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. 2015 Jun 24;10(6):e0131369.
doi: 10.1371/journal.pone.0131369. eCollection 2015.

Early-onset atopic dermatitis in children: which are the phenotypes at risk of asthma? Results from the ORCA cohort

Flore Amat  1 , Philippe Saint-Pierre  2 , Emmanuelle Bourrat  3 , Ariane Nemni  4 , Rémy Couderc  5 , Emmanuelle Boutmy-Deslandes  6 , Fatiha Sahraoui  4 , Isabelle Pansé  3 , Martine Bagot  3 , Sébastien Foueré  3 , Jocelyne Just  1
Affiliations

Early-onset atopic dermatitis in children: which are the phenotypes at risk of asthma? Results from the ORCA cohort

Flore Amat et al. PLoS One. .

Abstract

Background: Atopic dermatitis (AD) is known to predate asthma and other atopic disorders described under the term "atopic march". However, this classic sequence is not always present and only a few studies have addressed children at risk of developing asthma. The objective of this study is to define early-onset AD phenotypes leading to asthma.

Methods: We performed a cluster analysis with 9 variables of 214 infants with early-onset AD prospectively enrolled in the ORCA cohort and followed each year on the occurrence of asthma until the age of 6.

Results: We identified 3 clusters - cluster 1 (n = 94) with low to no sensitization to food (27.7%) or aeroallergens (10.6%) and moderate AD severity (SCORAD 25.29 +/- 14.6) called "AD with low sensitization"; - cluster 2 (n = 84) characterized by a higher AD severity (SCORAD 32.66+/-16.6) and frequent sensitization to food (98.9%) or aeroallergens (26.2%), most likely multiple (96.4% for food allergens), called "AD with multiple sensitizations" - cluster 3 (n = 36) with parental history, moderate AD severity (SCORAD 24.46+/-15.7), moderate rate of sensitization to food allergens (38.9%) (exclusively single) with no sensitization to aeroallergens, called "AD with familial history of asthma". Percentages of children suffering from asthma at the age of 6 were higher in clusters 2 and 3 (36.1% and 33.3% respectively versus 14.9% in cluster 1, p<0.01).

Conclusion: Two phenotypes in infants with early-onset AD convey a higher risk of developing asthma during childhood: multiple sensitization and familial history of asthma.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Dendogram for the entire population (n = 214), obtained with a hierarchical bottom-up clustering.
Three clusters were apparent. This agglomerative approach begins with each subject as a separate cluster and merges them into successively larger clusters. By Ward’s linkage, samples were merged into larger clusters to minimize the within-cluster sum of squares. Cluster 1: “AD with low sensitization”, cluster 2: “AD with multiple sensitizations”, cluster 3: “AD with familial history of asthma”.
Fig 2
Fig 2. Classification tree for the entire cohort based on two variables.
Each subject was assigned to one of the 3 clusters using the tree; 97% of the subjects were assigned to the appropriate cluster. Tree performance values are given in the table. Cluster 1: “AD with low sensitization”, cluster 2: “AD with multiple sensitizations”, cluster 3: “AD with familial history of asthma”.
Fig 3
Fig 3. Importance measure (permutation-based mean decrease accuracy) provided by the random forest analysis.
The values are not interpretable but the ranking is of interest since a high value of the importance measure is associated with a high predictive power. Sensitization is defined by specific IgE to one or more allergens ≥0.35 kUI/L. Multiple sensitizations were defined as at least two positive specific IgEs to allergens. Serum total IgE level expressed in kU/L, blood eosinophilia expressed in eosinophils/mm3
See this image and copyright information in PMC

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