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Multicenter Study
. 2014 Jun 10;9(6):e99609.
doi: 10.1371/journal.pone.0099609. eCollection 2014.

Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years

Marie Ekbäck  1 , Michaela Tedner  2 , Irene Devenney  1 , Göran Oldaeus  3 , Gunilla Norrman  4 , Leif Strömberg  5 , Karin Fälth-Magnusson  1
Affiliations
Multicenter Study

Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years

Marie Ekbäck et al. PLoS One. .

Abstract

Background: Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march" has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another.

Objective: In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age.

Methods: On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma.

Results: 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01) and asthma, (B = 10.17, P = 0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00) for asthma development at 10 years.

Conclusion: This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march", at least in more severe allergic disease.

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Conflict of interest statement

Competing Interests: GlaxoSmithKline supported the study with a minor grant in 2004 given as a scholarship to one of the junior researchers in the group. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. There are no competing interests, and the funder has no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No products in development or marketed products from GlaxoSmithKline were part of the study.

Figures

Figure 1
Figure 1. Average SCORAD points on inclusion for children with no airway symptoms, allergic rhinoconjunctivitis or asthma at 10 years.
Figure 2
Figure 2. Percentage of children who had had at least one episode of wheezing before inclusion in the groups who had no airway symptoms, allergic rhinoconjunctivitis and asthma at 10 years.
Figure 3
Figure 3. Percentage of children who had allergic rhinoconjunctivitis at 4.5 years among the groups with no airway symptoms, allergic rhinoconjunctivitis and asthma at 10 years.
Figure 4
Figure 4. Percentage of children who were diagnosed with asthma at 4.5 years in the groups with no airway symptoms, allergic rhinoconjunctivitis and asthma at 10 years.
See this image and copyright information in PMC

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