Asthma predictors in infantile atopic dermatitis

Comorbidity in Atopic Dermatitis

The negative impact of atopic dermatitis (AD) often extends beyond the skin. Children with AD experience increased rates of infectious, mental health, and allergic diseases compared to their non-atopic peers. The mechanisms underlying these associations remain elusive. New insights from genetic and epidermal research pinpoint the skin barrier as a primary initiator of AD. Epicutaneous sensitization represents an intriguing new model which links a disrupted skin barrier to the later development of IgE-mediated diseases in patients with AD. Recent epidemiological studies have identified new comorbidities linked to AD as well, including several mental health disorders and obesity. This manuscript reviews the recent literature regarding both classic and newly described AD comorbidities.

Association between polymorphisms in serine protease inhibitor, kazal type 5 and asthma phenotypes in a large German population sample

BACKGROUND

Atopic diseases are characterized by immunoglobulin E (IgE)-mediated immune responses towards common allergens, many of which are proteases. Recently it has been suggested that a proteinase inhibitor gene, SPINK5, which is located on chromosome 5q31, may play a role in the pathogenesis of atopic diseases.

OBJECTIVE

We investigated the association between the polymorphism G1258A leading to a putative amino acid change (Glu420Lys) in serine protease inhibitor, kazal type 5 (SPINK5) and phenotypes of atopic diseases in a large general population sample of German children.

METHODS

Parental questionnaires were used and children underwent skin prick testing, pulmonary function testing and bronchial challenge. Blood was collected for serum IgE measurements and DNA extraction. In total, 1161 children were genotyped for the SPINK5 Glu420Lys polymorphism and association studies were performed.

RESULTS

A significant association between SPINK5 420Lys and the development of asthma was observed (OR 1.77; 95%CI: 1.02-3.06, P=0.041 for 420Lys homocygotes). Atopic carriers of SPINK5 420Lys showed an increased risk for asthma and asthma symptoms (OR 2.06; 95%CI: 1.01-4.20, P=0.047). When children with a combination of asthma and atopic dermatitis were compared with normal controls, the SPINK5 420Lys genotype was more prevalent in the disease group (OR 4.56; 95%CI: 1.370-15.12, P=0.007). No association between SPINK5 420Lys genotypes and total serum IgE levels, skin prick test (SPT) reactivity or atopic dermatitis was observed.

CONCLUSION

These results suggest that SPINK5 Glu420Lys polymorphism may be associated with certain asthma phenotypes characterized by the concomitant expression of asthma and atopic dermatitis or SPT reactivity.

Development of allergies and asthma in infants and young children with atopic dermatitis--a prospective follow-up to 7 years of age

BACKGROUND

The prognosis of atopic dermatitis is usually good, but the risk of developing asthma and allergic rhinitis is very high. The aim of this study was to follow children with atopic eczema up to school age to chart the course of sensitization and development of clinical allergy, as well as to study risk factors of sensitization.

METHODS

Ninety-four children with atopic dermatitis were followed up to 7 years of age. The children were examined twice a year up to 3 years of age, and thereafter once yearly. At each visit, a clinical examination was performed, and a blood sample was taken. After 3 years of age, skin prick tests (SPTs) with inhalation allergens were performed at each visit. Information was obtained about atopy in the family, feeding patterns during infancy, symptoms of atopic disease, infections, and environmental factors.

RESULTS

During the follow-up, the eczema improved in 82 of the 94 children, but 43% developed asthma and 45% allergic rhinitis. The risk of developing asthma was higher in children with a heredity of eczema. Presence of severe eczema at the time of inclusion in the study was associated with an increased tendency to produce food-specific IgE. An early onset of eczema was associated with an increased risk of sensitization to inhalant allergens, and development of urticaria. Early allergic reactions to food were associated with later reactions to food, allergic rhinitis, urticaria, and sensitization to both food and inhalant allergens. Early feeding patterns, time of weaning, and introduction of solid food did not influence the risk of development of allergic symptoms. A large number of periods or days with fever during the follow-up was associated with an increased risk of developing allergic rhinitis and urticaria.

CONCLUSIONS

Our results confirm the good prognosis for the dermatitis and the increased risk of developing asthma and allergic rhinitis. Development of other allergic symptoms or sensitization was associated with the following factors: a family history of eczema, age at onset of eczema and its severity, early adverse reactions to foods, and proneness to infections.

