Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria-based assessment

Antibiotics taken within the first year of life are linked to infant gut microbiome disruption and elevated atopic dermatitis risk

BACKGROUND

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in both pediatric and adult populations. The development of AD has been linked to antibiotic usage, which causes perturbation of the microbiome and has been associated with abnormal immune system function. However, imbalances in the gut microbiome itself associated with antibiotic usage have been inconsistently linked to AD.

OBJECTIVES

This study aimed to elucidate the timing and specific factors mediating the relationship between systemic (oral or intravenous) antibiotic usage and AD.

METHODS

We used statistical modeling and differential analysis to link CHILD Cohort Study participants' history of antibiotic usage and early-life gut microbiome alterations to AD.

RESULTS

Here we report that systemic antibiotics during the first year of life, as compared to later, are associated with AD risk (adjusted odds ratio [aOR] = 1.81; 95% CI: 1.28-2.57; P < .001), with an increased number of antibiotic courses corresponding to a dose response-like increased risk of AD risk (1 course: aOR: 1.67; 95% CI: 1.17-2.38; 2 or more courses: aOR: 2.16; 95% CI: 1.30-3.59). Further, we demonstrate that microbiome alterations associated with both AD and systemic antibiotic usage fully mediate the effect of antibiotic usage on the development of AD (βindirect = 0.072; P < .001). Alterations in the 1-year infant gut microbiome of participants who would later develop AD included increased Tyzzerella nexilis, increased monosaccharide utilization, and parallel decreased Bifidobacterium and Eubacterium spp, and fermentative pathways.

CONCLUSIONS

These findings indicate that early-life antibiotic usage, especially in the first year of life, modulates key gut microbiome components that may be used as markers to predict and possibly prevent the development of AD.

Trajectory and determinants of agreement between parental and physicians' reports of childhood atopic dermatitis

BACKGROUND

Parent self-administered reports are commonly used in studies on childhood atopic dermatitis (AD) but data on its validity are sparse. We aimed to examine the agreement between parent- and physician-reported measures of childhood AD throughout early life and identify the determinants.

METHODS

In this prospective cohort study, we used data of 449 infants and their mothers recruited in the Ulm SPATZ Health Study in Germany. Longitudinal data of parental and children's caring physicians' reports were used to assess the point and cumulative agreement of parent- and physician-reported AD diagnoses, AD onset age, and trend of agreement at child ages between 1 and 6 years overall and by child and parent demographics and health conditions. A Generalized Estimating Equation model was fitted to identify factors associated with the sensitivity of parent reports.

RESULTS

The point agreement between parent- and physician-reported AD was substantial at the age of 1 (kappa = 0.63, 95% CI: 0.51-0.75) but declined with age and became fair after the age of 3 (kappa < 0.40). The cumulative agreement remained moderate at the age of 6 (kappa = 0.51, 95% CI: 0.43-0.60). Parents had a bias towards delayed reporting of the AD onset age. The AD severity was the only strong determinant for the agreement of AD diagnoses and largely explained the variance of the sensitivity of parent reports.

CONCLUSION

The disagreement between parent- and physician-reported AD increases with child age, likely due to the change of AD severity. Using parent-reported data might miss a substantial portion of mild childhood AD cases.

A comparison of case definitions for infant atopic dermatitis in a multicenter prospective cohort study

This study identified two infant AD case definitions that were strongly associated with known AD risk factors. These case definitions can be used to study novel AD risk factors in large cohort studies, potentially providing new insights into the epidemiology of infant AD.

Diagnosing atopic dermatitis in infancy using established diagnostic criteria: a cohort study

BACKGROUND

Diagnosing atopic dermatitis (AD) in infants is challenging.

OBJECTIVES

To determine the incidence and persistence of eczema and AD in infants using the UK Working Party (UKWP) and Hanifin and Rajka (H&R) criteria.

METHODS

A cohort of 1834 infants was examined clinically at 3, 6 and 12 months of age. AD was diagnosed by UKWP (3, 6 and 12 months) and H&R (12 months) criteria. Logistic regression models were used to assess the relationship between AD and eczema.

RESULTS

Eczema was observed in 628 (34·2%) infants (n = 240, n = 359 and n = 329 at 3, 6 and 12 months, respectively), with AD diagnosed in 212 (33·7%) infants with any eczema and in 64/78 (82%) infants with eczema at all three visits. The odds of AD were lower with first presentation of eczema at 6 [odds ratio (OR) 0·33, 95% confidence interval (CI) 0·22-0·48] or 12 months (OR 0·49, 95% CI 0·32-0·74) than at 3 months, and higher in infants with eczema at three (OR 23·1, 95% CI 12·3-43·6) or two (OR 6·5, 95% CI 4·3-9·9) visits vs. one visit only. At 12 months, 156/329 (47·4%) fulfilled the UKWP and/or H&R criteria; 27 (8%) fulfilled the UKWP criteria only and 65 (20%) only the H&R criteria. Of the 129 infants who fulfilled the H&R criteria, 44 (34·1%) did not meet the itch criterion.

CONCLUSIONS

Used in combination and at multiple timepoints, the UKWP and H&R criteria for AD may be useful in clinical research but may have limited value in most other clinical settings.

Early-onset-early-resolving atopic dermatitis does not increase the risk of development of allergic diseases at 3 Years old

BACKGROUND

Epidemiological findings showed the increased risk of allergic rhinitis (AR) and asthma in the children with preceding atopic dermatitis (AD). In this study, we aimed to observe the development of allergic diseases in infantile AD patients.

METHODS

We followed up the prospective observational cohort enrolling two-to four-month-old exclusively breastfed infants. The presence of physician-diagnosed asthma, AR and AD at age 3 was recorded with the laboratory tests for atopic sensitization.

RESULTS

Fifty infantile AD patients and 48 healthy controls were enrolled. The sex, age and parental atopy history were not significantly different between the two groups. At age 3, 21 (42%) patients had persistent AD in the infantile AD group while only 2 (4.2%) patients had newly diagnosed AD in the control group (p < 0.001). The early-onset-early-resolving AD (subsides before age 2) did not increase the risk of AR and asthma development, and the sensitization to allergens. However, the early-onset-persistent AD (persists after age 2) increased the risk of AR development and sensitization to inhalant allergens (adjusted odds ratio 2.83, 7.07, respectively). The parental atopy status was associated with any allergic disease at age 3 (p = 0.020). The maternal atopy history was the significant factor associated with AD, AR and eosinophilia at age 3 (p = 0.004, 0.014, 0.031, respectively).

CONCLUSION

The early-onset-early-resolving AD was not associated with allergic diseases development at age 3. The parental atopy history and early-onset-persistent AD might be the risk factors for development of allergic diseases at age 3.