Atopic Dermatitis in Early Life: Evidence for at Least Three Phenotypes? Results from the GUSTO Study.
BACKGROUND
Atopic dermatitis (AD) has been highlighted as a likely first step in the 'atopic march', emphasizing the need to define predisposing factors.


METHODS
We evaluated AD risk factors and phenotypes in an Asian mother-offspring cohort . We defined three phenotypes of doctor-diagnosed AD based on the time of onset of the disease: early AD occurring within the first 6 months of life, AD occurring between 6 and 12 months and late-onset AD starting after the age of 12 months.


RESULTS
Maternal allergic history was associated with an increased risk of developing early-onset AD (adjusted odds ratio (aOR) 20.46, 95% confidence interval (CI) 2.73-153.15, p < 0.01). Maternal allergic history and attendance at a daycare centre increased the odds of the development of AD between 6 and 12 months (aOR 4.19, 95% CI 1.01-17.45, p = 0.049 and aOR 11.42, 95% CI 1.49-87.50, p = 0.02, respectively). Risk factors associated with increased odds of late-onset AD from 12 months were the consumption of probiotics between the age of 9 and 12 months and antibiotic treatment in the first 6 months of life (aOR 4.32, 95% CI 1.07-17.45, p = 0.04 and aOR 3.11, 95% CI 1.10-8.76, p = 0.03, respectively). Early-onset AD was associated with an increased risk of developing allergic sensitization (aOR 46.51, 95% CI 3.44-628.81, p < 0.01).


CONCLUSIONS
We found that early-onset AD was mainly associated with familial factors, while late-onset AD was associated with the consumption of antibiotics or probiotics. The findings support the concept that different phenotypes of AD exist in young children.
Department of Paediatrics, National University of Singapore, Singapore, Singapore.
Evelyn Xiu Ling
EX
Loo
Lynette Pei-Chi
LP
Shek
Anne
A
Goh
Oon Hoe
OH
Teoh
Yiong Huak
YH
Chan
Shu E
SE
Soh
Seang Mei
SM
Saw
Kenneth
K
Kwek
Peter D
PD
Gluckman
Keith M
KM
Godfrey
Yap Seng
YS
Chong
Bee Wah
BW
Lee
Hugo P
HP
Van Bever
D017668:Age of Onset; D044466:Asian People; D015331:Cohort Studies; D003876:Dermatitis, Atopic / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010375:Pedigree; D010641:Phenotype; D012307:Risk Factors; D011795:Surveys and Questionnaires