Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood

Laura Maintz; Marie Therese Schmitz; Nadine Herrmann; Svenja Müller; Regina Havenith; Juliette Brauer; Claudio Rhyner; Anita Dreher; Eugen Bersuch; Danielle Fehr; Gertrud Hammel; Matthias Reiger; Daria Luschkova; Avidan Neumann; Claudia C.V. Lang; Ellen D. Renner; Peter Schmid-Grendelmeier; Claudia Traidl-Hoffmann; Cezmi A. Akdis; Roger Lauener; Marie Charlotte Brüggen; Matthias Schmid; Thomas Bieber

doi:10.1111/all.15721

Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood

Laura Maintz, Marie Therese Schmitz, Nadine Herrmann, Svenja Müller, Regina Havenith, Juliette Brauer, Claudio Rhyner, Anita Dreher, Eugen Bersuch, Danielle Fehr, Gertrud Hammel, Matthias Reiger, Daria Luschkova, Avidan Neumann, Claudia C.V. Lang, Ellen D. Renner, Peter Schmid-Grendelmeier, Claudia Traidl-Hoffmann, Cezmi A. Akdis, Roger LauenerMarie Charlotte Brüggen, Matthias Schmid, Thomas Bieber

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12 Scopus citations

Abstract

Background: Atopic dermatitis (AD) has long been regarded as a primarily pediatric disease. However, there is growing evidence for a high rate of adult-onset AD. We aimed to characterize factors associated with adult-onset versus childhood-onset AD and controls. Methods: We analyzed cross-sectional data of the CK-CARE-ProRaD cohorts Bonn, Augsburg, Davos, Zürich of 736 adult patients stratified by age of AD onset (childhood-onset <18 years: 76.4% (subsets: 0 to 2; ≥2 to 6; ≥7 to 11; ≥12 to 18); adult-onset ≥18 years: 23.6% (subsets: ≥18 to 40; ≥41 to 60; ≥61) and 167 controls (91 atopic, 76 non-atopic)). Results: We identified active smoking to be associated with adult-onset AD versus controls (adjusted Odds Ratio (aOR) = 5.54 [95% Confidence Interval: 1.06–29.01] vs. controls^non-atopic, aOR = 4.03 [1.20–13.45] vs. controls^atopic). Conjunctivitis showed a negative association versus controls^atopic (aOR = 0.36 [0.14–0.91]). Food allergy (aOR = 2.93 [1.44–5.96]), maternal food allergy (aOR = 9.43 [1.10–80.95]), palmar hyperlinearity (aOR = 2.11 [1.05–4.25]), and academic background (aOR = 2.14 [1.00–4.54]) increased the odds of childhood-onset AD versus controls^atopic. Shared AD-associated factors were maternal AD (4-34x), increased IgE (2-20x), atopic stigmata (2-3x) with varying effect sizes depending on AD onset and control group. Patients with adult-compared to childhood-onset had doubled odds of allergic rhinitis (aOR = 2.15 [1.12–4.13]), but reduced odds to feature multiple (3–4) atopic comorbidities (aOR = 0.34 [0.14–0.84]). Adult-onset AD, particularly onset ≥61 years, grouped mainly in clusters with low contributions of personal and familial atopy and high frequencies of physical inactivity, childhood-onset AD, particularly infant-onset, mainly in “high-atopic”-clusters. Conclusions: The identified associated factors suggest partly varying endo- and exogeneous mechanisms underlying adult-onset versus childhood-onset AD. Our findings might contribute to better assessment of the individual risk to develop AD throughout life and encourage prevention by non-smoking and physical activity as modifiable lifestyle factors.

Original language	English
Pages (from-to)	2181-2201
Number of pages	21
Journal	Allergy: European Journal of Allergy and Clinical Immunology
Volume	78
Issue number	8
Early online date	22 Mar 2023
DOIs	https://doi.org/10.1111/all.15721
State	Published - Aug 2023
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

Funding

We thank the Christine Kühne‐Center for Allergy Research and Education (CK‐CARE), Davos, Switzerland for funding of the study. Laura Maintz, Marie‐Therese Schmitz, Juliette Brauer, Svenja Müller, Regina Havenith, Claudio Rhyner, Anita Dreher, Eugen Bersuch, Daria Luschkova and Ellen D Renner were or are supported by, or were or are employees of CK‐CARE. Marie‐Charlotte Brüggen is supported by CK‐CARE. The funding sources did not participate in the study design and conduct, nor in the data collection, management, analysis, and interpretation, nor in preparation, review or approval of the manuscript nor in the decision to submit the article for publication.

