Real-World Onset of Atopic Comorbidities Relative to Atopic Dermatitis in Pediatric Patients.

Abstract

Introduction: Patients with atopic dermatitis (AD) have a high atopic comorbidity burden. Although traditionally seen as beginning with AD and progressing to other atopic comorbidities, the "atopic march" model does not fit all patients. This manuscript describes the onset of atopic comorbidities among children newly diagnosed with AD.

Methods: This retrospective, observational, cohort study used data from the Israeli Maccabi Healthcare Services. Patients (< 18 years) first diagnosed with AD during 2000-2019 with ≥ 12-month enrollment before and after AD diagnosis were included. Outcomes included cumulative asthma, allergic rhinitis (AR), and food allergy (FA) prevalence. Patients were grouped by age at AD diagnosis (< 3, 3-5, 6-11, and 12-17 years).

Results: Of 177,081 included patients, 60.4% were < 3 years old at AD diagnosis. The baseline asthma prevalence (at or before AD diagnosis) was lower in children aged < 3 versus ≥ 3 years at AD diagnosis (10.6% versus 26.3-28.5%). The baseline AR prevalence increased with age from 2.2% (< 3 years) to 23.2% (12-17 years), while FA decreased from 4.9% (< 3 years) to 2.1% (12-17 years). Cumulative asthma and FA prevalence increased sharply in the year following AD diagnosis among children diagnosed at < 3 years old. The cumulative ≥ 1 asthma/AR/FA prevalence increased to approximately 50% by 10 years after AD diagnosis.

Conclusions: Children diagnosed with AD at an early age mostly acquire atopic comorbidities within 1 year following AD diagnosis, while children diagnosed later have often already developed them. Eventually, all pediatric patients with AD display a similar, significant burden of atopic multimorbidity. Graphical abstract available for this article.

Trial registration: Not applicable.