Comparison of Prevalence and Risk Factors of Atopic Dermatitis by Physical Examination and Questionnaire Survey in Elementary School Children

Jung Hyun Lee; Eun Hye Kim; Joongbum Cho; Hye Young Kim; Jungmin Suh; Kangmo Ahn; Hae Kwan Cheong; Sang II Lee

doi:10.7581/pard.2011.21.3.186

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Lee, Kim, Cho, Kim, Suh, Ahn, Cheong, and Lee: Comparison of Prevalence and Risk Factors of Atopic Dermatitis by Physical Examination and Questionnaire Survey in Elementary School Children

Abstract

Pediatr Allergy Respir Dis 2011;21(3):186-196.

Published online: 20 January 2011

DOI: https://doi.org/10.7581/pard.2011.21.3.186

Comparison of Prevalence and Risk Factors of Atopic Dermatitis by Physical Examination and Questionnaire Survey in Elementary School Children

Jung Hyun Lee, MD¹, Eun Hye Kim, MS², Joongbum Cho, MD³, Hye Young Kim, MD⁴, Jungmin Suh, MD⁵, Kangmo Ahn, MD^5,^6,, Hae Kwan Cheong, MD², Sang II Lee, MD^5,⁶

¹Department of Pediatrics, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea

²Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea

³Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea

⁴Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea

⁵Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁶Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea

책임저자: 안강모, 서울특별시 강남구 일원동 50번지 성균관대학교 의과대학 삼성서울병원 소아청소년과 Tel: 02)3410-3539 Fax: 02)3410-0043 E-mail: kmaped@skku.edu

Received 25 May 2011 Revised 20 June 2011 Accepted 22 June 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The present study aimed to evaluate the accuracy of determining the prevalence of atopic dermatitis (AD) with a questionnaire by diagnosing AD with both a questionnaire and pediatricians' physical examinations and to determine the possible risk factors for AD.

Methods

A survey was conducted from December 2008 to February 2009 in four elementary schools. The Korean version of the International Study of Asthma and Allergies in Childhood written questionnaire (WQ) was used to identify AD ever and AD during the last 12 months. Current AD was diagnosed by well-trained pediatricians according to the Hanifin and Rajka's diagnostic criteria. A total of 2,729 children who completed the questionnaire and underwent a physical examination by pediatricians were included in this analysis.

Results

According to the WQ, the prevalence of AD in the entire life and in the last 12 months was 18.4% and 12.9%, respectively. The prevalence of clinically diagnosed AD by pediatricians was 8.8%. There was a significant positive relationship between the prevalence of AD diagnosed by physical examination and past history of allergic rhinitis (adjusted odds ratio [aOR], 1.45), allergy history of the mother (aOR, 2.48), and AD history of the mother (aOR, 1.61). According to the WQ, there was also a significant positive relationship between the prevalence of AD in the last 12 months and past history of asthma (aOR, 2.55) and AD history of the mother (aOR, 1.71).

Conclusion

Prevalence and risk factors of AD were different according to the survey methods. When prevalence of AD is determined with a questionnaire in the future, more careful attention should be used, because the result can be overestimated compared to the actual prevalence.

Keywords: Atopic dermatitis, Prevalence, Children, Risk factors, ISAAC

References

1. Sturgill S, Bernard LA. Atopic dermatitis update. Curr Opin Pediatr. 2004; 16:396–401.

2. Barnetson RS, Rogers M. Childhood atopic eczema. BMJ. 2002; 324:1376–9.

3. Sears MR. Epidemiology of childhood asthma. Lancet. 1997; 350:1015–20.

4. Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR. International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008; 121:947–54.e15.

5. Purvis DJ, Thompson JM, Clark PM, Robinson E, Black PN, Wild CJ, et al. Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age. Br J Dermatol. 2005; 152:742–9.

6. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008; 51:343–50.

7. Kim YH, Kim JW, Houh W. A study on incidence and genetic background of atopic dermatitis. Korean J Dermatol. 1979; 17:105–10.

8. Kim SH, Kim SJ, Park HS, Lee CH, Yoon HS. A survey of the distribution of allergic diseases in low grade children on primary school. J Korean Pediatr Soc. 1988; 31:1290–300.

9. Ahn YM, Choi EY. The result of skin prick tests with 9 common aeroallergen in Korea and RAST reactivity to D. farinae in a community school children. Allergy. 1990; 10:213–25.