Funders	Funder number
Christine Kühne – Center for Allergy Research and Education

Keywords

adult-onset
associated factor
atopic dermatitis
childhood-onset
phenotype

Access to Document

10.1111/all.15721

Cite this

Maintz, L., Schmitz, M. T., Herrmann, N., Müller, S., Havenith, R., Brauer, J., Rhyner, C., Dreher, A., Bersuch, E., Fehr, D., Hammel, G., Reiger, M., Luschkova, D., Neumann, A., Lang, C. C. V., Renner, E. D., Schmid-Grendelmeier, P., Traidl-Hoffmann, C., Akdis, C. A., ... Bieber, T. (2023). Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood. Allergy: European Journal of Allergy and Clinical Immunology, 78(8), 2181-2201. https://doi.org/10.1111/all.15721

@article{f797b06afd3a4782aff4601338b16faa,

title = "Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood",

abstract = "Background: Atopic dermatitis (AD) has long been regarded as a primarily pediatric disease. However, there is growing evidence for a high rate of adult-onset AD. We aimed to characterize factors associated with adult-onset versus childhood-onset AD and controls. Methods: We analyzed cross-sectional data of the CK-CARE-ProRaD cohorts Bonn, Augsburg, Davos, Z{\"u}rich of 736 adult patients stratified by age of AD onset (childhood-onset <18 years: 76.4% (subsets: 0 to 2; ≥2 to 6; ≥7 to 11; ≥12 to 18); adult-onset ≥18 years: 23.6% (subsets: ≥18 to 40; ≥41 to 60; ≥61) and 167 controls (91 atopic, 76 non-atopic)). Results: We identified active smoking to be associated with adult-onset AD versus controls (adjusted Odds Ratio (aOR) = 5.54 [95% Confidence Interval: 1.06–29.01] vs. controlsnon-atopic, aOR = 4.03 [1.20–13.45] vs. controlsatopic). Conjunctivitis showed a negative association versus controlsatopic (aOR = 0.36 [0.14–0.91]). Food allergy (aOR = 2.93 [1.44–5.96]), maternal food allergy (aOR = 9.43 [1.10–80.95]), palmar hyperlinearity (aOR = 2.11 [1.05–4.25]), and academic background (aOR = 2.14 [1.00–4.54]) increased the odds of childhood-onset AD versus controlsatopic. Shared AD-associated factors were maternal AD (4-34x), increased IgE (2-20x), atopic stigmata (2-3x) with varying effect sizes depending on AD onset and control group. Patients with adult-compared to childhood-onset had doubled odds of allergic rhinitis (aOR = 2.15 [1.12–4.13]), but reduced odds to feature multiple (3–4) atopic comorbidities (aOR = 0.34 [0.14–0.84]). Adult-onset AD, particularly onset ≥61 years, grouped mainly in clusters with low contributions of personal and familial atopy and high frequencies of physical inactivity, childhood-onset AD, particularly infant-onset, mainly in “high-atopic”-clusters. Conclusions: The identified associated factors suggest partly varying endo- and exogeneous mechanisms underlying adult-onset versus childhood-onset AD. Our findings might contribute to better assessment of the individual risk to develop AD throughout life and encourage prevention by non-smoking and physical activity as modifiable lifestyle factors.",

keywords = "adult-onset, associated factor, atopic dermatitis, childhood-onset, phenotype",

author = "Laura Maintz and Schmitz, {Marie Therese} and Nadine Herrmann and Svenja M{\"u}ller and Regina Havenith and Juliette Brauer and Claudio Rhyner and Anita Dreher and Eugen Bersuch and Danielle Fehr and Gertrud Hammel and Matthias Reiger and Daria Luschkova and Avidan Neumann and Lang, {Claudia C.V.} and Renner, {Ellen D.} and Peter Schmid-Grendelmeier and Claudia Traidl-Hoffmann and Akdis, {Cezmi A.} and Roger Lauener and Br{\"u}ggen, {Marie Charlotte} and Matthias Schmid and Thomas Bieber",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.",

year = "2023",

month = aug,

doi = "10.1111/all.15721",

language = "אנגלית",

volume = "78",

pages = "2181--2201",

journal = "Allergy: European Journal of Allergy and Clinical Immunology",

issn = "0105-4538",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "8",

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Maintz, L, Schmitz, MT, Herrmann, N, Müller, S, Havenith, R, Brauer, J, Rhyner, C, Dreher, A, Bersuch, E, Fehr, D, Hammel, G, Reiger, M, Luschkova, D, Neumann, A, Lang, CCV, Renner, ED, Schmid-Grendelmeier, P, Traidl-Hoffmann, C, Akdis, CA, Lauener, R, Brüggen, MC, Schmid, M & Bieber, T 2023, 'Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood', Allergy: European Journal of Allergy and Clinical Immunology, vol. 78, no. 8, pp. 2181-2201. https://doi.org/10.1111/all.15721

TY - JOUR

T1 - Atopic dermatitis

T2 - Correlation of distinct risk factors with age of onset in adulthood compared to childhood

AU - Maintz, Laura

AU - Schmitz, Marie Therese

AU - Herrmann, Nadine

AU - Müller, Svenja

AU - Havenith, Regina

AU - Brauer, Juliette

AU - Rhyner, Claudio

AU - Dreher, Anita

AU - Bersuch, Eugen

AU - Fehr, Danielle

AU - Hammel, Gertrud

AU - Reiger, Matthias

AU - Luschkova, Daria

AU - Neumann, Avidan

AU - Lang, Claudia C.V.

AU - Renner, Ellen D.

AU - Schmid-Grendelmeier, Peter

AU - Traidl-Hoffmann, Claudia

AU - Akdis, Cezmi A.

