Genetic, Clinical, and Environmental Factors Associated With Persistent Atopic Dermatitis in Childhood

Abstract

IMPORTANCE Knowledge about factors associated with persistence of atopic dermatitis (AD) during childhood is sparse. OBJECTIVE To explore heritable, environmental, and clinical factors associated with persistent AD based on 13 years' follow-up of an at-risk birth cohort. DESIGN, SETTING, AND PARTICIPANTS In the Copenhagen Prospective Study on Asthma in Childhood 2000 (COPSAC 2000) clinical birth cohort study, 411 children born to mothers with asthma were followed up until the age of 13 years at a clinical research unit in Copenhagen, Denmark, from August 1998 to June 2015. Atopic dermatitis was diagnosed prospectively during close clinical follow-up according to the criteria of Hanifin and Rajka. Data were gathered on parental history, social circumstances, and environmental factors through parent interviews. The cohort was followed up with biannual visits to the clinic until the age of 7 years and were seen again at age 13 years. Data were analyzed from August 2015 to January 2018. MAIN OUTCOMES AND MEASURES Atopic dermatitis was diagnosed using Hanifin and Rajka major and minor criteria, and severity was determined by Scoring Atopic Dermatitis (SCORAD) index, with possible scores from 0 to 83, with higher scores indicating more severe AD. RESULTS Of the 411 children in the cohort, 203 (49.4%) were male and 186 (45.3%) were diagnosed with AD before the age of 13 years; 40 of 166 children (24.1%) had persistent AD at the age of 13 years, and 126 (76.0%) experienced remission. Factors associated with persistent AD to age 13 years included heritability, environmental exposures, asthma and allergic sensitization, clinical presentation at the time of diagnosis, the composition of Hanifin and Rajka diagnostic minor criteria, and AD severity according to SCORAD. A higher AD genetic risk score was associated with an increased the risk for persistent AD (multivariable odds ratio [OR], 1.

Clinical characteristics, symptoms and burden of psoriasis and atopic dermatitis in adults

“…early-and late-onset psoriasis) and a pattern dominated by onset in early infancy and childhood for AD. 19,20 For both conditions, early onset was seen more frequently in those with severe disease. Women reported marginally earlier onset of psoriasis and AD than men.…”

Systematic review about 10 interventions in dermatitis. A document from the Latin American Society of Allergy, Asthma, and Immunology

“…43 Some genetic factors have been associated with persistent dermatitis, but these factors are not easy to use in clinical practice. 44 Some studies suggest that children with atopy from house dust mites or foods before their first year should be considered at risk of AD persistence; 45,46 although it is not clear if atopy is a consequence of greater severity, it could be used as a duration predictor.…”

Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study

“…In fact, all estimates for AD medication as predictor were robust and largely unaffected by parental history of AD. Since more than 40% of AD patients are likely to carry filaggrin gene mutations from their parents, our robust findings might also be independent of filaggrin gene mutations as well. However, we did not collect DNA to address this possibility.…”

“…Because persistence and remission are both common trajectories of AD, the study of predictors may ultimately have a large clinical impact and provide parents and caregivers useful insight. Filaggrin gene mutations, genetic risk scores, AD severity and a personal or parental history of atopic disease are useful parameters in some cases, but insufficient to identify more than a small fraction of patients at risk . The personal history of AD medication is easily obtained, may indicate how difficult it is to control the disease (regardless of the severity presented at clinical visits) and has not previously been examined as a prognostic factor for persistence.…”