Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood
Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood
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DOI：
10.1001/jamapediatrics.2017.0556
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发表时间：
2017-07-01
期刊：
影响因子：
26.1
通讯作者：
Lauener, Roger Pascal
中科院分区：
文献类型：
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作者：
Roduit, Caroline;Frei, Remo;Lauener, Roger Pascal
重要性特应性皮炎是一种炎症性、瘙痒性皮肤病，常发生在婴幼儿早期，并有慢性病程。然而，对特应性皮炎亚型的具体描述取决于疾病在儿童时期的发病和进展时间，缺乏具体的描述。目的根据6岁之前的症状来确定特应性皮炎的不同表型，并确定某些亚型是否更有可能发展为其他过敏性疾病。设计、背景和参与者农村环境中的过敏防护研究(牧场)是一个欧洲出生队列，孕妇在2002年8月至2005年3月期间被招募，并根据她们是否生活在农场被分为两组。研究对象为出生至6岁儿童特应性皮炎。研究对象为特应性皮炎。特应性皮炎定义为出生至6岁期间典型部位的瘙痒皮疹。采用潜在分类分析，根据病程确定儿童特应性皮炎的亚型。采用多因素Logistic回归分析特应性皮炎表型与其他过敏性疾病的关系。结果共纳入1038名儿童，其中506名为女孩。最适合牧场资料的潜在分类分析模型将儿童特应性皮炎分为4种表型：2个在2岁之前发病的早期表型(早期暂时性(96；9.2%)和早期持续性(67；6.5%))，2岁或2岁以上起病的晚期表型(n=50；4.8%)，以及从未/罕见表型(n=825；79.5%)，定义为无特应性皮炎。父母都有过敏史的儿童患特应性皮炎的风险是父母没有过敏史的儿童的5倍。这两种早期表型都与食物过敏密切相关。在早期-持续性表型中，发生哮喘的风险显著增加(调整后的优势比，2.87；95%可信区间，1.31-6.31)。晚期表型仅与变应性鼻炎呈正相关。结论通过潜伏期分类分析，根据疾病的发病和病程，特应性皮炎可识别出4种表型。在早期表型(2岁内)的儿童中，哮喘和食物过敏的患病率在6岁时显著增加，特别是持续症状。这些发现对于制定变态反应预防策略很重要。
IMPORTANCE Atopic dermatitis is an inflammatory, pruritic skin disease that often occurs in early infancy with a chronic course. However, a specific description of subtypes of atopic dermatitis depending on the timing of onset and progression of the disease in childhood is lacking.OBJECTIVE To identify different phenotypes of atopic dermatitis using a definition based on symptoms before age 6 years and to determine whether some subtypes are more at risk for developing other allergic diseases.DESIGN, SETTING, AND PARTICIPANTS The Protection Against Allergy Study in Rural Environments (PASTURE) is a European birth cohort where pregnant women were recruited between August 2002 and March 2005 and divided in 2 groups dependent on whether they lived on a farm. Children from this cohort with data on atopic dermatitis from birth to 6 years of age were included.EXPOSURES Atopic dermatitis, defined as an itchy rash on typical locations from birth to 6 years.MAIN OUTCOMES AND MEASURES The latent class analysis was used to identify subtypes of atopic dermatitis in childhood based on the course of symptoms. Multivariable logistic regressions were used to analyze the association between atopic dermatitis phenotypes and other allergic diseases.RESULTS We included 1038 children; of these, 506 were girls. The latent class analysis model with the best fit to PASTURE data separated 4 phenotypes of atopic dermatitis in childhood: 2 early phenotypes with onset before age 2 years (early transient [n = 96; 9.2%] and early persistent [n = 67; 6.5%]), the late phenotype with onset at age 2 years or older (n = 50; 4.8%), and the never/ infrequent phenotype (n = 825; 79.5%), defined as children with no atopic dermatitis. Children with both parents with history of allergies were 5 times more at risk to develop atopic dermatitis with an early-persistent phenotype compared with children with parents with no history of allergies. Both early phenotypes were strongly associated with food allergy. The risk of developing asthma was significantly increased among the early-persistent phenotype (adjusted odds ratio, 2.87; 95% CI, 1.31-6.31). The late phenotype was only positively associated with allergic rhinitis.CONCLUSIONS AND RELEVANCE Using latent class analysis, 4 phenotypes of atopic dermatitis were identified depending on the onset and course of the disease. The prevalence of asthma and food allergy by 6 years of age was strongly increased among children with early phenotypes (within age 2 years), especially with persistent symptoms. These findings are important for the development of strategies in allergy prevention.