The natural course of atopic dermatitis from birth to age 7 years and the association with asthma
The natural course of atopic dermatitis from birth to age 7 years and the association with asthma
复制标题
DOI：
10.1016/j.jaci.2004.01.778
复制
发表时间：
2004-05-01
影响因子：
14.2
通讯作者：
Wahn, U
中科院分区：
文献类型：
--
作者：
Illi, S;von Mutius, E;Wahn, U
背景：特应性皮炎（AD）被认为是特应性行进中的首要表现之一。然而，关于 AD 及其与儿童哮喘的关系的前瞻性研究很少。 目的：本研究的目的是前瞻性调查 AD 的自然病程，以确定影响其预后的因素，并分析 AD 与儿童哮喘的关系。 方法：德国出生队列多中心过敏研究对 1314 名从出生到 7 岁的儿童进行了随访。定期进行体格检查、家长对特应性症状和诊断的访谈以及特定 IgE 水平的测定。结果：生命前 2 年 AD 的累积患病率为 21.5%。在这些早期 AD 儿童中，43.2% 到 3 岁时完全缓解，38.3% 呈间歇性疾病模式，18.7% 每年都会出现 AD 症状。严重程度（调整后的累积比值比，5.86；95% CI，3.04-11.29）和特应性过敏（调整后的累积比值比，2.76；95% CI，1.29-5.91）是预后的主要决定因素。无论是否患有 AD，早期喘息和特定的敏化模式是学龄期喘息的重要预测因素。没有这些辅助因子的早期 AD 不会增加随后出现喘息（调整后的比值比，1.11；95% CI，0.56-2.20）或支气管高反应性的风险。 结论：AD 是婴儿期的常见病症，但在相当比例的儿童中，AD 会在 3 岁左右消失。预后主要取决于特应性致敏的严重程度和存在。早期 AD 与学龄期哮喘有关，但许多哮喘儿童在 AD 发病前或发病时出现喘息。患有 AD 和喘息的儿童肺功能明显丧失，表明其具有独特的表型，而不是从 AD 逐渐发展为哮喘。
Background: Atopic dermatitis (AD) is considered to be one of the first manifestations in the atopic march. However, few prospective studies on AD and its association with childhood asthma exist.Objective: The aim of this study was to prospectively investigate the natural course of AD to determine factors influencing its prognosis and to analyze the relationship of AD with childhood asthma.Methods: The Multicenter Allergy Study, a German birth cohort, followed 1314 children from birth to age 7 years. Physical examinations, parental interviews on atopic symptoms and diagnoses, and determination of specific IgE levels were performed regularly.Results: The cumulative prevalence of AD in the first 2 years of life was 21.5%. Of these children with early AD, 43.2% were in complete remission by age 3 years, 38.3% had an intermittent pattern of disease, and 18.7% had symptoms of AD every year. Severity (adjusted cumulative odds ratio, 5.86; 95% CI, 3.04-11.29) and atopic sensitization (adjusted cumulative odds ratio, 2.76; 95% CI, 1.29-5.91) were major determinants of prognosis. Early wheeze and a specific sensitization pattern were significant predictors for wheezing at school age, irrespective of AD. Early AD without these cofactors constituted no increased risk of subsequent wheeze (adjusted odds ratio, 1.11; 95% CI, 0.56-2.20) or bronchial hyperreactivity.Conclusion: AD is a common condition in infancy but disappears around age 3 years in a significant proportion of children. The prognosis is mostly determined by the severity and the presence of atopic sensitization. Early AD is associated with asthma at school age, but in many of these asthmatic children, wheezing manifests before or with the onset of AD. Children with AD and wheeze have a marked loss in lung function, suggesting a distinct phenotype rather than a progressive development from AD to asthma.