Introduction of the Reliable Estimation of Atopic Dermatitis in ChildHood: Novel, Diagnostic Criteria for Childhood Atopic Dermatitis

Abstract

PurposeQuestionnaire-based diagnostic criteria for atopic dermatitis (AD) have been proposed to detect the major group of AD with flexural dermatitis. We aimed to develop novel, questionnaire-based diagnostic criteria for childhood AD, which can detect more comprehensive AD including non-flexural type.MethodsThe draft version of questionnaire to detect childhood AD was prepared to be used for preliminary hospital- (n=1,756) and community-based (n=1,320) surveys. From analysis, the Reliable Estimation of Atopic dermatitis of ChildHood (REACH) was derived and verified in derivation (n=1,129) and validation (n=1,191) sets by community-based surveys.ResultsThe REACH consists of 11 questions including 2 major and 9 minor criteria. AD is diagnosed as the major group of 'eczema on the antecubital or popliteal fossa' to fulfill the 2 major criteria (2M), and the minor group of 'eczema on the non-antecubital or popliteal fossa' to fulfill the 1 major plus 4 or more minor criteria (1M+4m). In the validation set, the overall 1-year AD prevalence by the REACH was estimated as 12.3% (95% CI, 10.5%-14.2%), and the REACH showed a sensitivity of 75.2%, a specificity of 96.1%, and an error rate of 6.4%. The REACH demonstrated better diagnostic performance than the ISAAC in terms of the number of misclassification (10.0%).ConclusionsWe propose the REACH as new full, questionnaire-based diagnostic criteria for childhood AD in epidemiological surveys. Further studies are warranted to validate the REACH in different populations or countries in the context of large-scale, epidemiological surveys.

Burden of atopic dermatitis in Asia

“…18,20 The results of the recently published Korea National Health and Nutrition Examination Survey (KHANES), which was a cross-sectional survey of data from 2008 to 2011 of 8947 children (≤18 years), reported a prevalence of AD of 13.5%, ranging from 7.94% (15 years) to 19.8% (5 years) in different age groups. 21 In general, the prevalence was higher in younger children, in those with higher household incomes and for those living in urban areas. However, there is an increasing trend in prevalence of AD in children over time.…”

“…For example, a cross‐sectional survey published in 2011 of 4003 children in South Korea, which used the South Korean‐translated modified version of the ISAAC questionnaire, found a weighted 12‐month prevalence of AD of 17.9% for children aged 6–7 years and 11.2% for children aged 13–14 years; these values were considerably higher than those found in the ISAAC study from 2000 . The results of the recently published Korea National Health and Nutrition Examination Survey (KHANES), which was a cross‐sectional survey of data from 2008 to 2011 of 8947 children (≤18 years), reported a prevalence of AD of 13.5%, ranging from 7.94% (15 years) to 19.8% (5 years) in different age groups . In general, the prevalence was higher in younger children, in those with higher household incomes and for those living in urban areas.…”

“…43 Meanwhile, the Korean Atopic Dermatitis Association Atopic Dermatitis Criteria Group has proposed that novel diagnostic criteriathe Reliable Estimation of Atopic Dermatitis of Childhood (REACH)be adopted as a means to detect major and minor groups of AD for epidemiological surveys. 21 Major groups of AD were those which manifested with eczematous skin lesions on the antecubital or popliteal fossa while minor groups were those who manifested with eczematous skin lesions on other locations except the antecubital or popliteal fossa. 21 Chinese diagnostic criteria specific for adult/adolescent AD have been proposed because adult-onset AD is common within the Chinese population.…”

“…21 Major groups of AD were those which manifested with eczematous skin lesions on the antecubital or popliteal fossa while minor groups were those who manifested with eczematous skin lesions on other locations except the antecubital or popliteal fossa. 21 Chinese diagnostic criteria specific for adult/adolescent AD have been proposed because adult-onset AD is common within the Chinese population. 44 The criteria require a patient to have symmetrical eczema for more than 6 months and one or more of the following: a personal or family history of atopic disease, elevated serum immunoglobulin (Ig)E levels, positive allergen-specific IgE or eosinophilia.…”

“…Second, the 23 minor features characteristic of AD have been removed in the JDA criteria because of variation in frequency . Meanwhile, the Korean Atopic Dermatitis Association Atopic Dermatitis Criteria Group has proposed that novel diagnostic criteria – the Reliable Estimation of Atopic Dermatitis of Childhood (REACH) – be adopted as a means to detect major and minor groups of AD for epidemiological surveys . Major groups of AD were those which manifested with eczematous skin lesions on the antecubital or popliteal fossa while minor groups were those who manifested with eczematous skin lesions on other locations except the antecubital or popliteal fossa …”