Phenotypical Differences of Childhood- and Adult-Onset Atopic Dermatitis

Jonathan I Silverberg; Paras P. Vakharia; Rishi Chopra; Ryan Sacotte; Neha Patel; Supriya Immaneni; Takeisha White; Robert Kantor; Derek Y. Hsu

doi:10.1016/j.jaip.2017.10.005

Phenotypical Differences of Childhood- and Adult-Onset Atopic Dermatitis

Jonathan I Silverberg^*, Paras P. Vakharia, Rishi Chopra, Ryan Sacotte, Neha Patel, Supriya Immaneni, Takeisha White, Robert Kantor, Derek Y. Hsu

^*Corresponding author for this work

Dermatology

Research output: Contribution to journal › Article › peer-review

82 Scopus citations

Abstract

Background: Little is known about adult-onset atopic dermatitis (AD). Objective: To determine the associations and clinical characteristics of adult-onset AD. Methods: A prospective study of 356 adults with AD (age ≥18 years) was performed using standardized questionnaires and examination. AD severity was assessed using the Patient-Oriented Eczema Measure, Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, and numeric rating scale for itch and sleeplessness. Latent class analysis was used to determine dominant clinical phenotypes. Multivariate logistic regression was used to determine the relationship between adult-onset AD and distinct phenotypes. Results: One hundred forty-nine adults (41.9%) reported onset of AD during adulthood, with 87 (24.4%) after the age of 50 years. Adult- versus childhood-onset AD was associated with birthplace outside the United States (χ², P =.0008), but not sex, race/ethnicity, current smoking status, or alcohol consumption (P ≥.11); and decreased personal history of asthma, hay fever, and food allergy and family history of asthma and food allergy (P ≤.0001 for all). There was no significant difference in the Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, numeric rating scale for itch and sleeplessness, or Patient-Oriented Eczema Measure between adult- and childhood-onset AD (Mann-Whitney U test, P ≥.10). Latent class analysis identified 3 classes: (1) high probability of flexural dermatitis and xerosis with intermediate to high probabilities of head, neck, and hand dermatitis; (2) high probability of flexural dermatitis and xerosis, but low probabilities of head, neck, and hand dermatitis; and (3) lower probability of flexural dermatitis, but the highest probabilities of virtually all other signs and symptoms. Adult-onset AD was significantly associated with class 1 (multivariate logistic regression; adjusted odds ratio, 5.54; 95% CI, 1.59-19.28) and class 3 (adjusted odds ratio, 14.03; 95% CI, 2.33-85.50). Conclusions: Self-reported adult-onset AD is common and has distinct phenotypes with lesional predilection for the hands and/or head/neck.

Original language	English (US)
Pages (from-to)	1306-1312
Number of pages	7
Journal	Journal of Allergy and Clinical Immunology: In Practice
Volume	6
Issue number	4
DOIs	https://doi.org/10.1016/j.jaip.2017.10.005
State	Published - Jul 1 2018

Funding

Conflicts of interest: J. I. Silverberg has received research support from the American Medical Association Foundation, GlaxoSmithKline, the Dermatology Foundation, and the Agency for Healthcare Research and Quality; has received consultancy fees and is on the advisory boards for Abbvie, Anacor, Eli Lilly, Galderma, GlaxoSmithKline, Kiniksa, Leo, Medimmune, Pfizer, Realm-1, Regeneron-Sanofi, and Roivant; and has received lecture fees from Regeneron-Sanofi. The rest of the authors declare that they have no relevant conflicts of interest. This publication was made possible with support from the Agency for Healthcare Research and Quality (grant no. K12 HS023011) and the Dermatology Foundation. REDCap is supported at Feinberg School of Medicine by the Northwestern University Clinical and Translational Science Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences (grant no.: UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

Adult onset
Asthma
Atopic dermatitis
Atopic history
Eczema
Hay fever
Severity

ASJC Scopus subject areas

Immunology and Allergy

Access to Document

10.1016/j.jaip.2017.10.005

Cite this

@article{f47005c8c9e147568700cdc59ecd49ca,

title = "Phenotypical Differences of Childhood- and Adult-Onset Atopic Dermatitis",

