title: Asthma and frequency of wheeze: risk factors for the persistence of atopic dermatitis in children.
abstract: BACKGROUND
  Studies have examined the development of asthma in children with atopic dermatitis (AD); however, none have looked at the association of asthma or the frequency of wheeze with respect to persistence or difficulty in achieving AD clinical improvement in children.
  
  
  OBJECTIVE
  To determine whether children with AD who have asthma and increasing frequency of wheezing have more persistent AD.
  
  
  METHODS
  This is a cohort study using the Pediatric Eczema Elective Registry (PEER) database, which includes data obtained at enrollment and 3 years later. The AD outcome was the persistence of skin symptoms. Our covariates of interest were asthma diagnosis and wheezing symptoms, which were measured at enrollment and again at year 3 of the study. Multivariate logistic regression models assessed the magnitude of associations among AD symptoms, asthma diagnosis, and the frequency of wheeze. All models were adjusted for sex, age, and ethnicity.
  
  
  RESULTS
  A total of 2104 children were enrolled in the PEER study and had at least 3 years of follow-up at the time of this study. At enrollment, an asthma diagnosis decreased the likelihood of being rash free in the preceding 6 months by 30% (odds ratio, 0.70; 95% confidence interval, 0.59-0.84). At year 3, having asthma decreased the likelihood by 40% (odds ratio, 0.60; 95% confidence interval, 0.49-0.72). Increasing frequency of wheezing also decreased the likelihood that a child was rash free (P < .001).
  
  
  CONCLUSIONS
  For children with AD, a history of asthma and an increasing frequency of wheezing correlate strongly with more persistent AD.
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA. garrettjp@email.chop.edu
authors.forename: Jackie P-D
authors.initials: JP
authors.lastname: Garrett
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: Ole
authors.initials: O
authors.lastname: Hoffstad
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
mesh_terms: D000367:Age Factors; D001249:Asthma / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003876:Dermatitis, Atopic / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012135:Respiratory Sounds
references.citation: J Allergy Clin Immunol. 2007 Dec;120(6):1464-6
references.pmid: 17910892
references.citation: Immunol Allergy Clin North Am. 2010 Aug;30(3):269-80
references.pmid: 20670812
references.citation: J Allergy Clin Immunol. 2004 May;113(5):925-31
references.pmid: 15131576
references.citation: Allergy. 2003 May;58(5):420-5
references.pmid: 12752329
references.citation: J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):125-38
references.pmid: 9893196
references.citation: Ann Dermatol. 2010 May;22(2):125-37
references.pmid: 20548901
references.citation: J Allergy Clin Immunol. 2010 Sep;126(3):590-5.e1-3
references.pmid: 20816192
references.citation: J Allergy Clin Immunol. 2012 Oct;130(4):912-7
references.pmid: 22951058
references.citation: J Am Acad Dermatol. 2008 Jan;58(1):68-73
references.pmid: 17692428
references.citation: J Allergy Clin Immunol. 2007 Sep;120(3):565-9
references.pmid: 17655920
references.citation: Pediatr Pulmonol. 2011 Jan;46(1):1-17
references.pmid: 20963782
references.citation: N Engl J Med. 2008 Apr 3;358(14):1483-94
references.pmid: 18385500