AU - Lauener, Roger

AU - Brüggen, Marie Charlotte

AU - Schmid, Matthias

AU - Bieber, Thomas

PY - 2023/8

Y1 - 2023/8

N2 - Background: Atopic dermatitis (AD) has long been regarded as a primarily pediatric disease. However, there is growing evidence for a high rate of adult-onset AD. We aimed to characterize factors associated with adult-onset versus childhood-onset AD and controls. Methods: We analyzed cross-sectional data of the CK-CARE-ProRaD cohorts Bonn, Augsburg, Davos, Zürich of 736 adult patients stratified by age of AD onset (childhood-onset <18 years: 76.4% (subsets: 0 to 2; ≥2 to 6; ≥7 to 11; ≥12 to 18); adult-onset ≥18 years: 23.6% (subsets: ≥18 to 40; ≥41 to 60; ≥61) and 167 controls (91 atopic, 76 non-atopic)). Results: We identified active smoking to be associated with adult-onset AD versus controls (adjusted Odds Ratio (aOR) = 5.54 [95% Confidence Interval: 1.06–29.01] vs. controlsnon-atopic, aOR = 4.03 [1.20–13.45] vs. controlsatopic). Conjunctivitis showed a negative association versus controlsatopic (aOR = 0.36 [0.14–0.91]). Food allergy (aOR = 2.93 [1.44–5.96]), maternal food allergy (aOR = 9.43 [1.10–80.95]), palmar hyperlinearity (aOR = 2.11 [1.05–4.25]), and academic background (aOR = 2.14 [1.00–4.54]) increased the odds of childhood-onset AD versus controlsatopic. Shared AD-associated factors were maternal AD (4-34x), increased IgE (2-20x), atopic stigmata (2-3x) with varying effect sizes depending on AD onset and control group. Patients with adult-compared to childhood-onset had doubled odds of allergic rhinitis (aOR = 2.15 [1.12–4.13]), but reduced odds to feature multiple (3–4) atopic comorbidities (aOR = 0.34 [0.14–0.84]). Adult-onset AD, particularly onset ≥61 years, grouped mainly in clusters with low contributions of personal and familial atopy and high frequencies of physical inactivity, childhood-onset AD, particularly infant-onset, mainly in “high-atopic”-clusters. Conclusions: The identified associated factors suggest partly varying endo- and exogeneous mechanisms underlying adult-onset versus childhood-onset AD. Our findings might contribute to better assessment of the individual risk to develop AD throughout life and encourage prevention by non-smoking and physical activity as modifiable lifestyle factors.

AB - Background: Atopic dermatitis (AD) has long been regarded as a primarily pediatric disease. However, there is growing evidence for a high rate of adult-onset AD. We aimed to characterize factors associated with adult-onset versus childhood-onset AD and controls. Methods: We analyzed cross-sectional data of the CK-CARE-ProRaD cohorts Bonn, Augsburg, Davos, Zürich of 736 adult patients stratified by age of AD onset (childhood-onset <18 years: 76.4% (subsets: 0 to 2; ≥2 to 6; ≥7 to 11; ≥12 to 18); adult-onset ≥18 years: 23.6% (subsets: ≥18 to 40; ≥41 to 60; ≥61) and 167 controls (91 atopic, 76 non-atopic)). Results: We identified active smoking to be associated with adult-onset AD versus controls (adjusted Odds Ratio (aOR) = 5.54 [95% Confidence Interval: 1.06–29.01] vs. controlsnon-atopic, aOR = 4.03 [1.20–13.45] vs. controlsatopic). Conjunctivitis showed a negative association versus controlsatopic (aOR = 0.36 [0.14–0.91]). Food allergy (aOR = 2.93 [1.44–5.96]), maternal food allergy (aOR = 9.43 [1.10–80.95]), palmar hyperlinearity (aOR = 2.11 [1.05–4.25]), and academic background (aOR = 2.14 [1.00–4.54]) increased the odds of childhood-onset AD versus controlsatopic. Shared AD-associated factors were maternal AD (4-34x), increased IgE (2-20x), atopic stigmata (2-3x) with varying effect sizes depending on AD onset and control group. Patients with adult-compared to childhood-onset had doubled odds of allergic rhinitis (aOR = 2.15 [1.12–4.13]), but reduced odds to feature multiple (3–4) atopic comorbidities (aOR = 0.34 [0.14–0.84]). Adult-onset AD, particularly onset ≥61 years, grouped mainly in clusters with low contributions of personal and familial atopy and high frequencies of physical inactivity, childhood-onset AD, particularly infant-onset, mainly in “high-atopic”-clusters. Conclusions: The identified associated factors suggest partly varying endo- and exogeneous mechanisms underlying adult-onset versus childhood-onset AD. Our findings might contribute to better assessment of the individual risk to develop AD throughout life and encourage prevention by non-smoking and physical activity as modifiable lifestyle factors.

KW - adult-onset

KW - associated factor

KW - atopic dermatitis

KW - childhood-onset

KW - phenotype

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JF - Allergy: European Journal of Allergy and Clinical Immunology

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Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood

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