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Abstract
Purpose
Few studies have demonstrated the effects of aeroallergen sensitization on the development of atopic dermatitis (AD) in young children. This study aimed to investigate the sensitization rate of food and aeroallergens in AD patients under 2 years of age and to compare clinical characteristics between IgE- and non-IgE-mediated AD patients.
Methods
Children aged less than 2 years who had visited CHA Bundang Medical Center from 2013 through 2016 were enrolled. Allergen sensitization was measured by specific IgE levels for common allergens. Detailed information was obtained using an atopy questionnaire.
Results
A total of 173 patients were examined, 118 (68.2%) were male patients. The prevalence of aeroallergen sensitization under 1 year of age was 4.8% and increased to 19.5% for children aged 2 years (P=0.005). The mean age (13.6±6.3 months vs. 9.0±5.1 months, P=0.003) and the proportion of children born prematurel (15.4% vs. 2.3%, P=0.013) were higher in the aeroallergen-sensi-tized group than in nonsensitized group. Sensitization to food allergens between children aged less than 1 year and 2 years ap-peared to be similar (61.1% vs. 57.1%, P=0.651). There were no significant differences in clinical characteristics between food allergen IgE-mediated and non-IgE-mediated AD children.
Conclusion
Aeroallergen sensitization increased markedly in AD patients aged 2 years which is about 4 times that of the general population. However, there were no significant differences in clinical manifestations between allergen IgE-mediated and non-IgE-mediated AD children in both food and aeroallergens.
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Fig. 1.
Allergen specific IgE sensitization rates of food and aeroallergens. Aeroallergen specific IgE levels of 31 food allergens and 10 aeroallergens were measured in 173 children. The figure shows the test items of more than 5 times. Positive means specific IgE≥0.35 kIU/L. Der p, Dermatophagoides ptero-nyssinus; Der f, Dermatophagoides farina.
Fig. 2.
Comparison of symptom scores between different age groups. Symptom scores were measured every month after birth using questionnaires answered by parents. Total 173 subject's symptom score were divided to 3 groups (0 to 3 months, 4 to 12 months, and 12 to 24 months) and the average symptom scores of each group were compared. Box=25th and 75th percentiles; bars=min and max values. P-values refer to the comparisons indicated by the marker (Bonfer-roni, ∗ P<0.05).
Fig. 3.
Parent reported causes of atopic dermatitis answered by questionnaires. Total 173 subjects participated and multiple responses were allowed. Remodeling means remodeling of their house. New home means moving to a new house.
Table 1.
Baseline characteristics of study population
Table 2.
Comparison of demographic characteristics by food allergen sensitization
| Characteristic | Fs IgE-P (n=104) | Fs IgE-N (n=69) | P-value |
|---|---|---|---|
| Male sex | 71 (68.3) | 47 (68.1) | 1.000 |
| Age (mo) | 9.5±5.0 | 8.6±5.5 | 0.273 |
| Past history | |||
| Birth weight (kg) | 3.3±0.5 (n=100) | 3.2±0.4 (n=68) | 0.115 |
| Preterm | 4 (3.8) | 3 (4.3) | 1.000 |
| Asthma or wheezing | 12 (11.5) | 10 (14.5) | 0.643 |
| Atopic dermatitis diagnosed by doctor | 48 (47.1) | 28 (40.6) | 0.436 |
| Breast feeding | 57/85 (67.1) | 31/56 (55.4) | 0.160 |
| Family history | |||
| Parental allergic rhinitis | 48 (46.2) | 27 (39.1) | 0.434 |
| Parental atopic dermatitis | 20 (19.2) | 14 (20.3) | 1.000 |
| Parental asthma | 6 (5.8) | 2 (2.9) | 0.479 |
| Parental other allergies | 21 (20.2) | 17 (24.6) | 0.574 |
| Symptom score (SS) | 6.5±2.4 | 6.5±2.5 | 0.995 |
| Onset age (mo), SS ≥3 | 3.6±2.9 | 4.0±3.5 | 0.332 |
| Aggravation factor | |||
| Food | 65/97 (67.0) | 34/61 (55.7) | 0.154 |
| Sweating | 20/97 (20.6) | 15/61 (24.6) | 0.558 |
| Infection | 19/97 (19.6) | 6/61 (9.8) | 0.102 |
| Eosinophil count (/mm3) | 700.4±684.2 | 448.8±346.9 | 0.005∗ |
| Vitamin D (ng/mL) | 20.9±10.6 | 22.7±10.1 | 0.287 |
| Total IgE (kU/L) | 129.9±232.6 | 26.1±87.3 | 0.001∗ |
Table 3.