abstract = "Background: Little is known about adult-onset atopic dermatitis (AD). Objective: To determine the associations and clinical characteristics of adult-onset AD. Methods: A prospective study of 356 adults with AD (age ≥18 years) was performed using standardized questionnaires and examination. AD severity was assessed using the Patient-Oriented Eczema Measure, Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, and numeric rating scale for itch and sleeplessness. Latent class analysis was used to determine dominant clinical phenotypes. Multivariate logistic regression was used to determine the relationship between adult-onset AD and distinct phenotypes. Results: One hundred forty-nine adults (41.9%) reported onset of AD during adulthood, with 87 (24.4%) after the age of 50 years. Adult- versus childhood-onset AD was associated with birthplace outside the United States (χ2, P =.0008), but not sex, race/ethnicity, current smoking status, or alcohol consumption (P ≥.11); and decreased personal history of asthma, hay fever, and food allergy and family history of asthma and food allergy (P ≤.0001 for all). There was no significant difference in the Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, numeric rating scale for itch and sleeplessness, or Patient-Oriented Eczema Measure between adult- and childhood-onset AD (Mann-Whitney U test, P ≥.10). Latent class analysis identified 3 classes: (1) high probability of flexural dermatitis and xerosis with intermediate to high probabilities of head, neck, and hand dermatitis; (2) high probability of flexural dermatitis and xerosis, but low probabilities of head, neck, and hand dermatitis; and (3) lower probability of flexural dermatitis, but the highest probabilities of virtually all other signs and symptoms. Adult-onset AD was significantly associated with class 1 (multivariate logistic regression; adjusted odds ratio, 5.54; 95% CI, 1.59-19.28) and class 3 (adjusted odds ratio, 14.03; 95% CI, 2.33-85.50). Conclusions: Self-reported adult-onset AD is common and has distinct phenotypes with lesional predilection for the hands and/or head/neck.",

keywords = "Adult onset, Asthma, Atopic dermatitis, Atopic history, Eczema, Hay fever, Severity",

author = "Silverberg, {Jonathan I} and Vakharia, {Paras P.} and Rishi Chopra and Ryan Sacotte and Neha Patel and Supriya Immaneni and Takeisha White and Robert Kantor and Hsu, {Derek Y.}",

note = "Funding Information: Conflicts of interest: J. I. Silverberg has received research support from the American Medical Association Foundation, GlaxoSmithKline, the Dermatology Foundation, and the Agency for Healthcare Research and Quality; has received consultancy fees and is on the advisory boards for Abbvie, Anacor, Eli Lilly, Galderma, GlaxoSmithKline, Kiniksa, Leo, Medimmune, Pfizer, Realm-1, Regeneron-Sanofi, and Roivant; and has received lecture fees from Regeneron-Sanofi. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This publication was made possible with support from the Agency for Healthcare Research and Quality (grant no. K12 HS023011) and the Dermatology Foundation. REDCap is supported at Feinberg School of Medicine by the Northwestern University Clinical and Translational Science Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences (grant no.: UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2017 American Academy of Allergy, Asthma & Immunology",

year = "2018",

month = jul,

day = "1",

doi = "10.1016/j.jaip.2017.10.005",

language = "English (US)",

volume = "6",

pages = "1306--1312",

journal = "Journal of Allergy and Clinical Immunology: In Practice",

issn = "2213-2198",

publisher = "American Academy of Allergy, Asthma and Immunology",

number = "4",

}

TY - JOUR

T1 - Phenotypical Differences of Childhood- and Adult-Onset Atopic Dermatitis

AU - Silverberg, Jonathan I

AU - Vakharia, Paras P.

AU - Chopra, Rishi

AU - Sacotte, Ryan

AU - Patel, Neha

AU - Immaneni, Supriya

AU - White, Takeisha

AU - Kantor, Robert

AU - Hsu, Derek Y.

N1 - Funding Information: Conflicts of interest: J. I. Silverberg has received research support from the American Medical Association Foundation, GlaxoSmithKline, the Dermatology Foundation, and the Agency for Healthcare Research and Quality; has received consultancy fees and is on the advisory boards for Abbvie, Anacor, Eli Lilly, Galderma, GlaxoSmithKline, Kiniksa, Leo, Medimmune, Pfizer, Realm-1, Regeneron-Sanofi, and Roivant; and has received lecture fees from Regeneron-Sanofi. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This publication was made possible with support from the Agency for Healthcare Research and Quality (grant no. K12 HS023011) and the Dermatology Foundation. REDCap is supported at Feinberg School of Medicine by the Northwestern University Clinical and Translational Science Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences (grant no.: UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2017 American Academy of Allergy, Asthma & Immunology

