PURPOSE OF THE STUDY.
Atopic dermatitis is known to be a risk factor for asthma. A recent study in an adolescent population suggests that asthma is associated with both the incidence and persistence of atopic dermatitis. This study also raised the question of whether the natural history of atopic dermatitis varies depending on the age of onset. The purpose of this study was to determine whether children with atopic dermatitis and a diagnosis of asthma were more likely to have persistence of skin disease and whether this finding was associated with frequency of wheeze.
A total of 1041 children ages 2 to 18 years of age, who were enrolled in an observational cohort study on pediatric eczema (Pediatric Eczema Elective Registry), had a diagnosis of asthma at enrollment, and completed a questionnaire 3 years after enrollment.
Information was collected via questionnaire on the presence of atopic dermatitis, need for medications for the condition, presence of asthma, and frequency of wheezing. Information was collected biannually. The primary outcome of interest was the self-reported persistence of atopic dermatitis symptoms. The primary covariate of interest was asthma at baseline and frequency of wheezing in the previous 6 months, based on self-report.
Overall, 934 (90%) of the 1041 children who reported asthma at enrollment had asthma at the 3-year follow-up. The frequency of wheezing progressed over time: 76.3% noted ≥1 episode of wheezing in the previous 6 months; this figure increased to 88.7% at 3 years. At enrollment, those with a diagnosis of asthma were 30% less likely to be rash-free compared with those with no history of asthma and wheeze. At enrollment and throughout the study period, there was an association between the frequency of wheezing and the presence of rash as well as the need for skin medications. Increased frequency of wheezing was associated with a decreased chance of resolution of the rash and an increased need for medications.
This study suggests that those children with a diagnosis of asthma and more frequent wheezing will have more persistent atopic dermatitis.
This study provides useful prognostic information for physicians caring for patients with asthma and atopic dermatitis. Parents of children with asthma and atopic dermatitis are likely to have persistent skin disease, especially with more severe asthma. This study does not tell us, however, whether improved control of asthma would have an effect on the persistence of skin disease.
- Copyright © 2013 by the American Academy of Pediatrics