pediatrics
December 2017, VOLUME140 /ISSUE Supplement 3

Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood

C Roduit, R Frei, M Depner and the PASTURE study group. JAMA Pediatr. 2017;171(7):655662
  1. Michael Pistiner, MD, MMSc
  1. Boston, MA

PURPOSE OF THE STUDY.

To use a symptom-based definition of atopic dermatitis to identify different phenotypes and to determine if certain subtypes are at higher risk to develop comorbid atopic disease.

STUDY POPULATION.

A total of 1038 European children from The Protection Against Allergy Study in Rural Environments (PASTURE) birth cohort (designed to assess impact of living on a farm) were recruited between August 2002 and March 2005. This study included participants with data on atopic dermatitis up until age 6 years.

METHODS.

Subtypes of atopic dermatitis in children were identified by using latent class analysis. Subtypes were based on the timing of onset and symptom course. The authors used multivariate logistic regression to analyze the association between atopic dermatitis subtypes and other allergic diseases.

RESULTS.

Four subtypes of atopic dermatitis were identified. These phenotypes were identified as early transient (n = 96; 9.2%), early persistent (n = 67; 6.5%), late (n = 50; 4.8%), and never/infrequent (n = 825; 79.5%). The early transient and early persistent phenotypes had onset before 2 years of age, while the late phenotype had onset at or after 2 years of age. Multivariate logistic regression demonstrated a strong association between the early transient (adjusted odds ratio [aOr], 3.69; 95% confidence interval [CI], 1.93–7.035) and early persistent (aOR, 7.08; 95% CI, 3.59–13.975) subtypes with food allergy up to age 6 years, in addition to an association between the early persistent subtype and asthma up to age 6 (aOR, 2.87; 95% CI, 1.31–6.31). The late subtype had a positive association with allergic rhinitis. Parental history of allergy was a risk factor for the early persistent subtype.

CONCLUSIONS.

The authors identified 4 subtypes of atopic dermatitis by using latent class analysis, and demonstrated associations between early phenotypes of atopic dermatitis and other allergic disease, including food allergy and asthma.

REVIEWER COMMENTS.

This is a timely study that reinforces current trends in the literature. Knowing risk association with the early atopic dermatitis phenotypes may help guide future research and clinical care in regard to food allergy and asthma prevention strategies.