Early atopic dermatitis associated with allergic rhinitis

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A recent study from Denmark suggested that the increasing severity of early-onset atopic dermatitis was associated with the development of sensitization to aeroallergens and allergic rhinitis during childhood.

The investigators, led by Hans Bisgaard, MD, DMSc, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, believed their results called for a randomized controlled trial of early oral exposure to aeroallergens to reduce the risk. to develop awareness of aeroallergens and allergic rhinitis in children.

Prior to the study, data indicated that an alteration in the epidermal barrier of the skin of children with atopic dermatitis was involved in the development of allergic sensitization.

As such, Bisgaard and colleagues used data from the at-risk mother-child cohort of the Copenhagen Prospective Childhood Asthma Studies 2000 (COPSAC2000) to determine whether early atopic dermatitis and the severity of the disease. disease were associated with the development of sensitization to aeroallergens and allergic rhinitis. at 6, 7 and 12 years old.

The methods

A total of 368 children were included in the study, all born between August 1998 and December 2001 to mothers with a history of asthma.

Each child was followed from birth to 12 years old, with a total of 19 planned clinic visits.

Atopic dermatitis in participants was diagnosed during acute care visits from birth to age 6 according to Hanifin and Rajka criteria. The severity of atopic dermatitis was assessed using the Atopic Dermatitis Scoring Index (SCORAD) during the same visits.

Blood samples were taken from each child to assess IgE levels at ages 6 and 12, and allergic rhinitis was diagnosed at ages 7 and 12 based on interviews with parents about their children’s history of symptoms.

The results

The investigators assessed allergic rhinitis in 290 (71%) of 411 children at 7 years, in 353 (86%) children at 12 years and in 368 (90%) children at 7 and / or 12 years.

Sensitization to aeroallergens measured by sIgE (≥ 0.35 kUA / L) at 6 years was present in 29/84 (35%) children with early atopic dermatitis versus 45/207 (22%) children without early onset AD.

At 12 years, sensitization to aeroallergens was present in 48/89 (54%) vs 92/215 (43%). The researchers found that the GEE model of early-onset atopic dermatitis showed a significantly increased OR for the development of aeroallergen sensitization at both time points of 1.68. [1.08; 2.62].

Among children with early-onset AD, the highest severity score for AD (SCORAD) measured between 0 and 1 year of age showed associations with the development of sensitization to aeroallergens as measured by sIgE.

Among children with late-onset atopic dermatitis, the highest SCORAD measured between 1 and 6 years of age showed no significant association with the subsequent development of sensitization to aeroallergens.

Bisgaard and colleagues noted that the severity of early-onset atopic dermatitis imposed a higher risk of developing sensitization to sIgE aeroallergens than late-onset severity.

Despite these results, investigators felt that “weaknesses” such as high dropout rates and lack of compliance led to several limitations in the study. As such, further research has been suggested.

“To establish whether early sublingual exposure to aeroallergens can prevent the development of sensitization and allergic rhinitis in children with early-onset severe atopic dermatitis, randomized controlled trials taking all of these factors into account are needed,” wrote the team.

The study, “Increased severity of early but not late atopic dermatitis associated with the development of sensitization to aeroallergens and allergic rhinitis in children”, has been published online in the European Journal of Allergy and Clinical Immunology.


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