Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife

Abstract

Background: Atopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial.

Objective: We sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset.

Methods: We conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave.

Results: The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease.

Conclusion: Rates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.

Keywords: Atopic eczema; atopic dermatitis; epidemiology; natural history.

Graphical abstract

Fig 1

Flow chart of ages at which atopic eczema activity was assessed. Percentages represent the proportion of the original sample assessed at each age. Red shading indicates ages used to define childhood-onset atopic eczema, and blue shading indicates ages used to define adult-onset atopic eczema. Data from age 16 years were included with childhood-onset disease in a sensitivity analysis.

Fig 2

Atopic eczema (AE) period prevalence and cumulative lifetime prevalence by age and cohort. *Prevalence from age 0 to 5 years for the 1970 cohort and age 0 to 7 years for the 1958 cohort. Bars represent 95% CIs.

Fig 3

Proportion of subjects with symptom onset in adulthood among those with active atopic eczema (AE) at each survey wave in adulthood. Note: Age periods marked by asterisks are from the 1958 cohort; the remainder are from the 1970 cohort. Childhood-onset disease was defined as first report at age 0 to 11 years, and adult-onset disease was defined as first report after age 22 to 23 years.

Fig E1