Pediatric Atopic Dermatitis Linked to Allergy Development

Diverse patterns of disease progression that start in childhood and progress as patients age have been identified in a new analysis that investigated correlations between atopic dermatitis (AD) and the eventual appearance of allergic diseases, per new research published in JAMA Network Open.1 In particular, distinct trajectories were identified that included transient, recurrent, and persistent forms. These and more were explored for potential links to the development of other allergic conditions such as food allergies and asthma.

Overall, the authors emphasize their findings underscore that AD phenotypes can be influenced by genetic, environmental, and demographic elements, which then can serve as a sound foundation on which to base further analysis.

For their investigation, the authors examined outcomes among children born between April 1980 and June 2019 (N = 5314), using data from 12 observational birth cohorts from the Environmental Influences on Child Health Outcomes Children’s Respiratory and Environmental Workgroup. Of these 12 cohorts, 9 provided study data: Respiratory Syncytial Virus Infection During Infancy and Asthma During Childhood (30.2%), Childhood Allergy Study (12.5%), Cincinnati Childhood Allergy and Air Pollution Study (12.3%), Columbia Center for Children’s Environmental Health (11.0%), Urban Environment and Childhood Asthma (9.7%), Epidemiology of Home Allergens and Asthma Study (9.1%), Infant Immune Study (7.0%), Childhood Origins of Asthma (5.2%), and Wisconsin Infant Study Cohort (2.9%). The Microbes, Allergy, Asthma Precision Prevention, Tucson Children’s Respiratory Study, and Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study cohorts did not provide data because each had fewer than 3 AD assessments. Follow-up was through September 2022, and the data were analyzed from December 2020 to April 2024.

Only children with 3 or more assessments for AD during their first 7 years (84 months) were included. Most were in the general risk cohort (63.6%), male (51.4%), White (62.9%) or Black or African American (20.4%), and born in the 2000s (35.7%) or 2010s (33.0%).

Overall, across each year, AD was common, showing up at a prevalence of 24.1% to 28.4%. However, the high-risk children (36.4% of the total study population) only exhibited a higher prevalence at ages 12 months (P < .001) and 24 months (P = .13) vs the general-risk children who had higher prevalences from ages 36 months (P < .001) to 60 months (P = .29) and at 84 months (P < .001). Five classes of AD also were identified that were associated with the presence, onset, and persistence of AD:

• Transient early: prevalence of AD peaked at age 3 (4.9%)
• Early with potential reoccurrence: high prevalence of AD in the first 2 years that soon dropped but rebounded by age 6 to 7 years (4.3%)
• Late-onset: prevalence increased after age 2 years, peaking at approximately age 6 years (9.0%)
• Persistent: high prevalence throughout childhood (15.4%)
• Minimal or none: low prevalence throughout childhood (66.3%)

In this study, adjusting for cohort type, decade of birth, sex, and race demonstrated that early AD with potential recurrence was 79% more likely to occur in high-risk cohorts. | Image Credit: Maggie L. Shaw/sora.chatgpt.com

Adjusting for cohort type, decade of birth, sex, and race demonstrated that early AD with potential recurrence was 79% (adjusted OR [aOR], 1.79; 95% CI, 1.05-3.06) more likely to occur in high-risk cohorts. Female children were 55% (aOR, 0.45; 95%CI, 0.27-0.74) less likely to have early AD vs male children, and Black or African American children compared with White children were 226% (aOR, 3.26; 95%CI, 2.06-5.18) more likely to have transient early AD, 272% (aOR, 3.72; 95%CI, 2.35-5.90) more likely to have early AD with potential reoccurrence, and 101% (aOR, 2.01; 95%CI, 1.54-2.63) more likely to have persistent AD. Transient early AD and early AD with potential reoccurrence were 131% (aOR, 2.31; 95%CI, 1.13-4.70) and 227% (aOR, 3.27; 95%CI, 1.73-6.18) more likely in multiracial children and children with other race reported vs White children.

Children who had parents with asthma were significantly more likely to have early AD with potential reoccurrence or transient early AD, and siblings and parents with asthma meant a higher risk of persistent AD; older gestational age, lower risk of transient early AD.

A final analysis looked at comorbidities and Th2 biomarkers.

Higher odds of food allergy were connected to 3 classes of AD in the first 6 years of life: transient early AD (aOR, 2.15; 95% CI, 1.48-3.08), early AD with potential reoccurrence (aOR, 2.43; 95% CI, 1.66-3.50), and persistent AD (aOR, 2.26; 95% CI, 1.84-2.78). Allergic rhinitis appearing between ages 5 to 7 years was more likely to occur in the presence of late-onset AD (aOR, 1.84; 95% CI, 1.38-2.43) and persistent AD (aOR, 2.02; 95%CI, 1.64-2.48). Asthma was most likely comorbid with persistent AD (aOR, 2.31; 95%CI, 1.91-2.79), and these children were also more likely to wheeze between ages 1 and 5 years. Food sensitization had associations with transient early AD (aOR, 2.15; 95% CI, 1.48-3.08) and persistent AD (aOR, 2.26; 95% CI, 1.84-2.78), with peanut sensitization having the greatest association overall, at age 24 months (aOR, 3.31; 95% CI, 1.47-7.05)—more so than egg, milk, and perennial sensitization.

Lastly, medium (aOR, 2.09; 95% CI, 1.56-2.81) and high (aOR, 3.71; 95% CI, 2.52-5.45) levels of total immunoglobulin E (IgE)—the body’s overreaction to an allergen that gives rise to symptoms in the nose, lungs, throat, or skin, with each type of IgE having its own targets2—were more likely to be seen in children with persistent AD.

The authors note that their findings show that an overall one-third of children had atopic dermatitis within their first 7 years of life and that their results were higher than those reported in earlier analyses from recent years from Spain and the US.3,4 Further, their data and additional work on identifying AD phenotypes “may inform targeted prevention strategies using precision medicine approaches to reduce AD and potentially associated comorbid conditions.”

References

1. Sitarik AR, Eapen AA, Biagini JM, et al. Phenotypes of atopic dermatitis and development of allergic diseases. JAMA Netw Open. 2025;8(6):e2515094. doi:10.1001/jamanetworkopen.2025.15094
2. Immunoglobulin E (IgE) defined.American Academy of Allergy Asthma and immunology. Accessed June 13, 2025. https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/immunoglobulin-e-(ige)-defined
3. Gilaberte Y, Pérez-Gilaberte JB, Poblador-Plou B, Bliek-Bueno K, Gimeno-Miguel A, Prados-Torres A. Prevalence and comorbidity of atopic dermatitis in children: a large-scale population study based on real-world data. J Clin Med. 2020;9(6):1632. doi:10.3390/jcm9061632
4. McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123(2):173-178.e1. doi:10.1016/j.anai.2019.05.014