What plays a role in the severity of atopic dermatitis in children?

Background/aim: Determining the characteristics and risk factors of severe disease is extremely important to combat atopic dermatitis (AD), which has recently shown increasing prevalence. In this study, we aimed to investigate the clinical characteristics of pediatric patients with AD and identifying the factors associated with the severity of the disease. Materials and methods: A total of 304 pediatric patients diagnosed with atopic dermatitis were included in the study. The patients’ age at admission, age at onset of symptoms, the presence of atopy history in their family, eosinophil levels obtained from blood counts were recorded, together with the data of cigarette exposure, and area of residence. Disease severity was determined according to the SCORAD index. Epidermal prick tests (EPT) were applied to all patients. Results: There was a negative correlation between the SCORAD score and both age at admission (r = 0.277, p < 0.001) and age at onset of the symptoms (r = –0.474, p < 0.001). Food sensitization rates were higher in individuals with moderate-severe disease (90.7% vs. 23.1%; p < 0.001) and patients with food allergy (FA) had significantly higher SCORAD scores [33 (IQR: 22–44) vs. 14 (IQR: 12–16); p < 0.001]. SCORAD scores of the individuals living in rural areas were higher than the ones living in urban [22 (IQR: 15–39.5) vs. 15 (IQR: 12–22); p < 0.001]. Familial atopy history was more common in patients with moderate-severe disease (66.5% vs. 17.5%; p < 0.001). The SCORAD scores were higher in patients exposed to passive smoking [21 (IQR:14.75–38) vs. 13 (IQR: 12–16); p < 0.001]. The eosinophil count found to be positively correlated with SCORAD scores (r = 0.531, p < 0.001). Conclusion: Our findings show that early-onset, food sensitivity, living in rural areas, having familial atopy history and passive cigarette smoke exposure play a role in severe AD. Since it is remarkably correlated with SCORAD scores, eosinophil count can be used as a marker to assess the severity of AD in children.Key words: Atopic dermatitis, children, food allergy, risk factors