Comparison of demographic characteristics by aeroallergen sensitization
| Characteristic | As IgE-P (n=13) | As IgE-N (n=132) | P-value |
|---|---|---|---|
| Male sex | 8 (61.5) | 94 (71.2) | 0.466 |
| Age (mo) | 13.6±6.8 | 9.0±5.1 | 0.003∗ |
| Past history | |||
| Birth weight (kg) | 2.9±0.4 | 3.2±0.4 (n=128) | 0.005∗ |
| Preterm | 2 (15.4) | 3 (2.3) | 0.013∗ |
| Asthma or wheezing | 2 (15.4) | 16 (12.1) | 0.734 |
| Atopic dermatitis diagnosed by doctor | 7 (53.8) | 54 (41.2) | 0.380 |
| Breast feeding | 5 (38.5) | 66/105 (62.9) | 0.090 |
| Family history | |||
| Parental allergic rhinitis | 6 (46.2) | 55 (41.7) | 0.755 |
| Parental atopic dermatitis | 2 (15.4) | 27 (20.5) | 0.663 |
| Parental asthma | 1 (7.7) | 4 (3.0) | 0.379 |
| Parental other allergies | 4 (30.8) | 27 (20.5) | 0.387 |
| Symptom score (SS) | 7.1±1.5 | 6.6±2.4 | 0.444 |
| Onset age (mo), SS ≥3 | 3.5±3.6 | 3.8±3.2 | 0.816 |
| Aggravation factor | |||
| Food | 9 (69.2) | 70 (59.8, n=117) | 0.510 |
| Sweating | 2 (15.4) | 27 (23.1, n=117) | 0.527 |
| Infection | 4 (30.8) | 16 (13.7, n=117) | 0.105 |
| Eosinophil count (/mm3) | 706.8±525.6 | 559.0±577.1 | 0.376 |
| Vitamin D (ng/mL) | 22.2±10.1 | 22.3±10.3 (n=129) | 0.969 |
| Total IgE (kUL) | 284.8±327.1 | 50.9±118.9 (n=131) | 0.000∗ |
Table 4.
Comparison of demographic characteristics by vitamin D deficiency
| Characteristic | Vit D-def (n=72) | Vit D-nor (n=95) | P-value |
|---|---|---|---|
| Male sex | 49 (68.1) | 67 (70.5) | 0.731 |
| Age (mo) | 8.3±4.9 | 9.6±5.4 | 0.108 |
| Past history | |||
| Birth weight (kg) | 3.2±0.4 | 3.2±0.4 | 0.450 |
| Preterm | 2 (2.8) | 4 (4.2) | 0.622 |
| Asthma or wheezing | 11 (15.3) | 11 (11.6) | 0.484 |
| Atopic dermatitis diagnosed by doctor | 36 (50.0) | 39 (41.5) | 0.275 |
| Breast feeding | 55/63 (87.3) | 31/73 (42.5) | 0.000∗ |
| Sensitization | |||
| Food | 48/72 (66.7) | 51/95 (53.7) | 0.091 |
| Milk | 29/70 (41.4) | 23/91 (25.3) | 0.030∗ |
| Egg | 43/70 (61.4) | 44/91 (48.4) | 0.099 |
| Aeroallergen | 5/58 (8.6) | 8/84 (9.5) | 0.854 |
| Der p | 4/35 (11.4) | 2/53 (3.8) | 0.210 |
| Der f | 1/23 (4.3) | 2/29 (6.9) | 1.000 |
| Symptom score (SS) | 6.4±2.4 | 6.7±2.4 | 0.301 |
| Onset age (mo), SS ≥3 | 3.5±3.2 | 3.9±3.2 | 0.434 |
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