10. Shin TS, Lee GJ, Yoon HS. A survey of the distribution of allergic diseases in primary schoolchildren. Allergy. 1990; 10:201–12.

11. Kim JW, Lee WC, Lee SC, Byun DG. The prevalence and clinical features of atopic dermatitis in kindergarten children in Puchon city, Kyonggi-Do. Allergy. 1995; 15:639–49.

12. Lee SC, Byun DG, Lee WC, Kim JW. The prevalence and some minor clinical features of atopic dermatitis. Korean J Dermatol. 1995; 33:1–7.

13. Kim CW, Park CJ, Kim JW, Koo DW, Kim KW, Kim TY. Prevalence of atopic dermatitis in Korea. Acta Derm Venereol. 2000; 80:353–6.

14. Lee SI, Shin MH, Lee HB, Lee JS, Son BK, Koh YY, et al. Prevalences of symptoms of asthma and other allergic diseases in Korean children: a nationwide questionnaire survey. J Korean Med Sci. 2001; 16:155–64.

15. Oh JW, Kim KE, Pyun BY, Lee HR, Choung JT, Hong SJ, et al. Nationwide study for epidemiological change of atopic dermatitis in school aged children between 1995 and 2000 and kindergarten aged children in 2003 in Korea. Pediatr Allergy Respir Dis(Korea). 2003; 13:227–37.

16. Jee HM, Kim KW, Kim CS, Sohn MH, Shin DC, Kim KE. Prevalence of asthma, rhinitis and eczema in Korean children using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Pediatr Allergy Respir Dis(Korea). 2009; 19:165–72.

17. Lee HY, Lee JR, Roh JY. Epidemiological features of preschool childhood atopic dermatitis in Incheon. Korean J Dermatol. 2009; 47:164–71.

18. Popescu CM, Popescu R, Williams H, Forsea D. Community validation of the United Kingdom diagnostic criteria for atopic dermatitis in Romanian schoolchildren. Br J Dermatol. 1998; 138:436–42.

19. Kalyoncu AF, Selçuk ZT, Enünlü T, Demir AU, Cöplü L, Sahin AA, et al. Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart. Pediatr Allergy Immunol. 1999; 10:261–5.

20. Marks R, Kilkenny M, Plunkett A, Merlin K. The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis. Br J Dermatol. 1999; 140:468–73.

21. Laughter D, Istvan JA, Tofte SJ, Hanifin JM. The prevalence of atopic dermatitis in Oregon schoolchildren. J Am Acad Dermatol. 2000; 43:649–55.

22. Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE. Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The odense adolescence cohort study on atopic diseases and dermatitis. Br J Dermatol. 2001; 144:523–32.

23. Tay YK, Kong KH, Khoo L, Goh CL, Giam YC. The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children. Br J Dermatol. 2002; 146:101–6.

24. Werner S, Buser K, Kapp A, Werfel T. The incidence of atopic dermatitis in school entrants is associated with individual lifestyle factors but not with local environmental factors in Hannover, Germany. Br J Dermatol. 2002; 147:95–104.

25. Haileamlak A, Lewis SA, Britton J, Venn AJ, Woldemariam D, Hubbard R, et al. Validation of the International Study of Asthma and Allergies in Children (ISAAC) and U.K. criteria for atopic eczema in Ethiopian children. Br J Dermatol. 2005; 152:735–41.

26. Saeki H, Iizuka H, Mori Y, Akasaka T, Takagi H, Kitajima Y, et al. Prevalence of atopic dermatitis in Japanese elementary schoolchildren. Br J Dermatol. 2005; 152:110–4.

27. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980; 92:(. (Suppl):44–7.

28. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993; 186:23–31.

29. Choi SW, Ju YS, Kim DS, Kim JY, Kwon HJ, Kang DH, et al. Reliability and validity of the Korean version of ISAAC questionnaire. Korean J Prev Med. 1998; 31:361–71.

30. Topf M. Three estimates of interrater reliability for nominal data. Nurs Res. 1986; 35:253–5.

31. Vickers CF. The natural history of atopic eczema. Acta Derm Venereol. 1980; 92:113–5.

32. Schultz Larsen F. The epidemiology of atopic dermatitis. Monogr Allergy. 1993; 31:9–28.

33. Moore MM, Rifas-Shiman SL, Rich-Edwards JW, Kleinman KP, Camargo CA Jr, Gold DR, et al. Perinatal predictors of atopic dermatitis occurring in the first six months of life. Pediatrics. 2004; 113(3 Pt 1):468–74.

