Early‐life infections in association with the development of atopic dermatitis in infancy and early childhood: a nationwide nested case–control study

Abstract

Background Microbial dysbiosis has been implicated in the development of atopic dermatitis (AD). The risk of development of AD following early‐life infections remains unclear. Objective To investigate the impact of early‐life infections on AD development. Methods This population‐based nested case–control study was conducted using the Taiwan's National Health Insurance Research Database. A total of 5454 AD patients and 16 362 control subjects without AD were identified, for the period 1997 to 2013. Demographic characteristics, comorbidities and maternal factors were compared. Adjusted odds ratio (aOR) was calculated to examine the associations between early‐life infections and subsequent AD by conditional stepwise logistic regression analysis. Results Mean age was 2.6 ± 2.9 years in both groups. Overall infections (41.8% vs. 28.9%) before the diagnosis of AD were more common in AD patients than in control subjects (P < 0.001). Infectious diseases [aOR, 1.40; 95% confidence interval (CI), 1.29–1.51], skin infections (aOR, 1.55; 95% CI, 1.40–1.71) and systemic antibiotic exposure (aOR 1.67, 95% CI 1.55–1.79) before AD diagnosis were independently associated with AD development on multivariate analyses. These results were consistent across observation periods (0–1, 1–2 and >2 years after birth) and sensitivity analyses after redefining the index date as 3 or 6 months before the date of AD diagnosis. Other independent risk factors included asthma, allergic rhinitis, intussusception and neonatal hyperbilirubinemia. No association with subsequent AD was found for maternal age at delivery, Caesarean delivery or prenatal antibiotic exposure. Conclusion Infections in early life are associated with AD development in infancy and early childhood.

Early exposure to infections increases the risk of allergic rhinitis—a systematic review and meta-analysis

“…According to their findings, infections are not associated with AR in offspring, although adjusting it did not notably affect the use of antibiotics, increasing the risk of allergic disease. However, Lin et al's study [ 54 ] found that both the initial infection and antibiotic use are independent risk factors for secondary atopic dermatitis in children. Thus, future research should examine whether infections and AR are related, whether the correlation could be confounded by antibiotic use, and whether antibiotics are related to these conditions.…”

Risk of Venous Thromboembolism Among Adults With Atopic Dermatitis

“…The definition of an AD case required an AD diagnosis confirmed 3 or more times in an outpatient department within 1 year or a discharge diagnosis using International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) code 691.8 and ICD-10-CM code L20. These diagnostic codes have been applied in previous studies using the NHIRD . We excluded patients who received a diagnosis of AD before 2003 to ensure that patients with a new diagnosis of AD were identified.…”

“…These diagnostic codes have been applied in previous studies using the NHIRD. [21][22][23] We excluded patients who received a diagnosis of AD before 2003 to ensure that patients with a new diagnosis of AD were identified. The index date (when the follow-up started) for the patients in the exposed (AD) cohort was defined as the date of the third outpatient diagnosis of AD or the date of the first inpatient diagnosis, whichever came first.…”

Microbiome and Allergy: New Insights and Perspectives

“…It is known that changes in the composition of the microbiome-dysbiosis-are linked to the pathogenesis of certain conditions (cardiovascular, gastrointestinal, metabolic, and neurodegenerative diseases and cancer) and can increase the risk of others, including allergic diseases such as asthma, allergic rhinitis, atopic dermatitis (AD), and food allergy (Figure 1) [9][10][11][12][13][14][15][16][17][18].…”