Early-Onset Atopic Dermatitis in Children: Which Are the Phenotypes at Risk of Asthma? Results from the ORCA Cohort

Abstract

BackgroundAtopic dermatitis (AD) is known to predate asthma and other atopic disorders described under the term “atopic march”. However, this classic sequence is not always present and only a few studies have addressed children at risk of developing asthma. The objective of this study is to define early-onset AD phenotypes leading to asthma.MethodsWe performed a cluster analysis with 9 variables of 214 infants with early-onset AD prospectively enrolled in the ORCA cohort and followed each year on the occurrence of asthma until the age of 6.ResultsWe identified 3 clusters - cluster 1 (n = 94) with low to no sensitization to food (27.7%) or aeroallergens (10.6%) and moderate AD severity (SCORAD 25.29 +/- 14.6) called “AD with low sensitization”; - cluster 2 (n = 84) characterized by a higher AD severity (SCORAD 32.66+/-16.6) and frequent sensitization to food (98.9%) or aeroallergens (26.2%), most likely multiple (96.4% for food allergens), called “AD with multiple sensitizations” - cluster 3 (n = 36) with parental history, moderate AD severity (SCORAD 24.46+/-15.7), moderate rate of sensitization to food allergens (38.9%) (exclusively single) with no sensitization to aeroallergens, called “AD with familial history of asthma”. Percentages of children suffering from asthma at the age of 6 were higher in clusters 2 and 3 (36.1% and 33.3% respectively versus 14.9% in cluster 1, p<0.01).ConclusionTwo phenotypes in infants with early-onset AD convey a higher risk of developing asthma during childhood: multiple sensitization and familial history of asthma.

Early polysensitization is associated with allergic multimorbidity in PARIS birth cohort infants

“…Some other teams have assessed allergic profiles based on either sensitization data or both sensitization and clinical data collected throughout childhood, and studied relations between sensitization and allergic morbidity. Simpson et al.…”

New insights into the phenotypes of atopic dermatitis linked with allergies and asthma in children: An overview

“…Although food sensitization is frequent in children with early‐onset AD, FA is not systematic. In the ORCA Study, where all the children had early‐onset (<12 months) moderate‐to‐severe AD, 57.5% of them had food sensitization at baseline, whereas FA was reported in only 11.7% . In this study, FA was not defined by food challenge but by relevant allergic symptoms following consumption of a food allergen, associated with an IgE sensitization to the same allergen, and confirmed by an allergist.…”

“…Familial history is not always considered as a risk factor for the atopic march, although it has been demonstrated to be a risk factor for the transition from early wheezing to asthma . In the ORCA Study, the cluster with the highest rate of parental history of asthma was significantly associated with asthma at the age of 6 years . One hypothesis to explain this result could be a specific genetic susceptibility, involving both inflammation and epithelial barrier pathways.…”

Allergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies

“…Moreover, allergy with polysensitisation to birch pollen [32], cat or dog [31], or peanut (Asarnoj, in preparation) at age four can predict the onset and/or persistence of rhinitis and asthma at 16 years. The MeDALL results have been confirmed in patient cohorts [88, 89]. It is therefore suggested that preschool children with asthma and rhinitis already sensitized may be considered as candidates for AIT.…”