PDF

___

1. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American of Academy of Dermatology 2014; 70 (2): 338-351. doi: 10.1016/j.jaad.2013.10.010
2. Silverberg JI, Simpson EL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatric Allergy and Immunology 2013; 24 (5): 476-486. doi: 10.1111/pai.12095
3. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. The Lancet 2006; 368 (9537): 733-743. doi: 10.1016/S0140-6736(06)69283-0
4. Kapur S, Watson W, Carr S. Atopic dermatitis. Allergy Asthma Clinical Immunology 2018; 14 (Suppl 2): 52. doi: 10.1186/ s13223-018-0281-6
5. Hanifin, J. Diagnostic features of atopic eczema. Acta Dermato Venereologica (Stockh) 1980; 60 (92): p. 44-47. doi : 10.2340/00015555924447
6. Vakharia PP, Chopra R, Silverberg JI. Systematic Review of Diagnostic Criteria Used in Atopic Dermatitis Randomized Controlled Trials. American Journal of Clinical Dermatology 2018; 19 (1): 15-22. doi: 10.1007/s40257-017-0299-4
7. Böhme M, Wickman M, Lennart Nordvall S, Svartengren M, Wahlgren C. Family history and risk of atopic dermatitis in children up to 4 years. Clinical & Experimental Allergy 2003; 33 (9): 1226-1231. doi: 10.1046/j.1365-2222.2003.01749.x
8. Ertam I, Su O, Alper S, Sarıcaoglu H, Karadag AS et al. The Turkish guideline for the diagnosis and management of atopic dermatitis-2018. TURKDERM-Turkish Archives of Dermatology and Venereology 2018; 52 (1): p. 6-23. doi: 10.4274/turkderm.87143
9. Kahveci M, Koken G, Şahiner ÜM, Soyer Ö, Şekerel BE. Immunoglobulin E-Mediated Food Allergies Differ in East Mediterranean Children Aged 0-2 Years. International Archives of Allergy Immunology 2020; 181 (5): 365-374. doi: 10.1159/000505996
10. Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G et al. The skin prick test - European standards. Clinical and Translational Allergy 2013; 3 (1): 3. doi: 10.1186/2045-7022-3- 3.
11. Oranje AP. Practical issues on interpretation of scoring atopic dermatitis: SCORAD Index, objective SCORAD, patient-oriented SCORAD and Three-Item Severity score. Current Problems Dermatology 2011; 41: 149-155. doi: 10.1159/000323308
12. Ricci G, Patrizi A, Baldi E, Menna G, Tabanelli M et al. Longterm follow-up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. Journal of the American Academy Dermatology 2006; 55 (5): 765-771. doi: 10.1016/j.jaad.2006.04.064
13. Akan A, Azkur D, Civelek E, Erkoçoğlu M, Yılmaz-Öztorun Z et al. Risk factors of severe atopic dermatitis in childhood: single-center experience. The Turkish Journal of Pediatrics 2014; 56 (2): 121-126.
14. Ozceker D, Bulut M, Ozbay AC, Dilek F, Koser M et al. Assessment of IL-31 levels and disease severity in children with atopic dermatitis. Allergologia Immunopathologia (Madr) 2018; 46 (4): 322-325. doi: 10.1016/j.aller.2017.10.005
15. Su O, Bahalı AG, Demir AD, Ozkaya DB, Uzuner S et al. The relationship between severity of disease and vitamin D levels in children with atopic dermatitis. Postepy Dermatology Allergology 2017; 34 (3): 224-227. doi: 10.5114/pdia.2017.66054
16. Huang E, Ong PY. Severe Atopic Dermatitis in Children. Current Allergy and Asthma Reports 2018; 18 (6): 35. doi: 10.1007/s11882-018-0788-4
17. Larsen, F.S. and J.M. Hanifin, Epidemiology of atopic dermatitis. Immunology and Allergy Clinics of North America 2002; 22 (1): 1-24. doi : 10.1016/S0889-8561(03)00066-3
18. Williams H, Robertson C, Stewart A, Aït-Khaled N, Anabwani G et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. Journal Allergy and Clinical Immunology 1999; 103 (1 Pt 1): 125-138. doi: 10.1016/s0091- 6749(99)70536-1
19. Ballardini N, Kull I, Söderhäll C, Lilja G, Wickman M et al. Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort. British Journal of Dermatology 2013; 168 (3): 588-594. doi: 10.1111/bjd.12196
20. Yang L, Fu J, Zhou Y. Research Progress in Atopic March. Frontiers in Immunology 2020; 11: 1907. doi: 10.3389/ fimmu.2020.01907
21. Illi S, von Mutius E, Lau S, Nickel R, Grüber C et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. Journal of Allergy Clinical Immunology 2004; 113 (5): 925-931. doi: 10.1016/j. jaci.2004.01.778
22. De Benedictis FM, Franceschini F, Hill D, Naspitz C, Simons FE et al. The allergic sensitization in infants with atopic eczema from different countries. Allergy 2009; 64 (2): 295-303. doi: 10.1111/j.1398-9995.2008.01779.x
23. Kijima A, Murota H, Takahashi A, Arase N, Yang L et al. Prevalence and impact of past history of food allergy in atopic dermatitis. Allergology International 2013; 62 (1): 105-112. doi: 10.2332/allergolint.12-OA-0468
24. Flohr C, Pascoe D, Williams HC. Atopic dermatitis and the ‘hygiene hypothesis’: too clean to be true? British Journal of Dermatology 2005; 152 (2): 202-216. doi: 10.1111/j.1365- 2133.2004.06436.x
25. Flohr C, Yeo L. Atopic dermatitis and the hygiene hypothesis revisited. Current Problems Dermatology 2011; 41: 1-34. doi: 10.1159/000323290
26. Schram ME, Tedja AM, Spijker R, Bos JD, Williams HC et al. Is there a rural/urban gradient in the prevalence of eczema? A systematic review. British Journal of Dermatology 2010; 162 (5): 964-973. doi: 10.1111/j.1365-2133.2010.09689.x
27. Apfelbacher CJ, Diepgen TL, Schmitt J. Determinants of eczema: population-based cross-sectional study in Germany. Allergy 2011; 66 (2): 206-213. doi: 10.1111/j.1398-9995.2010.02464.x
28. Wen HJ, Chen PC, Chiang TL, Lin SJ, Chuang YL et al. Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors. British Journal Dermatology 2009; 161 (5): 1166-1172. doi: 10.1111/j.1365-2133.2009.09412.x
29. Lannerö E, Wickman M, Van Hage M, Bergström A, Pershagen G et al. Exposure to environmental tobacco smoke and sensitisation in children. Thorax 2008; 63 (2): 172-176. doi: 10.1136/thx.2007.079053
30. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert review of clinical immunology 2017; 13 (1): 15-26. doi: 10.1080/1744666X.2016.1212660
31. Bieber, T. Atopic dermatitis. The New England Journal of Medicine 2008; 358: 1483-1494. doi: 10.1056/NEJMra074081
32. Özdoğru EE, Gönülal M. Atopic dermatitis, inhalant allergy and food allergy: a paediatric approach. Dermatologic Therapy 2020: e14542. doi: 10.1111/dth.14542