Risk of Atopic Dermatitis and the Atopic March Paradigm in Children of Mothers With Atopic Illnesses: A Birth Cohort Study From the United Kingdom
Year: 2024
Type: conference-abstract
Abstract: Atopic dermatitis (AD) is a common, pruritic, inflammatory skin disorder that typically presents in early childhood. It is associated with other allergic illnesses (OAI) including asthma, environmental allergies, and food allergies. This study sought to investigate the incidence of AD and the progression of the atopic march including OAI in children.Child parent cohorts of mothers with and without AD in the United Kingdom. All children were registered to their general provider’s practice within 60 days of birth had at least 2 office visits in a clinical database. Mother and child were matched by the same medical provider and lived in the same household.This study used information from the IQVIA Medical Research Data set, which is a large database collecting anonymous longitudinal clinical data from a patient’s chart. It is estimated to include approximately 10% of the United Kingdom population (approximately 20 million patients). Data collection began in 2004 and ended in 2021.Data on 1, 224,243 child-mother pairs was analyzed: 913,693 mothers without AD and 310,550 with AD. The average age of mother at birth was 28.6 years and 75% were white. A total of 15.28% of the mothers had AD, 14.19% had seasonal allergies, 16.88% had asthma, and 0.3% had food allergy. Mothers with AD had a higher prevalence of OAI compared with mothers without AD. With respect to the children, 50.1% were male (N = 600 905) and predominately white (73.7%). The mean follow-up was 10.8 years for the children in this study. There was a higher prevalence of AD in the children of mothers with AD (37.17% versus 23.24% in the children of mothers without AD) and children of mothers with AD also had higher rates of OAI. AD diagnosis occurred earlier in children of mothers with AD (2.98 years versus 3.42 years in the children of mothers without AD), especially if the mother had a history of all 4 atopic illnesses (2.09 years). Children with AD were also more likely to have asthma, seasonal allergies, and food allergies compared with children without AD. In children with AD, 91.0% had a recorded diagnosis of AD first; in children with asthma, 66.0% had a recorded diagnosis of asthma first and 27.8% had a recorded diagnosis of AD first; in children with seasonal allergies, 38.8% had a recorded diagnosis of seasonal allergies first and 36.8% had a recorded diagnosis of AD first. No difference between sex, ethnicity, and risk of AD was seen.In this birth cohort, children born to mothers with AD had almost twice the risk of developing AD earlier in life compared with children born to mothers without AD. These children were also at an increased risk of developing other atopic illnesses, including asthma, seasonal allergies, and food allergies. AD tended to occur earlier in life than asthma and seasonal allergies, as children with AD developed AD first 91% of the time. However, in children with asthma and seasonal allergies, AD appeared first only approximately 30% of the time.The current rationale is that the breakdown of the skin barrier and exposure to environmental and food exposures in patients with AD is the first step in a sequential pathway of allergen sensitization, leading to immunologic dysregulation and development of OAI. One of the advantages of this study is the large number of mother and children cohorts (1.2 million) analyzed, with an almost 11-year mean follow-up data available for the children. It reinforces evidence that children born to mothers with atopy have a higher risk of atopy and generally, but not always, AD is encountered first. Limitations include the use of recorded data, the large proportion of white mothers and children, and that this data may not be generalizable to other locations, races, or ethnicities.
Source: PEDIATRICS
Author: Marcella Aquino
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4404925474