Published online September 5, 2006
PEDIATRICS Vol. 118 Supplement August 2006, pp. S4-S5 (doi:10.1542/peds.2006-0900G)
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Infantile Eczema at One Month of Age Is Associated With Cord Blood Eosinophilia and Subsequent Development of Atopic Dermatitis and Wheezing Illness Until Two Years of Age

Jennifer M. Maloney, MD and Scott H. Sicherer, MD

New York, NY

ABSTRACT

PURPOSE OF THE STUDY.: To determine if a correlation exists between the prevalence of neonatal skin eruptions at 1 month of age and the later development of atopic dermatitis. In addition, the authors sought to determine if the presence of cord blood eosinophils correlated with the development of later skin disease.

STUDY POPULATION.: One hundred five newborn infants born by normal vaginal delivery in Mitoyo General Hospital (Kagawa, Japan) from May 1987 to March 1989.

METHODS.: The cord blood eosinophil count was measured at the time of delivery. The neonates were examined at 1 (all subjects) and 24 (98 subjects) months of age by a doctor who was unaware of the cord blood eosinophil count. The subjects’ histories of allergic symptoms or physician-diagnosed wheezing bronchitis or asthma during the first 8 years of life were also determined by direct examination or interviews with the guardians (67 subjects). The age of each subject at the onset of the allergic symptoms was determined. Skin eruptions at 1 month of age were classified into 4 categories: (1) infantile eczema; (2) seborrheic dermatitis; (3) intertrigo; or (4) diaper dermatitis. The diagnosis of atopic dermatitis was made according to the criteria by Hanifin and Rajka (Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Arch Dermatol Venereol. 1980;92:44–47), and each rash was defined carefully by appearance.

RESULTS.: At 1 month of age, infantile eczema, seborrheic dermatitis, intertrigo, and diaper dermatitis were diagnosed in a total of 29, 7, 14, and 24 neonates, respectively. No associations (such as family history of allergic disease or mode of feeding) were found for the prevalence of these eruptions. Neonates with infantile eczema had a significantly higher number of eosinophils in the cord blood (P < .0001). In contrast, no such tendency was found for any other skin eruption. In neonates with infantile eczema at 1 month of age, the diagnosis of atopic dermatitis had been made significantly earlier, and the prevalence of wheezing illness was significantly higher compared with infants who did not have infantile eczema.

CONCLUSIONS.: Infantile eczema, but not other skin eruptions, precedes the development of atopic dermatitis and wheezing illness during early infancy. This may be secondary to the activation of eosinophils before birth.

REVIEWER COMMENTS.: Patients with infantile eczema are at increased risk for atopic disease. The measurement of cord blood eosinophils may aid in predicting which infants will develop infantile eczema and, in addition, may have diagnostic utility in predicting which patients are at risk for the development of further allergic disease.

Matsumoto K, Shimanouchi Y, Kawakubo K, et al. Int Arch Allergy Immunol. 2005;137:69–76