Paediatrics
Do most children with eczema go on to get asthma and hay fever?
Open access · cc by · source: Europe PMC
Only a small minority of children with allergy-type symptoms follow the classic path from eczema to wheeze to hay fever; most have just one or two of these conditions in their own distinct pattern.
Study at a glance
- Design
- Cohort — Prospective population-based birth cohorts (ALSPAC and MAAS) with parent-reported symptoms at five ages from infancy to 11; Bayesian latent class machine learning grouped children by their symptom trajectories.
- N
- N=9801 · 9,801 children with data at two or more time points (8,665 from ALSPAC, 1,136 from MAAS); sensitisation trajectories used MAAS only, and the moderate/severe eczema sub-analysis used a reduced MAAS sample.
- Population
- Children in Avon (mothers recruited 1991-92) and in South Manchester/Cheshire (mothers recruited 1995-97), England, enrolled before birth.
- Outcome
- Latent classes of joint eczema, wheeze and rhinitis trajectories from age 1 to 11; allergic sensitisation by skin prick test across classes.
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
The best-fitting model found eight classes. About half of children (51.3%) had no disease, and only 3.1% followed an atopic-march-like profile, in which eczema also rarely resolved; the other classes included eczema only (15.3%), rhinitis only (9.6%), transient wheeze (7.7%) and persistent wheeze with later rhinitis (5.7%). The atopic march class had by far the highest risk of sensitisation (odds ratio about 22 versus no disease), and some classes with very different symptoms had similar sensitisation patterns. Results held in each cohort separately and in children with moderate/severe eczema.
Methodology
The authors pooled data on 9,801 children from two English birth cohorts whose parents answered validated questionnaires about eczema, wheeze and rhinitis at five points between infancy and age 11. They fitted three Bayesian machine-learning models: one treating each symptom as independent, one hard-wiring the atopic-march sequence, and an unconstrained latent-class model that let the data define groups of children with similar symptom histories. Skin prick tests measured allergic sensitisation.
Limitations
Symptoms were reported by parents rather than diagnosed, and question wording differed slightly between cohorts, which could blur the classes. The models describe patterns of co-occurrence and cannot show what causes a child to follow one path or another, and class labels are the authors' interpretation. Sensitisation over time was available only for the smaller Manchester cohort, food allergy was not included, and both cohorts are English children born between 1991 and 1997, so the findings may not generalise to other populations.
How this study connects
Role on claims
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Many children's lung and allergic problems change course, and the classic atopic march is uncommon.
Childhood patterns are often not fixed: between a third of children with obstructive and a half with restrictive spirometry moved to normal lung function by early adulthood, and in two UK cohorts only 3.1% of children followed an 'atopic march'-like path from eczema to wheeze and rhinitis.
Evidence for the claim as stated.
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