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[6 min read] Childhood atopic dermatitis: genetic, clinical and environmental factors
What are the genetic, clinical and environmental factors associated with persistent atopic dermatitis in childhood?
Little is known about the factors associated with persistence of atopic dermatitis during childhood. A study explored the heritable, environmental and clinical factors associated with persistent disease based on 13 years’ follow-up of an at-risk cohort.
In the Copenhagen Prospective Study on Asthma in Childhood 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-ups. 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 seven years and were seen again at age 13 years. Data were analysed from August 2015 to January 2018.
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 disease.
Of the 411 children in the cohort, (of which 49.4 per cent were male), 186 (45.3 per cent) were diagnosed with atopic dermatitis before the age of 13 years. Forty of 166 children (24.1 per cent) had persistent atopic dermatitis at the age of 13 years. In total, 126 (76 per cent) experienced remission.
Factors associated with persistent atopic dermatitis to age 13 years included heritability, environmental exposures, asthma and allergic sensitisation, clinical presentation at the time of diagnosis, the composition of Hanifin and Rajka diagnostic minor criteria, and disease severity according to SCORAD.
A higher atopic dermatitis genetic risk score was associated with an increased the risk for persistent atopic dermatitis (multivariable odds ratio [OR], 1.8; 95% CI, 1.1-2.9; P = .02), together with paternal asthma (multivariable OR, 3.7; 95% CI, 1.2-11.5; P = .02); paternal atopic dermatitis (multivariable OR, 6.2; 95% CI, 1.17-23.2; P = .007), and higher social circumstances (multivariable OR, 1.6; 95% CI, 1.0-2.5; P = .05).
Particular clinical presentations at time of diagnosis were also associated with specific minor criteria of Hanifin and Rajka (Dennie-Morgan and anterior neck folds, white dermographism, intolerance to wool, itching when sweating, tendency to skin infection, food intolerance, and food allergy) (OR, 2.6; 95% CI, 1.1-6.2; P = .03) as well as increased severity at diagnosis (OR, 1.1; 95% CI, 1.0-1.1; P = .007).
To summarise, known genetic atopic dermatitis risk variants, paternal asthma and atopic dermatitis, high social circumstances, diagnostic minor criteria of Hanifin and Rajka, and disease severity at onset were significantly associated with persistent atopic dermatitis.
The findings of this study suggest that genetic profile is one of the factors most often associated with persistent atopic dermatitis at age 13 years, and that the likelihood of persistence can be evaluated at the onset of atopic dermatitis using existing clinical tools.
These findings may be applied in clinical practice to evaluate the likely disease course for individual patients.
Source: Thorsteinsdottir S, Stokholm J, Thyssen JP, et al. Genetic, Clinical, and Environmental Factors Associated With Persistent Atopic Dermatitis in Childhood. JAMA Dermatol. 2019;155(1):50–57. doi:10.1001/jamadermatol.2018.4061
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