34. Kim H, Jang EY, Sim JH, Kim JH, Chung Y, park SH, et al. Effects of family history on the occurrence of atopic dermatitis in infants. Pediatr Allergy Respir Dis(Korea). 2009; 19:106–14.

35. Ministry of Environment. Health effect of environmental exposure in children. Gwacheon: Ministry of Environment. 2008.

Fig. 1.

Scheme of subject eligibility for this study. AD, atopic dermatitis.

Table 1.

Age and Gender Profile of the Subjects

	Incheon (n=779)	Gwangju (n=1,142)	Busan (n=450)	Ulsan (n=358)	Total (n=2,729)
Age (yr)
7	155 (19.9)	200 (17.5)	91 (20.2)	52 (14.6)	498 (18.2)
8	183 (23.5)	215 (18.9)	114 (25.3)	71 (19.8)	583 (21.4)
9	149 (19.1)	223 (19.5)	85 (18.9)	61 (17.0)	518 (19.0)
10	155 (19.9)	254 (22.3)	66 (17.1)	88 (24.6)	574 (21.0)
11	137 (17.6)	250 (21.9)	83 (18.5)	86 (24.0)	556 (20.4)
Gender
Male	394 (50.6)	583 (51.1)	225 (50.0)	204 (57.0)	1,406 (51.5)
Female	385 (49.4)	559 (48.9)	225 (50.0)	154 (43.0)	1,323 (48.5)

Values are presented as number (%).

Table 2.

The Prevalence of Atopic Dermatitis by ISAAC Questionnaire and Physical Examination

	No. of Subject	ISAAC questionnaire				Physical examination
	No. of Subject	AD, Ever	Prevalence (95% CI)	AD, last 12 mo	Prevalence (95% CI)	AD	Prevalence (95% CI)
Age (yr)
7	498	93	18.7 (15.1–22.2)	58	11.6 (9.0–14.9)	35	7.0 (4.9–9.6)
8	583	116	19.9 (16.6–23.2)	85	14.5 (11.7–17.4)	63	10.8 (8.2–13.3)
9	518	91	17.6 (14.3–20.9)	72	13.9 (10.9–16.8)	48	9.2 (6.7–11.7)
10	574	113	19.7 (16.4–23.0)	78	13.5 (10.7–16.4)	56	9.7 (7.3–12.1)
11	556	93	16.7 (13.6–19.8)	59	10.6 (8.0–14.1)	40	7.1 (5.0–9.3)
Gender
Male	1,406	215	15.3 (13.4–17.2)	143	10.1 (8.5–1.7)	112	7.9 (6.5–9.3)
Female	1,323	288	21.8 (10.6–24.1)	209	15.8 (13.8–17.7)	130	9.8 (8.2–11.4)
Districts
Incheon	779	163	20.9 (18.0–23.8)	114	14.6 (12.1–17.1)	88	11.3 (9.0–13.5)
Gwangju	1,142	202	17.7 (15.5–19.9)	137	12.0 (10.1–13.8)	98	8.5 (6.9–10.2)
Busan	450	76	16.9 (13.4–20.3)	57	12.6 (9.5–15.7)	29	6.4 (4.1–8.7)
Ulsan	358	63	17.5 (13.6–21.6)	44	12.2 (8.8–15.7)	27	7.5 (4.7–10.2)
Total	2,729	505	18.4 (17.0–19.9)	352	12.9 (11.6–15.7)	242	8.8 (7.8–9.9)

ISAAC, International Study of Asthma and Allergies in Childhood; AD, atopic dermatitis; CI, confidence interval.

Table 3.

Relationship between the Diagnosis of Atopic Dermatitis by ISAAC Questionnaire and Physical Examination

	Physical examination		Total
	AD (+)	AD (−)	Total
ISAAC questionnaire (AD ever)
AD (+)	172	332	504
AD (−)	70	2,155	2,225
ISAAC questionnaire (AD last 12 mo)
AD (+)	157	195	352
AD (−)	85	2,292	2,377
Total	242	2,487	2,729

ISAAC, International Study of Asthma and Allergies in Childhood; AD, atopic dermatitis.

Table 4.

