Impact of Food Allergy on the Atopic March Progression from Atopic Dermatitis in Early Childhood to Other Atopic Disorders at School Age.

Abstract

Background: The relationship between food allergy (FA) in children with atopic dermatitis (AD) aged birth to 36 months and the prevalence of other atopic disorders at ages 5-11 years needs further study.

Objective: To analyze the progression of AD with and without FA from infancy/toddlers to other atopic disorders from ages 5-11 years.

Methods: Using electronic health records, 10,688 children with AD onset (2 separate ICD-9/10 coded AD visits and 2 separate AD dispensed medications) from birth to 36 months were identified. Atopic disorders were determined based on ICD-9/10 coded visits. Moderate-severe asthma was defined as GINA-step care level of ≥3 for ≥4 years from ages 5-11 years. Unadjusted and adjusted risk ratios for moderate-severe asthma, allergic rhinitis (AR) plus aeroallergen sensitization, and anaphylaxis in children at aged 5-11 years with FA (FA+) and without FA (FA-) by age 36 months were determined by using Robust Poisson Regression.

Results: Compared to FA- (N=8,415), FA+ (N=2,273) children were significantly more likely (P<.001) to be male, of Asian/Pacific Islander ethnicity, have an earlier onset of AD, have more physician visits and dispensed medications for AD, and have higher incidence of asthma visits by age 36 months. Multivariate analysis revealed increased adjusted risk ratios (aRR, 99% CI) (P<.001) for the prevalences of moderate-severe asthma (aRR:1.42, 1.14-1.76), AR (aRR:1.34, 1.19-1.51), and anaphylaxis (aRR: 1.69, 1.33-2.15).

Conclusions: Early-onset FA in infants/toddlers with AD enhances the atopic march by increasing the risk from ages 5-11 years for future moderate-severe asthma, AR, and anaphylaxis.