Characterizing Pollen Season Flares in Children With Atopic Eczema

itch on child
Male doctor examining girl’s arm.
The phenotype characteristics that best describe children flaring during pollen season were investigated.

Potential correlates of pollen season-related flares in children with atopic eczema have been identified in study data published in the Journal of Dermatology. A retrospective cohort study of children with eczema found that younger age, having hay fever, and dark skin type were associated with more severe disease during the pollen season.

Investigators conducted a retrospective cohort study of children who received care at the specialized treatment unit of a dermatology clinic in the Netherlands. Children with difficult-to-treat atopic eczema who received care at this facility from 2011 to 2015 were eligible for inclusion. Difficult-to-treat eczema was defined as eczema that had failed to respond to conventional topical and/or systemic therapies. Demographic and clinical data were extracted from medical records. Parameters of interest included age, sex, Fitzpatrick skin type, and the presence of seasonal allergies, hay fever, and/or asthma. The primary outcome was the presence of eczema flares during pollen season, as reported by the child or caregiver. Sensitization to certain allergens was determined through testing of immunoglobulin E (IgE) levels. Multivariable regression was used to identify correlates of eczema flaring during pollen season.

The study cohort comprised 110 children, of whom 58 were boys and 52 were girls. Mean age was 7.7 ± 5.1 years. The majority of children had dark skin (n=71; 65%), defined as Fitzpatrick type IV, V, or VI. Flaring of eczema during the pollen season was reported by 40 children (36%). Compared with children who did not flare during pollen season, children with flares were more sensitized to 1 or more types of pollen (28% vs 73%; P <.0001). In addition, children with flares were more likely to report hay fever (70% vs 19%; P <.0001) and asthma (48% vs 25%; P =.05) than their counterparts without flares. Children flaring in the pollen season were more likely to have dark skin compared with children who did not flare (78% vs 44%; P =.03), the researchers noted.

In stepwise regression models, the combination of hay fever (odds ratio [OR], 42.07; 95% confidence interval [CI], 5.75-307.55; P <.001), dark skin type (OR, 5.13; 95% CI, 1.35-19.48; P =.02), and age (OR, 0.80; 95% CI, 0.66-0.96; P =.02) was most strongly associated with flares during pollen season. Children with pollen season-related flares more often had asthma (OR, 2.25; 95% CI, 0.57-8.95), although the trend was not significant (P =.25).

These data indicate to the researchers that a substantial percentage of children with difficult-to-treat eczema experience flares during the pollen season. These flares are associated with younger age, dark skin, and a history of hay fever. Sensitization to tree and grass pollen was also more common in children with flares.

As study limitations, investigators noted the small cohort size and the use of self-reported measures rather than a clinical standard.

“[P]atient-reported flares in spring and summer are experienced by one-third of children with difficult-to-treat atopic eczema,” investigators wrote. “This phenotype can be characterized as young children having hay fever and a dark skin type and can be identified based on clinical parameters alone without the need to perform immunoglobulin E blood testing or skin prick tests.”


Bosma AL, Ouwerkerk W, Middelkamp-Hup MA. Children with atopic eczema experiencing increased disease severity in the pollen season more often have hay fever at a young age and a dark skin type. Published online January 6, 2021. J Dermatol. doi: 10.1111/1346-8138.15750