Early-Onset Eczema May Increase Risk for Childhood Asthma

Baby with atopic dermatitis (infantile eczema).
Baby with atopic dermatitis (infantile eczema).
Children diagnosed with eczema before the age of 2 years may be at increased risk for early-onset asthma.

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.

ORLANDO — Early-onset eczema was identified as a risk factor for childhood asthma, according to data presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology/World Allergy Organization (AAAAI/WAO), held March 2-5, in Orlando, Florida.

Although eczema has long been known to be a potential risk factor for asthma development, researchers hypothesized that the age of asthma onset in children with early-onset eczema would be younger compared with children with asthma and no eczema.

A total of 988 patients were identified from the Tucson Children’s Respiratory Study, a nonselected birth cohort that enrolled infants between 1980 and 1984 with follow-up visits taking place at multiple ages through 32 years.

Early-onset eczema was diagnosed by a physician before 2 years of age, using a questionnaire completed by the child’s caregiver:

  • Has this child ever had eczema (allergic skin rash)?
  • Has a doctor told you this child had eczema?
  • At what age did the eczema begin?

Asthma was also diagnosed by a physician based on symptoms during the past year and also assessed by questionnaire at multiple time points from age 6 years to age 32 years.

The prevalence of early eczema was 9.1%: 4.6% beginning by age 6 months and 4.5% beginning between ages 6 and 24 months. More than 80% of patients with eczema were diagnosed with asthma by age 11 years compared with 47.9% of patients without eczema (P <.001). The researchers found no differential risk for asthma if eczema began before or after 6 months of age (P =.4).

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By age 32, children with eczema were twice as likely to develop asthma (hazard ratio [HR], 2.0; 95% CI, 1.5-2.7; P <.001), with a slightly higher risk in male patients (HR, 2.2; 95% CI, 1.5-3.3; P <.001) compared with female patients (HR, 1.7; 95% CI, 1.1-2.7; P =.024). Early-onset eczema in relation to asthma was independent of maternal asthma, sex, race, ethnicity, and atopy at age 6 years (HR, 1.7; 95% CI, 1.2-2.4; P =.002).

“These findings indicate that eczema not only increases an individual’s lifetime risk for asthma, but also increases their risk for developing asthma at a much earlier age,” the researchers concluded.

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Cassell HR, Stern DA, Wright AL, Martinez FD. Early onset eczema and the association with early onset asthma. Presented at: 2018 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress; March 2-5, 2018; Orlando, FL. Poster 413.