Atopic Dermatitis Risk in Children

Discover the complex links between maternal health and childhood allergies in this groundbreaking study.

Children born to mothers with atopic dermatitis (AD) are more likely to develop AD, with some children developing other allergic illnesses (OAIs) prior to developing AD.

Key Findings:

• Children of mothers with AD were significantly more likely to develop the condition.
• Maternal history of OAI increased the child’s risk of developing AD.
• The majority of children diagnosed with AD developed the condition before OAI like asthma and seasonal allergies.
• Some children may develop asthma or seasonal allergies before AD.
• The sequential development of AD, or atopic march, demonstrates a complex and individualized disease progression.

Introduction: An Association Between Parental Allergic Disease and the Development of Atopic Dermatitis in Offspring Has Not Been Established

AD is a common inflammatory skin condition that begins in childhood. AD is thought to precede the development of OAIs, such as asthma and food allergies, in a temporal manner, a process referred to as atopic march. This indicates common pathophysiology and environmental triggers. It is, however, unclear how allergic conditions in mothers influence the risk of AD and atopic march paradigm in their offspring.

A study published in the Journal of the American Academy of Dermatology assessed the risk of incident AD and the timing and progression of allergic disease onset in children born to mothers diagnosed with AD compared to non-AD mothers.

Methodology: Retrospective Longitudinal Cohort Study

The study collected longitudinal and randomized data from a primary care database in the United Kingdom. A total of 1,224,243 child–mother pairs were included. The median age of the mothers was 28.6 (28.5–28.6) years at the time of the birth of their children. Approximately 15.28% of the mothers were diagnosed with AD.

Compared to mothers without AD, mothers with AD demonstrated a greater prevalence of OAIs, and children of these mothers reported a significantly higher likelihood of AD and OAIs (p < 0.00001). The average age of AD diagnosis was earlier in children of mothers suffering from AD compared to mothers without AD (2.98 (2.95–3.02) years vs. 3.42 (3.40–3.44) years, respectively).

Results:

• Children Born to Mothers With Atopic Dermatitis Were More Likely to Develop Atopic Dermatitis

In the adjusted models, children had a 59% greater likelihood of AD diagnosis if their mothers were also diagnosed with AD. Similarly, children of mothers with OAI including asthma, seasonal allergy, and food allergy also reported a 7%, 30%, and 29% increased risk of AD development compared to children born to mothers without the development of OAI. The risk of AD in children was proportionally related to the number of OAI in the mother.

• The Majority of Children Diagnosed With Atopic Dermatitis Developed the Disease Prior to Other Allergic Illnesses

Among children who were diagnosed with AD, 91.0% exhibited the classic “atopic march” pattern, in which AD precedes OAIs. However, 6.47% of the children had a recorded diagnosis of asthma first and 2.53% of the children were first diagnosed with seasonal allergies prior to AD. Of the children who had a recorded diagnosis of AD first, the age of AD onset was earlier compared to when AD development occurred after asthma and seasonal allergies.

• Some Children Demonstrated the Development of Other Allergic Illnesses Before Atopic Dermatitis

Of the children who were diagnosed with asthma, 66.0% were diagnosed with asthma before they were diagnosed with AD, 27.8% were diagnosed with AD first, and 6.30% were diagnosed with seasonal allergies first. Of the children who were diagnosed with seasonal allergies, 38.8% were diagnosed with seasonal allergies before they were diagnosed with AD, 36.8% were diagnosed with AD first, and 24.35% were diagnosed with asthma first.

Conclusion: Children of Mothers With AD Have an Increased Risk of AD and Other Allergic Illnesses

Children born to mothers diagnosed with AD were more prone to the development of AD and OAI, with a higher risk of disease development at an earlier age compared to children born to mothers without AD. Many children follow the atopic march trajectory, developing AD first before OAIs like asthma or allergies; however, a significant subset develops OAIs prior to AD.

Future studies are needed to investigate the timing of the onset of AD and OAI in relation to one another.

Source:

Fuxench, Z. C. C., Mitra, N., Del Pozo, D., Hoffstad, O., Shin, D. B., & Margolis, D. J. (2023). Risk of atopic dermatitis and the atopic march paradigm in children of mothers with atopic illnesses: A birth cohort study from the United Kingdom. Journal of the American Academy of Dermatology, 90(3), 561–568. https://doi.org/10.1016/j.jaad.2023.11.013

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