Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization

Abstract

Background Atopic dermatitis (AD) is associated with multiple comorbid conditions, such as asthma and food allergy. We sought to determine the impact of eczema severity on the development of these disorders and other non-atopic comorbidities in AD. Methods We used the 2007 National Survey of Children's Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children age 0-17 years. Prevalence and severity of eczema, asthma, hay fever and food allergy, sleep impairment, healthcare utilization, recurrent ear infections, visual and dental problems were determined. Results In general, more severe eczema correlated with poorer overall health, impaired sleep and increased healthcare utilization, including seeing a specialist, compared to children with mild or moderate disease (Rao-Scott Chi-square, P<0.0001). Severe eczema was associated with higher prevalence of comorbid chronic health disorders, including asthma, hay fever and food allergies (P<0.0001). In addition, the severity of eczema was directly related to the severity of the comorbidities. These associations remained significant in multivariate logistic regression models that included age, sex and race/ethnicity. Severe eczema was also associated with recent dental problems, including bleeding gums (P<0.0001), toothache (P=0.0004), but not broken teeth (P=0.04) or tooth decay (P=0.13). Conclusions These data indicate that severe eczema is associated with multiple comorbid chronic health disorders, impaired overall health and increased healthcare utilization. Further, these data suggest that children with eczema are at risk for decreased oral health. Future studies are warranted to verify this novel association.

Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements

“…28,29 This finding adds to the body of work that supports the "atopic march," the hypothesis that AD pathology predisposes individuals to the development of other atopic diseases and comorbid conditions associated with impaired overall health and increased health care utilization. 1,28,29 As in other studies, allergies to peanut, cow's milk, and egg white were the most common, and were seen in a higher percentage of study participants than in the general population (3.9% to 6.6% of patients in this study had peanut allergy versus a reported 1.0% to 2.5% of all North American children). 2,30 Estimated rates of allergy to wheat and soybean vary widely; in clinical studies of children and adolescents with AD, rates as high as 30% have been reported.…”

“…This disorder is associated with many comorbid conditions leading to impaired overall health and increased health care utilization. 1 Children with AD are more likely to develop other atopic conditions, including food allergy, than children who have no history of the disease. [2][3][4] Previous clinical studies have documented greatly varying estimates of the rate of IgE-mediated food allergy in AD patients, ranging from 15% to 40%.…”

Environmental risk factors and their role in the management of atopic dermatitis

“…Yet, until recently, there was little evidence to support this notion. One study found that relocating children with AD from the home subarctic/temperate climate of Norway to a subtropical climate in Gran Canary for 4 weeks improved skin symptoms and quality of life [3,[83][84][85][86][87][88]. The climate in a given geographic location is determined by a combination of multiple factors, including temperature, humidity, and precipitation, as well as related factors, such as ultraviolet (UV) exposure.…”

Association between childhood eczema and headaches: An analysis of 19 US population-based studies

“…However, the distribution of this variable was bimodal and highly skewed, and therefore it was dichotomized into 0 to 3 versus 4 to 7 nights of sufficient sleep, which was similar to a previous study. 5 Separate bivariate and multivariate logistic regression models were constructed that included each of the abovementioned sleep-related variables, history of eczema, and a statistical interaction term between them. Estimates of effect size for significant interactions between eczema and a sleep-related variable were conducted for each level of the covariate by using contrast statements.…”