Diagnosis of eczema in preschool children and course of disease during childhood

Abstract

Abstract In childhood atopic dermatitis (AD) is the most frequent inflammatory condition. Validated eczema questionnaires have been available for schoolchildren only, but the incidence of atopic dermatitis is highest during infancy. Evidence is needed on the further development of asthma, and rhinitis in these infants with AD and on remission of AD in children. We aimed to validate a parental questionnaire to identify AD in infants and preschool children, to estimate the association between AD in infancy and the onset of asthma and rhinitis later in life and to analyze factors associated with remission of AD in childhood. Parents of infants and preschool children answered a written questionnaire prior to an examination by a physician. Sensitivity, specificity, predictive values and test-retest reliability of the questionnaire were assessed; a physician’s diagnosis was used as the gold standard. Further, infants and preschool children with and without AD were studied in the year 2000, and followed up 5 years later. The association between infant onset AD and the incidence of asthma and rhinitis later in childhood, as well as the association between remission, background, health, lifestyle, and environmental variables was estimated with crude and multivariable logistic regression. Validation of the questionnaire showed for the infants and preschool children a high sensitivity and specificity. Children with AD had a 3-fold increased odds of developing asthma and rhinitis. About half of the children underwent remission. For the development of asthma and rhinitis, the chances were increased for severe, early-onset, and persistent AD; for remission, the chances were increased for milder AD, later-onset AD, and atypical location of AD. Thus, for both development of asthma and rhinitis and for remission of AD, the most important factors were the aspects of AD. The questionnaire identified AD in infants and preschool children with high accuracy. Once having AD in infancy it is the strongest factor associated with development of asthma and rhinitis during the following 5-year period. For remission, aspects of eczema, and rural living were important for remission, but other modifiable lifestyle and environmental factors we examined were not associated in our sample.

Abstract (Swedish)

Popular Abstract in English

The dissertation is divided into two parts. The first part deals with the development of a questionnaire diagnostic instrument for atopic dermatitis (AD). The second part concerns following a cohort and assessing the natural history of AD, in which the effect of specified risk factors is analysed.

In Värmland, Sweden, a questionnaire that diagnoses AD in infants and preschool children was developed and validated. Physician diagnosis was used as the gold standard, and the questionnaire diagnosis was compared against that. Children with and without AD were recruited consecutively from childcare centres. The first study on preschool children included 60 individuals. The second validation study on infants included a sample of 476 children. The children were examined clinically for the presence of eczema. The examining physicians were blinded to the answers to the questionnaire. Physician diagnosis was adopted as the gold standard, and the questionnaire diagnosis was compared against that. It was shown that the questionnaire was able to diagnose AD with high accuracy both in infants and in preschool children (sensitivity 0.87 and 0.91, respectively; specificity 0.98 and 1.00, respectively).

Further, a cohort of children was followed over a five-year period. An investigation was made as to whether children with AD had greater odds of developing asthma and rhinitis; also, the factors associated with remission of AD were identified. A high proportion of AD children subsequently developed asthma and rhinitis (adjusted odds ratio [aOR] 3.07; 95 % CI 1.79–5.27; aOR, 2.63; 1.85–3.73), though 52% of children also underwent remission of AD. For the development of asthma and rhinitis, the odds were increased for severe, early-onset, and persistent AD; for remission, the odds were increased for milder AD, later-onset AD, and atypical location of AD. Thus, for both development of asthma and rhinitis and for remission of AD, the most important factors were the aspects of AD.

The main supervisor of this work was Åke Svensson, Lund University. The work for this dissertation was conducted in association with my co-supervisors Carl-Gustaf Bornehag, Karlstads University and Mikael Hasselgren, Örebro University. The studies presented here are part of the Dampness in Buildings and Health (DBH) study and the Swedish Environmental Mother and child Asthma and allergy study (SELMA) study.

• author: von Kobyletzki, Laura
• supervisor: Åke Svensson; Carl-Gustaf Bornehag; Mikael Hasselgren
• opponent: Professor Ejner Andersen, Klaus, Dermato-venereologi, Klinisk Institut, Odense Universitetshospital
• organization: Dermatology (research group)
• publishing date: 2013
• type: Thesis
• publication status: published
• subject: Dermatology and Venereal Diseases
• keywords: Child, preschool, dermatitis, atopic/diagnosis, infant, questionnaire, written parental, atopic dermatitis, preschool child, longitudinal study, prognosis, epidemiology, asthma, and rhinititis
• in: Lund University Faculty of Medicine Doctoral Dissertation Series
• volume: 2013:29
• pages: 110 pages
• defense location: Lilla Aulan, Jan Waldenströms gata 5, ingång 59, Skånes Universitetssjukhus i Malmö
• defense date: 2013-03-25 13:00:00
• ISSN: 1652-8220
• ISBN: 978-91-87189-98-2
• language: English
• LU publication?: yes
• additional info: The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Department of Dermatology and Venerology (013241320)
• id: 72043127-dcc3-41c3-b5cd-a5e7f0731bbc (old id 3558958)
• date added to LUP: 2016-04-01 14:36:21
• date last changed: 2019-05-22 00:31:07