Childhood eczema and asthma incidence and persistence: A cohort study from childhood to middle age

doi:10.1016/j.jaci.2008.05.018

Journal of Allergy and Clinical Immunology

Volume 122, Issue 2, August 2008, Pages 280-285

https://doi.org/10.1016/j.jaci.2008.05.018 Get rights and content

Background

The association between eczema and asthma is well documented, but the temporal sequence of this association has not been closely examined.

Objectives

To examine the association between childhood eczema and asthma incidence from preadolescence to middle age, and between childhood eczema and asthma persisting to middle age. A further aim was to examine any effect modification by nonallergic childhood exposures on the association between childhood eczema and both childhood asthma and later life incident asthma.

Methods

Data were gathered from the 1968, 1974, and 2004 surveys of the Tasmanian Longitudinal Health Study. Multivariable logistic regression examined the association between childhood eczema and childhood asthma. Cox regression examined the association between childhood eczema and asthma incidence in preadolescence, adolescence, and adult life. Binomial regression examined the association between childhood eczema and childhood asthma persisting to age 44 years.

Results

Childhood eczema was significantly associated with childhood asthma and with incident asthma in preadolescence (hazard ratio [HR], 1.70; 95% CI, 1.05-2.75), adolescence (HR, 2.14; 95% CI, 1.33-3.46), and adult life (HR, 1.63; 95% CI, 1.28-2.09). Although childhood eczema was significantly associated with asthma persisting from childhood to middle age (relative risk, 1.54; 95% CI, 1.17-2.04), this association was no longer evident when adjusted for allergic rhinitis.

Conclusion

Childhood eczema increased the likelihood of childhood asthma, of new-onset asthma in later life and of asthma persisting into middle age.

Section snippets

Study population and data collection

The TAHS began in 1968 when a cohort (n = 8583) of 7-year-old children attending school in Tasmania was surveyed. A questionnaire completed by parents detailed each child's history of asthma, hay fever, eczema, food or medicine allergy, and urticaria. At a medical examination, FEV₁, forced vita capacity, and forced expiratory flow from 25% to 75% of the forced vital capacity were measured with a wedge-bellows spirometer (Vitalograph Ltd, Buckinghamshire, United Kingdom). These measurements were

Prevalence of eczema and other allergic disorders

In the cohort at the age of 7 years (n = 8583), a response to both eczema questions was obtained for 8237 (96.0%). Of these, 520 (6.3%; 95% CI, 5.8% to 6.9%) were reported as having both infantile and flexural eczema (conjoint eczema), 301 (3.7%; 95% CI, 3.3% to 4.1%) had infantile eczema only, and 279 (3.4%; 95% CI, 3.0% to 3.8%) had flexural eczema only.

A response to the infantile eczema question was obtained for 8311 (96.8%). Of these, 821 (9.9%; 95% CI, 9.2% to 10.5 %) were identified as

Discussion

To our knowledge, this is the first study that examines the association between childhood eczema and asthma development and persistence from childhood to middle age. The results suggest that the effect of childhood eczema on asthma risk continues well past childhood, extending what is already known about this subject. Although the majority of children with eczema will not develop childhood asthma,¹⁸ our results suggest that childhood eczema may progress to incident asthma in preadolescence,