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Little is known about adult-onset atopic dermatitis (AD). Objective: To determine the associations and clinical characteristics of adult-onset AD. Methods: A prospective study of 356 adults with AD (age ≥18 years) was performed using standardized questionnaires and examination. AD severity was assessed using the Patient-Oriented Eczema Measure, Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, and numeric rating scale for itch and sleeplessness. Latent class analysis was used to determine dominant clinical phenotypes. Multivariate logistic regression was used to determine the relationship between adult-onset AD and distinct phenotypes. Results: One hundred forty-nine adults (41.9%) reported onset of AD during adulthood, with 87 (24.4%) after the age of 50 years. Adult- versus childhood-onset AD was associated with birthplace outside the United States (χ2, P =.0008), but not sex, race/ethnicity, current smoking status, or alcohol consumption (P ≥.11); and decreased personal history of asthma, hay fever, and food allergy and family history of asthma and food allergy (P ≤.0001 for all). There was no significant difference in the Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, numeric rating scale for itch and sleeplessness, or Patient-Oriented Eczema Measure between adult- and childhood-onset AD (Mann-Whitney U test, P ≥.10). Latent class analysis identified 3 classes: (1) high probability of flexural dermatitis and xerosis with intermediate to high probabilities of head, neck, and hand dermatitis; (2) high probability of flexural dermatitis and xerosis, but low probabilities of head, neck, and hand dermatitis; and (3) lower probability of flexural dermatitis, but the highest probabilities of virtually all other signs and symptoms. Adult-onset AD was significantly associated with class 1 (multivariate logistic regression; adjusted odds ratio, 5.54; 95% CI, 1.59-19.28) and class 3 (adjusted odds ratio, 14.03; 95% CI, 2.33-85.50). Conclusions: Self-reported adult-onset AD is common and has distinct phenotypes with lesional predilection for the hands and/or head/neck.

AB - Background: Little is known about adult-onset atopic dermatitis (AD). Objective: To determine the associations and clinical characteristics of adult-onset AD. Methods: A prospective study of 356 adults with AD (age ≥18 years) was performed using standardized questionnaires and examination. AD severity was assessed using the Patient-Oriented Eczema Measure, Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, and numeric rating scale for itch and sleeplessness. Latent class analysis was used to determine dominant clinical phenotypes. Multivariate logistic regression was used to determine the relationship between adult-onset AD and distinct phenotypes. Results: One hundred forty-nine adults (41.9%) reported onset of AD during adulthood, with 87 (24.4%) after the age of 50 years. Adult- versus childhood-onset AD was associated with birthplace outside the United States (χ2, P =.0008), but not sex, race/ethnicity, current smoking status, or alcohol consumption (P ≥.11); and decreased personal history of asthma, hay fever, and food allergy and family history of asthma and food allergy (P ≤.0001 for all). There was no significant difference in the Eczema Area and Severity Index, Scoring Atopic Dermatitis, body surface area, numeric rating scale for itch and sleeplessness, or Patient-Oriented Eczema Measure between adult- and childhood-onset AD (Mann-Whitney U test, P ≥.10). Latent class analysis identified 3 classes: (1) high probability of flexural dermatitis and xerosis with intermediate to high probabilities of head, neck, and hand dermatitis; (2) high probability of flexural dermatitis and xerosis, but low probabilities of head, neck, and hand dermatitis; and (3) lower probability of flexural dermatitis, but the highest probabilities of virtually all other signs and symptoms. Adult-onset AD was significantly associated with class 1 (multivariate logistic regression; adjusted odds ratio, 5.54; 95% CI, 1.59-19.28) and class 3 (adjusted odds ratio, 14.03; 95% CI, 2.33-85.50). Conclusions: Self-reported adult-onset AD is common and has distinct phenotypes with lesional predilection for the hands and/or head/neck.

KW - Adult onset

KW - Asthma

KW - Atopic dermatitis

KW - Atopic history

KW - Eczema

KW - Hay fever

KW - Severity

UR - http://www.scopus.com/inward/record.url?scp=85033573664&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033573664&partnerID=8YFLogxK

U2 - 10.1016/j.jaip.2017.10.005

DO - 10.1016/j.jaip.2017.10.005

M3 - Article

C2 - 29133223

AN - SCOPUS:85033573664

SN - 2213-2198

VL - 6

SP - 1306

EP - 1312

JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

IS - 4

ER -

Phenotypical Differences of Childhood- and Adult-Onset Atopic Dermatitis

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this