Early-Life Infection Linked With Atopic Dermatitis Development in Infants, Children

Infections early in life may increase the risk of atopic dermatitis (AD) development among infants and young children, according to study findings published recently in Journal of the European Academy of Dermatology and Venereology.

In patients with AD, both skin barrier and immune deficits are known to increase the risk of infection. With infections also exacerbating AD severity outcomes, researchers note that accumulating evidence shows microorganisms to potentially underlie the development of the skin condition as well.

“Microbial colonization in early life can shape host immune development, resulting in enduring consequences: immune tolerance to environmental exposures or susceptibility to allergic diseases in later life,” they explained.

Seeking to further investigate the risk of AD development following early-life infections, the authors conducted a population-based nested case-control study of patient data from Taiwan’s National Health Insurance Research Database for those born between 1997 and 2013.

In the study, 5454 patients with AD were matched 1:3 with 16,362 control subjects without AD by age, gender, index date, and maternal age at delivery; demographic characteristics, comorbidities, and maternal factors also were compared. Conditional stepwise logistic regression analysis assessed the risk between early-life infections and subsequent AD.

Among both groups, the mean (SD) age was 2.6 (2.9) years, with overall infections before the diagnosis of AD more common in patients with AD than in control subjects (41.8% vs 28.9%; P < .001). After adjusting for potential confounders, findings of the multivariate analyses indicated several factors before AD diagnosis that were independently associated with AD development:

• Infectious diseases (adjusted OR [aOR], 1.40; 95% CI, 1.29-1.51)
• Skin infections (aOR, 1.55; 95% CI, 1.40-1.71)
• Systemic antibiotic exposure (aOR, 1.67; 95% CI, 1.55-1.79)

“These results were consistent across observation periods (0-1, 1-2, and >2 years after birth) and sensitivity analyses after redefining the index date as 3 or 6 months before the date of AD diagnosis,” noted the study authors.

Notably, each incremental year of age was associated with a lower risk of AD (aOR, 0.90; 95% CI, 0.89-0.92). Other independent risk factors associated with AD development included asthma (aOR, 1.47; 95% CI, 1.29-1.68), allergic rhinitis (aOR, 1.44; 95% CI, 1.29-1.68), intussusception (aOR, 1.49; 95% CI, 1.10-2.02), and neonatal hyperbilirubinemia (aOR, 1.23; 95% CI, 1.05-1.45).

No association with subsequent AD was found for maternal age at delivery, Cesarean delivery, or prenatal antibiotic exposure.

“Our results suggested that infectious diseases in early life, including overall infections and skin infections, are associated with subsequent AD,” concluded the researchers. “The interactions among infections, microbiota dysbiosis, and immune development are worth further investigation.”

Reference

Lin T-L, Fan Y-H, Chang Y-L, Ho HJ, Wu C-Y, Chen Y-J. Early-life infections in association with development of atopic dermatitis in infancy and early childhood: A nationwide nested case-control study. J Eur Acad Dermatol Venereol. Published online January 9, 2022. doi:10.1111/jdv.17908