January 09, 2019

The investigators sought to explore heritable, environmental, and clinical factors linked to persistent atopic dermatitis based on 13 years of follow-up in an at-risk birth cohort.

In a population of children at-risk for asthma, heritability, environmental exposures, asthma and allergic sensitization, and clinical characteristics at diagnosis are among factors associated with persistent AD at age 13. Results of the cohort study were published in JAMA Dermatology.

The investigators sought to explore heritable, environmental, and clinical factors linked to persistent AD based on 13 years of follow-up in an at-risk birth cohort. A total of 411 children born to mothers with asthma were followed until 13 years of age at a clinical research unit in Copenhagen, Denmark, between August 1998 and June 2015. Data were obtained with respect to parental history, environmental factors, and social circumstances via parent interviews. The cohort was followed with biannual visits until patients were 7 years of age; participants were seen again at the clinic at 13 years of age. All data were analyzed from August 2015 through January 2018.

AD was diagnosed with the use of Hanifin and Rajka major and minor criteria. The severity of AD was determined with the use of Scoring Atopic Dermatitis (SCORAD) index, with possible scores between 0 and 83; higher scores are indicative of more severe AD.

Among the participants, 49.4% (203 of 411) were men, and 45.3% (186 of 411) had been diagnosed with AD at <13 years of age. Overall, 24.1% (40 of 166) of the children had persistent AD at 13 years of age, and 76.0% (126 of 166) experienced disease remission. Factors associated with persistent AD up to age 13 included: environmental exposures, asthma and allergic sensitization, heritability, clinical presentation at the time of AD diagnosis, Hanifin and Rajka diagnostic minor criteria, and AD severity based on SCORAD.

A higher AD risk score was associated with a significantly increased risk for persistent AD (odds ratio [OR] 1.8; 95% CI, 1.1-2.9; P =.02), along with paternal asthma (OR 3.7;
95% CI, 1.2-11.5; P =.02); paternal AD (OR 6.2; 95% CI, 1.17-23.2; P =.007); and higher social circumstances (OR 1.6; 95% CI, 1.0-2.5; P =.05).

Certain clinical presentations at the time of diagnosis were also significantly associated with specific minor Hanifin and Rajka criteria, including Dennie-Morgan and anterior neck folds, white dermographism, tendency for skin infection, wool intolerance, itching when sweating, food allergy, and food intolerance (OR 2.6; 95% CI, 1.1-6.2; P =.03), as well as increased severity of AD at diagnosis (OR 1.1; 95% CI, 1.0-1.1; P =.007).

Overall, the results suggest a strong genetic role in the development and persistence of AD, with diagnostic minor criteria of Hanifin and Rajka and SCORAD both serving as good predictors of disease course. These findings can be utilized in clinical practice to assess the likely course of disease among individual patients, the researchers concluded.

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Reference

Thorsteinsdottir S, Stokholm J, Thyssen JP, et al. Genetic, clinical, and environmental factors associated with persistent atopic dermatitis in childhood [published online November 14, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.4061