Atopic Eczema Prevalence Remains High After Childhood

Young girl with Atopic dermatitis,type of eczema,is an inflammatory, chronically relapsing, non-contagious and pruritic skin disease. It has been given names like “prurigo Besnier,” “neurodermitis,” “endogenous eczema,” “flexural eczema,” “infantile eczema,” and “prurigo diathsique.
Adult-onset atopic eczema is common and has different risk factor associations than childhood-onset eczema.

Self-reported adult-onset atopic eczema is relatively common in the United Kingdom, a study in the Journal of Allergy and Clinical Immunology reports. Female sex, asthma history, adult smoking, being born in Scotland or Northern England, and coming from a lower socioeconomic group during childhood were predictive of adult-onset eczema activity in this study.

The study was a longitudinal cohort analysis of data from the ongoing 1958 and 1970 British Cohort Studies (BCS 1958 and BCS70) comprising a total of 17,196 and 17,415 individuals born in Great Britain during 1 week of the respective study years. Parental or self-reported atopic eczema prevalence comprised the primary outcome of the analysis.

Participants were categorized as those who had a first report of atopic eczema during childhood (positive parental report either during or prior to last year at age 5 to 7 years and/or 10 to 11 years) and individuals with adult-onset atopic eczema (first atopic eczema report at age 23 years or older). The researchers followed patients from birth through age 42 to 50 years.

In the 1958 and 1970 cohorts, the cumulative lifetime prevalence rates of atopic eczema were 18% and 28%, respectively. Approximately 43% and 40% of patients with atopic eczema in the 1957 and 1970 cohorts, respectively, reported disease for the first time during adulthood. The majority of people who reported eczema at each survey wave during adulthood did not report eczema in childhood (62%).

Relative to individuals who reported eczema in childhood, participants with adult-onset eczema activity were more likely to be female (odds ratio [OR], 1.66; 95% CI, 1.44-1.92; P <.001), born in Scotland or Northern England (OR, 1.31; 95% CI, 1.01-1.71; P =.045), from a lower socioeconomic group during childhood (OR, 1.38; 95% CI, 1.01-1.89; P =.044), a smoker as an adult (OR, 1.20; 95% CI, 1.04-1.38), and less likely to have an asthma history (OR, 0.79; 95% CI, 0.68-0.93; P =.004).

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While there was an association between filaggrin null mutations with both childhood-onset and adult-onset atopic eczema, the association was strongest in childhood-onset disease (OR, 2.73; 95% CI, 2.06-3.63) vs adult-onset disease (OR, 1.49, 95% CI, 1.01-2.19). In the multivariable analysis, a high nonfilaggrin genetic risk score (ie, >28 risk alleles) was predictive of childhood-onset atopic eczema (OR, 1.81; 95% CI, 1.37-2.40). Additionally, a high allergen-specific immunoglobulin E (ie, ≥3.5 kU/L) was predictive of childhood-onset atopic eczema (OR, 1.90; 95% CI, 1.32-2.74).

Limitations of the study include the reliance on self-reported survey data, the inclusion of only individuals from Great Britain, and the potential for attrition over the long-term duration of the studies.

“These data are particularly timely because dozens of new treatments are under development and clinical testing for [atopic dermatitis],” the researchers wrote, “and trial populations selected on the basis of early onset disease are unlikely to be representative of the general population of adults.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Abuabara K, Ye M, McCulloch CE, et al. Clinical onset of atopic eczema: Results from two nationally representative British birth cohorts followed through midlife [published online June 28, 2019]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2019.05.040