Ten-year prognosis for generalized infantile eczema

Forty children treated in our hospital for generalized infantile eczema were re-examined at 11-13 years of age. In 7 (18%) children the eczema had disappeared and in 26 (65%) it had become less severe. Unrelated to dermatological status or gender, allergic rhinitis was diagnosed in 31 (78%) and asthma in 21 (53%) children. Only 8 children continued without either of these two conditions. All 32 children with allergic rhinitis and/or asthma showed at least one positive skin test reaction in a test panel of 11 common inhalant and food allergens compared with only 4 of 8 children without either allergic rhinitis or asthma (p < 0.001). Our results showed an improvement of dermatological status in most children with generalized infantile eczema but there was a high risk of a concomitant respiratory allergy and development of allergic rhinitis or asthma.

Child psychiatric problems in "autonomous dysfunction"

The Riley-Day syndrome, also known by the name Familial Dysautonomia, is characterized by a marked deficit in autonomic homeostatic function. A review of the literature and a case illustration describe the physical, emotional, social and learning problems. It is new known that sub-normal intelligence is not part of the syndrome. The impact of the symptoms on the child and on the mother-child relationship may aggravate the deficient emotional balance. Since marked improvement of the condition does occur, especially in patients who reach the age of six, a hopeful attitude in the guidance and treatment is justified and highly beneficial.

Psychiatric problems of hemophilic boys and their families

Some often described clinical observations on psychological problems of hemophilic boys and their families, were examined in a controlled study of twenty mothers of hemophilic boys and the same number of mothers of non-hemophilic healthy boys of the same age and similar socio-demographic background. The findings confirmed statistically the existence of considerable defiance and hostility of the boys and depressed mood of the mothers. The fathers showed a trend to provide little control and support. The defiance of hemophilic boys contrasts with the frequently described tendency towards compliance of asthmatic children. The differences between these two conditions are discussed. Therapeutic implications of the findings are outlined.

Maternal feelings towards asthmatic children

In this study asthmatic and nonasthmatic children of elementary school age were compared. They were matched for similar familial and individual constitutional allergic backgrounds and similar sociodemographic data. In addition to testing the children, the mothers were tested for their feelings about the children, the fathers and their own childhood family. The main purpose in this part of a wider study on childhood asthma, was to measure maternal feelings towards asthmatic children by determining with which figures in her childhood family the mothers identify the children. There were no differences between the two groups of children in birth order, number of siblings of the mothers and numbers of siblings of the children. The asthmatic children were clearly more frequently identified with positive figures and less with negative figures from the mother's childhood family than the nonasthmatic children. This finding was discussed in relation to previously described findings on these asthmatic children and their mothers.

Emotional disorders of asthmatic children

Depression, anxiety, defiance and hostility in sixty asthmatic and non-asthmatic children of school age, all with the same familial and constitutional allergic background, were measured with the Mother-Child Questionnaire. In the sample as a whole it was found that boys were more disturbed than girls and high-dependent children were more disturbed than low-dependent children. However, asthmatic low-dependent children were significantly more disturbed than non-asthmatic low-dependent children, whereas asthmatic high-dependent children tend to be less disturbed than non-asthmatic high-dependent children. The findings show that emotional disorders in the asthmatic children are associated with pathogenic maternal family relationship patterns.

Psychological factors in maternal grandparents of asthmatic children

The presently perceived past family interactions between mothers and maternal grandparents of asthmatic children and nonasthmatic children were compared. All the children included in this study had a common factor in that they suffered from early infantile eczema in the 1st year of life, and in their families there were many cases of asthma, hay fever, and eczema. With the use of two different test instruments for the measurement of family relationships, it was found that maternal grandmothers of asthmatic boys had a highly positive relationship with the mothers of the boys and that the maternal grandfathers were perceived by the mothers as rejecting figures. Even though the correlation between the two tests was rather high, they showed differences in their sensitivity. There was a striking difference between the mothers of asthmatic boys and the mothers of asthmatic girls in both tests. This fact together with the established greater vulnerability of boys to asthma seem to justify studying the sexes separately. It could be assumed that the asthmatic and nonasthmatic children in this study had a similar constitutional-familial allergic predisposition and that the differences between these groups of children were mainly influenced by environmental factors. The mothers' perception of the family relationship with their parents was considered to be minimally influenced by the asthma of their children.