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Citation Excerpt :
A systematic review from 2007 suggested that children with AD were 2.14 times more likely to develop asthma than those without AD.22 Many new cohort studies10-13,17-21,23-43 have been conducted since 2007 to clarify the relationship between AD and the subsequent asthma. We aimed to explore the risk for developing asthma in patients with AD based on the aggregate results of these studies.
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We analyzed 39 publications with 458,810 participants. The RR for asthma in AD was 2.16 (95% CI, 1.88-2.48). The risk in persistent AD (RR, 3.36; 95% CI, 2.83-3.99) was higher than in transient AD (RR, 1.52; 95% CI, 1.34-1.73), and the risk in severe AD (RR, 2.40; 95% CI, 1.96-2.94) was higher than in mild AD (RR, 1.82; 95% CI, 1.03-3.23) or moderate AD (RR, 1.51; 95% CI, 1.30-1.75). The risk for asthma in early-onset AD was slightly higher than in late-onset AD and higher in boys than in girls.
The AD and asthma definitions differed across the included studies.
Patients with persistent or severe AD were at a higher risk for developing asthma. These findings further elucidate the atopic march and identify target populations for asthma prevention.
Allergic symptoms in association with naturalness, greenness, and greyness: A cross-sectional study in schoolchildren in the Alps
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Greenness may protect from or contribute to allergy risk by influencing air pollution and human-microbe interactions. However, existing research on the issue is heterogeneous and produced conflicting results. Less in known about the effects of greyness. This study investigated the association between different characteristics of residential and school environment and allergic symptoms in schoolchildren.
The present cross-sectional survey was undertaken in 2004/2005 among 1251 schoolchildren (8–12 years old) in several alpine valleys in Austria and Italy. Children's mothers completed a questionnaire that asked about allergic symptoms (International Study of Asthma and Allergies in Childhood questionnaire), sociodemographic information, lifestyle, perinatal data, and housing conditions. We constructed four aggregate outcome variables: current asthma symptoms, ever asthma symptoms, ever allergic rhinitis (AR) symptoms, and ever eczema symptoms. We employed well-known greenness and greyness exposure indicators (Normalized Difference Vegetation Index, tree canopy cover, agricultural cover, imperviousness cover, and industrial cover), as well as an alternative naturalness index (Distance to Nature, D2N). Adjusted logistic regressions were used to explore associations between each exposure-outcome pair. Air pollution (NO₂), traffic noise and time spent outdoors were tested as potential mediators in causal mediation analysis.
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: The Tasmanian Longitudinal Health Study is supported by grants from the National Health and Medical Research Council of Australia, the Victorian and Tasmanian Asthma Foundations, the Clifford Craig Medical Research Trust, and the Royal Hobart Hospital Research Foundation. J.A.B. is supported by a Research Scholarship from the University of Melbourne. G.B.B., M.C.M., J.L.H., and S.C.D. are supported by the National Health and Medical Research Council of Australia.

: Disclosure of potential conflict of interest: S. C. Dharmage has received research support from the National Health Medical Research Council, the Asthma Foundation, and the Ilhan Allergy Foundation. M. J. Abramson has served as a member of the Australian Lung Foundation. E. H. Walters has received research support from the National Health Medical Research Council, GlaxoSmithKline, and the Royal Hobart Research Foundation. The rest of the authors have declared that they have no conflict of interest.

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Reviews and feature articleChildhood eczema and asthma incidence and persistence: A cohort study from childhood to middle age

Background

Objectives

Methods

Results

Conclusion

Section snippets

Study population and data collection

Prevalence of eczema and other allergic disorders

Discussion

J Am Acad Dermatol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Am Acad Dermatol

J Allergy Clin Immunol

J Allergy Clin Immunol

Aust N Z J Public Health

J Am Acad Dermatol

J Invest Dermatol

Lancet

J Allergy Clin Immunol

The burden of atopic dermatitis: impact on the patient, family, and society

Pediatr Dermatol

Social impact of atopic dermatitis

Med Health R I

Atopic eczema: its impact on the family and financial cost

Arch Dis Child

Asthma and other atopic diseases in Australian children. Australian arm of the International Study of Asthma and Allergy in Childhood

Med J Aust

The burden of atopy and asthma in children

Allergy

Atopic dermatitis in 5-6-year-old Swedish children: cumulative incidence, point prevalence, and severity scoring

Allergy

The burden of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema in children and adolescents in six New Zealand centres: ISAAC Phase One

N Z Med J

Atopic eczema: its social and financial costs

J Paediatr Child Health

Prevalence of symptoms of asthma, allergic rhinitis, conjunctivitis and atopic eczema: ISAAC (International Study of Asthma and Allergies in Childhood) in a population of schoolchildren in Zagreb

Acta Med Croatica

A population-based survey of eczema prevalence in the United States

Dermatitis

Secular change in the occurrence of atopic dermatitis

Acta Derm Venereol Suppl (Stockh)

Reviews and feature article
Childhood eczema and asthma incidence and persistence: A cohort study from childhood to middle age