Diagnosis of eczema in preschool children and course of disease during childhood

Abstract In childhood atopic dermatitis (AD) is the most frequent inflammatory condition. Validated eczema questionnaires have been available for schoolchildren only, but the incidence of atopic dermatitis is highest during infancy. Evidence is needed on the further development of asthma, and rhinitis in these infants with AD and on remission of AD in children. We aimed to validate a parental questionnaire to identify AD in infants and preschool children, to estimate the association between AD in infancy and the onset of asthma and rhinitis later in life and to analyze factors associated with remission of AD in childhood. Parents of infants and preschool children answered a written questionnaire prior to an examination by a physician. Sensitivity, specificity, predictive values and test-retest reliability of the questionnaire were assessed; a physician’s diagnosis was used as the gold standard. Further, infants and preschool children with and without AD were studied in the year 2000, and followed up 5 years later. The association between infant onset AD and the incidence of asthma and rhinitis later in childhood, as well as the association between remission, background, health, lifestyle, and environmental variables was estimated with crude and multivariable logistic regression. Validation of the questionnaire showed for the infants and preschool children a high sensitivity and specificity. Children with AD had a 3-fold increased odds of developing asthma and rhinitis. About half of the children underwent remission. For the development of asthma and rhinitis, the chances were increased for severe, early-onset, and persistent AD; for remission, the chances were increased for milder AD, later-onset AD, and atypical location of AD. Thus, for both development of asthma and rhinitis and for remission of AD, the most important factors were the aspects of AD. The questionnaire identified AD in infants and preschool children with high accuracy. Once having AD in infancy it is the strongest factor associated with development of asthma and rhinitis during the following 5-year period. For remission, aspects of eczema, and rural living were important for remission, but other modifiable lifestyle and environmental factors we examined were not associated in our sample.