studies on childhood and adulthood AD in different continents are still needed, especially on the incidence of AD during adulthood.
BackgroundThis study aimed to estimate the association between eczema in early childhood and the onset of asthma and rhinitis later in life in children.MethodsA total of 3,124 children aged 1–2 years were included in the Dampness in Building and Health (DBH) study in the year 2000, and followed up 5 years later by a parental questionnaire based on an International Study of Asthma and Allergies in Childhood protocol. The association between eczema in early childhood and the incidence of asthma and rhinitis later in life was estimated by univariable and multivariable logistic regression modelling.ResultsThe prevalence of eczema in children aged 1–2 years was 17.6% at baseline. Children with eczema had a 3-fold increased odds of developing asthma (adjusted odds ratio [aOR], 3.07; 95% confidence interval (CI) 1.79–5.27), and a nearly 3-fold increased odds of developing rhinitis (aOR, 2.63; 1.85–3.73) at follow-up compared with children without eczema, adjusted for age, sex, parental allergic disease, parental smoking, length of breastfeeding, site of living, polyvinylchloride flooring material, and concomitant allergic disease. When eczema was divided into subgroups, moderate to severe eczema (aOR, 3.56; 1.62–7.83 and aOR, 3.87; 2.37–6.33, respectively), early onset of eczema (aOR, 3.44; 1.94–6.09 and aOR, 4.05; 2.82–5.81; respectively), and persistence of eczema (aOR, 5.16; 2.62–10.18 and aOR, 4.00; 2.53–6.22, respectively) further increased the odds of developing asthma and rhinitis. Further independent risk factors increasing the odds of developing asthma were a parental history of allergic disease (aOR, 1.83; 1.29–2.60) and a period of breast feeding shorter than 6 months (aOR, 1.57; 1.03–2.39). The incidence of rhinitis was increased for parental history of allergic disease (aOR, 2.00; 1.59–2.51) and polyvinylchloride flooring (aOR, 1.60; 1.02–2.51).ConclusionEczema in infancy is associated with development of asthma and rhinitis during the following 5-year period, and eczema is one of the strongest risk factors. Early identification is valuable for prediction of the atopic march.
Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities. 1,2 Severely affected patients are often treated with immune-modulating systemic drugs. 3,4 On 11 March 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide is increasing exponentially and poses a major health threat, especially for those who are elderly and immunocompromised, or have comorbidities. This also applies to AD patients on systemic immune-modulating treatment. In these days of uncertainty, reallocation of medical resources, curfew, hoarding and shutdown of normal social life, patients, caregivers and doctors ask questions regarding the continuation of systemic immunemodulating treatment of AD patients. The ETFAD decided to address some of these questions here: What do we recommend for AD patients treated with immune-modulating therapy at times of SARS-Cov-2 pandemic?
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