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. 2019 Jan 26;12(1):100003.
doi: 10.1016/j.waojou.2018.11.003. eCollection 2019.

Under-diagnosis of atopic dermatitis in Puerto Rican children

Ge Yang  1   2   3 , Yueh-Ying Han  1 , Erick Forno  1 , Edna Acosta-Pérez  4 , Angel Colón-Semidey  4   5 , María Alvarez  4   5 , Glorisa Canino  4   5 , Wei Chen  1 , Juan C Celedón  1
Affiliations

Under-diagnosis of atopic dermatitis in Puerto Rican children

Ge Yang et al. World Allergy Organ J. .

Abstract

Background: Little is known about atopic dermatitis (AD) among children in Puerto Rico.

Objective: To examine risk factors and identify approaches to better diagnose AD in Puerto Rican children.

Methods: Case-control study of AD among 540 children aged 6-14 years in San Juan, Puerto Rico. AD was defined as: 1) physician-diagnosed AD, 2) RAST-AD: AD symptoms plus ≥1 positive IgE to allergens, and 3) STR-AD: AD-symptoms and skin test reactivity to ≥1 allergen. Logistic regression was used for the multivariable analysis. We also evaluated the diagnostic performance of various approaches by comparing their sensitivity, specificity, positive predicted value [PPV], negative predictive value [NPV], and area under curve [AUC]).

Results: Of the 70 children with STR-AD, only 5 (7.1%) had PD-AD. In children without asthma, a positive IgE to Dermatophagoides (D.) pteronyssinus and signs of mold/mildew at home were significantly associated with 3.3 and 5 times increased odds of STR-AD, respectively. Among children with asthma, private/employer-based health insurance and a positive IgE to D. pteronyssinus were each significantly associated with approximately twofold increased odds of STR-AD. A combination of current eczema symptoms and a positive IgE to D. pteronyssinus yielded a sensitivity ≥ 70%, specificity and NPV ≥ 95%, PPV ≥ 88%, and an AUC ≥ 0.85 for STR-AD. Replacing a positive IgE to D. pteronyssinus with a positive IgE to ≥1 allergen slightly increased sensitivity without affecting other parameters.

Conclusions: AD is markedly under-diagnosed by physicians in Puerto Rico. This could be improved by assessing eczema symptoms and measuring IgEs to common allergens.

Keywords: AD, Atopic dermatitis; AUC, Area under curve; Atopic dermatitis; BMI, Body mass index; Children; NPV, Negative predictive value; PD-AD, Physician diagnosed atopic dermatitis; PPV, Positive predictive value; Puerto Rico; RAST, Radioallergosorbent test; ROC, Receiver operating curve; STR, Skin test reactivity; STR-AD, Skin test reactivity atopic dermatitis; Under-diagnosis.

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Figures

Fig. 1
Fig. 1
Venn diagram of STR-AD and PD-AD in all children (A), in children with asthma (B) and in children without asthma (C).
See this image and copyright information in PMC

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