Early Atopic Dermatitis Modifies the Risk for Allergic Respiratory Disease

The presence of atopic dermatitis phenotypes in young children may have a modifying effect on the association between food allergies and the risk of developing allergic respiratory disease (ARD) by age 10, according to study findings presented at the American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting, held from November 10 to 14, 2022, in Louisville, Kentucky.

Investigators hypothesized that having atopic dermatitis by 2 years of age would modify the association between various allergic factors and the risk of developing ARD (including asthma and allergic rhinitis) by 10 years of age. Allergic factors considered included food/aeroallergen sensitization at 2 years of age and food allergy at 3-5 years of age.

The researchers conducted a review and analysis of the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study (WHEALS) birth cohort, which was established to identify environmental factors related to the development of allergy and asthma in infancy and childhood. The researchers analyzed data on reported sensitization to 10 common food and aeroallergens at 2 years of age, physician-assessed food allergy at 3 to 5 years of age, and physician assessments of asthma and allergic rhinitis at 10 years of age and of atopic dermatitis at 2 and 10 years of age. Adjusted Poisson regression with robust error variance was used to calculate risk ratios.

Investigators found the association between food allergy at 3 to 5 years of age and the risk of ever having asthma by 10 years of age was significantly modified by having atopic dermatitis at 2 years of age (P =.027). In the absence of atopic dermatitis, food allergy was linked to an increased risk of ever having asthma (adjusted risk ratio [aRR]=3.36; 95% CI, 1.71-6.58; P <.001), while no difference was observed in the presence of atopic dermatitis (aRR 1.24; 95% CI, 0.57-2.68; P =.99).

The researchers found an association between food sensitization in the absence of atopic dermatitis and the increased risk of ever having asthma (aRR 2.04; 95% CI, 1.03-4.05; P =.038), but found no association between food sensitization in the presence of atopic dermatitis and ever having asthma (aRR 0.89; 95% CI, 0.45-1.78; P =.99) or ever having allergic rhinitis (aRR 1.45; 95% CI, 0.97-2.16; P =.078). Sensitization to at least 1 aeroallergen at 2 years of age was not associated with a significant difference in risk of ARD in either atopic dermatitis subgroup.

“Identifying early atopic phenotypes may help identify later ARD risk,” concluded investigators.