Severity of Atopic Dermatitis Determined by Physical Examination

	No. of subject	Mild AD n (%)	Moderate to severe AD n (%)	Mean SCORAD (95% CI)
Age (yr)
7	35	22 (62.9)	13 (37.1)	13.9 (10.8–16.6)
8	63	34 (54.0)	29 (46.0)	15.2 (13.4–17.0)
9	48	20 (41.7)	28 (58.3)	16.4 (14.1–18.6)
10	56	29 (51.7)	27 (48.2)	15.6 (13.4–17.9)
11	40	17 (42.5)	23 (57.5)	16.1 (14.1–18.1)
Gender
Male	112	66 (58.9)	46 (41.1)	14.2 (12.9–15.6)
Female	130	56 (43.1)	74 (56.9)	16.6 (15.2–17.9)
Districts
Incheon	88	35 (40.0)	53 (60.0)	17.4 (15.6–19.3)
Gwangju	98	55 (56.1)	43 (43.9)	14.0 (12.9–15.2)
Busan	29	19 (65.5)	10 (34.5)	13.0 (10.9–15.0)
Ulsan	27	13 (48.1)	14 (51.9)	17.1 (13.6–20.7)
Total	242	122 (50.4)	120 (49.6)	15.5 (14.5–16.4)

AD, atopic dermatitis; SCORAD, SCORing of atopic dermatitis, CI, confidence interval.

Table 5.

Association of Risk Factors with Atopic Dermatitis Diagnosed by Questionnaire and Physical Examination

	ISAAC questionnaire (n=352)		Physical examination (n=242)
	n (%)	aOR (95% CI)	n (%)	aOR (95% CI)
Living with a dog or cat	13 (3.7)	1.22 (0.58–2.61)	10 (4.1)	0.79 (0.38–1.68)
Passive smoking	61 (17.3)	1.23 (0.79–1.91)	46 (19.0)	1.24 (0.85–1.80)
Diagnosis of asthma	37 (10.5)	2.55^∗ (1.24–5.27)	28 (11.5)	1.90 (0.98–3.69)
Diagnosis of allergic rhinitis	114 (32.4)	1.36 (0.89–2.08)	79 (32.6)	1.45^∗ (1.01–2.07)
Paternal allergy	42 (11.9)	1.32 (0.62–2.82)	25 (10.3)	0.83 (0.42–1.63)
Paternal atopic dermatitis	25 (7.1)	1.17 (0.65–2.10)	23 (9.5)	1.33 (0.81–2.20)
Maternal allergy	54 (15.3)	1.34 (0.62–2.91)	37 (15.3)	2.48^∗ (1.30–4.73)
Maternal atopic dermatitis	33 (9.3)	1.71^∗ (1.00–2.91)	30 (12.4)	1.61^∗ (1.00–2.59)

aOR, adjusted odds ratio; CI, confidence interval.

Multiple logistic regression analysis was used to assess the relationship between atopic dermatitis and all the parameters. OR was adjusted by age, sex, body mass index, districts and observers and its 95% CI of risk factors.

^∗ P<0.05

Table 6.

Risk Factors Associated with Severity of Atopic Dermatitis

	Normal: mild AD		Normal: moderate to severe AD
	n (%)	aOR (95% CI)	n (%)	aOR (95% CI)
Living with a dog or cat	6 (5.0)	0.69 (0.25–1.93)	4 (3.2)	0.64 (0.23–1.79)
Passive smoking	21 (17.5)	1.13 (0.69–1.85)	25 (20.5)	1.13 (0.69–1.87)
Diagnosis of asthma	12 (10.0)	1.90 (0.83–4.37)	16 (13.1)	2.36^∗ (1.07–5.20)
Diagnosis of allergic rhinitis	34 (28.3)	1.37 (0.88–2.13)	35 (28.7)	1.41 (0.89–2.23)
Paternal allergy	14 (11.7)	0.61 (0.24–1.58)	11 (9.0)	1.20 (0.49–2.95)
Paternal atopic dermatitis	8 (6.7)	1.21 (0.63–2.31)	15 (12.3)	1.54 (0.80–2.98)
Maternal allergy	16 (13.3)	2.01 (0.84–4.80)	21 (17.2)	2.58^∗ (1.06–6.25)
Maternal atopic dermatitis	16 (13.3)	1.95^∗ (1.09–3.47)	14 (11.5)	1.30 (0.66–2.56)

AD, atopic dermatitis; aOR, adjusted odds ratio; CI, confidence interval.

Polychotomous logistic regression analysis was used to assess the relationship between atopic dermatitis severity and all the parameters.

OR was adjusted by age, sex, body mass index, districts and observers and its 95% CI of risk factors.

^∗ P<0.05

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