Diagnosing atopic dermatitis in infancy using established diagnostic criteria: a cohort study.
Journal
The British journal of dermatology
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
accepted:
26
01
2021
pubmed:
30
1
2021
medline:
4
3
2022
entrez:
29
1
2021
Statut:
ppublish
Résumé
Diagnosing atopic dermatitis (AD) in infants is challenging. 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. 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. 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. 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.
Sections du résumé
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.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
50-58Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.
Références
Silverberg JI. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin 2017; 35:283-9.
Odhiambo JA, Williams HC, Clayton TO et al. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009; 124:1251-8.
Roduit C, Frei R, Depner M et al. Phenotypes of atopic dermatitis depending on the timing of onset and progression in childhood. JAMA Pediatr 2017; 171:655-62.
Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet 1998; 351:1715-21.
Yew YW, Thyssen JP, Silverberg JI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol 2019; 80:390-401.
Illi S, von Mutius E, Lau S et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol 2004; 113:925-31.
Abuabara K, Margolis DJ, Langan SM. The long-term course of atopic dermatitis. Dermatol Clin 2017; 35:291-7.
Siegfried EC, Hebert AA. Diagnosis of atopic dermatitis: mimics, overlaps, and complications. J Clin Med 2015; 4:884-917.
Brenninkmeijer EE, Schram ME, Leeflang MM et al. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol 2008; 158:754-65.
Akan A, Dibek-Misirlioglu E, Civelek E et al. Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria. Allergol Immunopathol (Madr) 2020; 48:175-81.
Williams HC, Burney PG, Pembroke AC, Hay RJ, The UK. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation. Br J Dermatol 1994; 131:406-16.
Fleming S, Bodner C, Devereux G et al. An application of the United Kingdom Working Party diagnostic criteria for atopic dermatitis in Scottish infants. J Invest Dermatol 2001; 117:1526-30.
Vakharia PP, Chopra R, Silverberg JI. Systematic review of diagnostic criteria used in atopic dermatitis randomized controlled trials. Am J Clin Dermatol 2018; 19:15-22.
Lodrup Carlsen KC, Rehbinder EM, Skjerven HO et al. Preventing Atopic Dermatitis and ALLergies in Children-the PreventADALL study. Allergy 2018; 73:2063-70.
Skjerven HO, Rehbinder EM, Vettukattil R et al. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2020; 395:951-61.
Martin PE, Koplin JJ, Eckert JK et al. The prevalence and socio-demographic risk factors of clinical eczema in infancy: a population-based observational study. Clin Exp Allergy 2013; 43:642-51.
Padem N, Glick Robison R. The infant and toddler with wheezing. Allergy Asthma Proc 2019; 40:393-5.
NICE. Asthma: diagnosis, monitoring and chronic asthma management. Available at: https://www.nice.org.uk/guidance/ng80 (last accessed 5 March 2021).
Wan J, Mitra N, Hoffstad OJ et al. Longitudinal atopic dermatitis control and persistence vary with timing of disease onset in children: a cohort study. J Am Acad Dermatol 2019; 81:1292-9.
Bieber T, D'Erme AM, Akdis CA et al. Clinical phenotypes and endophenotypes of atopic dermatitis: where are we, and where should we go? J Allergy Clin Immunol 2017; 139(4S):S58-64.
Burr ML, Dunstan FD, Hand S et al. The natural history of eczema from birth to adult life: a cohort study. Br J Dermatol 2013; 168:1339-42.
Dharma C, Lefebvre DL, Tran MM et al. Diagnosing atopic dermatitis in infancy: questionnaire reports vs criteria-based assessment. Paediatr Perinat Epidemiol 2018; 32:556-67.
Williams HC, Burney PG, Pembroke AC, Hay RJ. Validation of the U.K. diagnostic criteria for atopic dermatitis in a population setting. U.K. Diagnostic Criteria for Atopic Dermatitis Working Party. Br J Dermatol 1996; 135:12-17.
Johnke H, Vach W, Norberg LA et al. A comparison between criteria for diagnosing atopic eczema in infants. Br J Dermatol 2005; 153:352-8.
Leed JE, Chinn LK, Lockman JJ. Reaching to the self: the development of infants' ability to localize targets on the body. Psychol Sci 2019; 30:1063-73.