Food allergy, dermatologic diseases, and anaphylaxis
The natural course of atopic dermatitis from birth to age 7 years and the association with asthma

https://doi.org/10.1016/j.jaci.2004.01.778Get rights and content

Abstract

Background

Atopic dermatitis (AD) is considered to be one of the first manifestations in the atopic march. However, few prospective studies on AD and its association with childhood asthma exist.

Objective

The aim of this study was to prospectively investigate the natural course of AD to determine factors influencing its prognosis and to analyze the relationship of AD with childhood asthma.

Methods

The Multicenter Allergy Study, a German birth cohort, followed 1314 children from birth to age 7 years. Physical examinations, parental interviews on atopic symptoms and diagnoses, and determination of specific IgE levels were performed regularly.

Results

The cumulative prevalence of AD in the first 2 years of life was 21.5%. Of these children with early AD, 43.2% were in complete remission by age 3 years, 38.3% had an intermittent pattern of disease, and 18.7% had symptoms of AD every year. Severity (adjusted cumulative odds ratio, 5.86; 95% CI, 3.04-11.29) and atopic sensitization (adjusted cumulative odds ratio, 2.76; 95% CI, 1.29-5.91) were major determinants of prognosis. Early wheeze and a specific sensitization pattern were significant predictors for wheezing at school age, irrespective of AD. Early AD without these cofactors constituted no increased risk of subsequent wheeze (adjusted odds ratio, 1.11; 95% CI, 0.56-2.20) or bronchial hyperreactivity.

Conclusion

AD is a common condition in infancy but disappears around age 3 years in a significant proportion of children. The prognosis is mostly determined by the severity and the presence of atopic sensitization. Early AD is associated with asthma at school age, but in many of these asthmatic children, wheezing manifests before or with the onset of AD. Children with AD and wheeze have a marked loss in lung function, suggesting a distinct phenotype rather than a progressive development from AD to asthma.

Section snippets

Study population

The German Multicenter Atopy Study (MAS), a prospective observational birth cohort, recruited 1314 of 7609 infants born in 1990 in 6 German delivery wards in 5 German cities. A detailed description of the stratified sampling scheme and study subjects is given elsewhere.4 Briefly, 499 newborns with risk factors for atopy (increased cord blood IgE [≥0.9 kU/L], at least 2 atopic family members, or both) and 815 newborns with none of these risk factors were included in the cohort. These children

Response rates (see e-text in the Journal's Online Repository at www.mosby.com/jaci)

Of the 1314 children in the MAS birth cohort, 1123 (85.5%) children participated in at least one follow-up in each of the first 2 years of life. Of these 1123 children, 665 (59.2%) participated in blood sampling at age 2 years, and 858 (76.4%) had complete data on the course of AD up to the age of 7 years (ie, participated in every follow-up).

Early manifestation of AD

Of the 1123 MAS children included in the present analyses, 13.4% had AD in the first year of life. By age 2 years, the lifetime prevalence amounted to

Discussion

In a large, observational, population-based birth cohort, we assessed and analyzed the manifestation and natural course of AD. Early AD, defined as onset of disease in the first 2 years of life, was a frequent phenomenon with a prevalence of 21.5%. Almost half (43.2%) of these children, however, were in remission after their second birthday. Major determinants of the prognosis of early AD were severity of disease and early atopic sensitization. Early AD was significantly associated with wheeze

Acknowledgements

We thank all participants of the MAS for their cooperation. Furthermore, we thank the nurses Petra Wagner, Berlin, Gabriele Leskosek, Düsseldorf, Roswitha Mayerl, München, and Brigitte Hampel, Mainz, and the mathematicians Günter Edenharter and Christine Sommerfeld.

References (16)

There are more references available in the full text version of this article.

Cited by (0)

Supplementary data associated with this article can be found at doi:10.1016/j.jaci.2004.01.778.

Collaborators of the Multicenter Allergy Study (MAS) group: Volker Wahn, MD, and Marketa Groeger, MD, Düsseldorf; Fred Zepp, MD, and Imke Bieber, MD, Mainz; Johannes Forster, MD, and Uta Tacke, MD, Freiburg; and Carl-Peter Bauer, MD, Gaisach; Renate Bergmann, Berlin.

View full text