Approach to the Assessment and Management of Pediatric Patients with Atopic Dermatitis: A Consensus Document. Section II: Comorbid Disease in Pediatric Atopic Dermatitis

Abstract

Pediatric atopic dermatitis (AD) is one of the most common skin conditions encountered by health-care providers caring for infants, children, and adolescents. Pediatric patients with AD may present with other allergic and nonallergic comorbidities that require appropriate treatment and referral. They may also experience a trajectory of allergic diseases known as the atopic march, which depends on a complex interaction between genetic and environmental factors and likely involves early epidermal barrier dysfunction. Here we provide a review and clinical recommendations on the assessment and referral of comorbidities in pediatric AD.

Keywords

atopic dermatitis pediatric comorbidities atopic march ocular comorbidities allergic disease depression anxiety

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References

Hill

DA.

Spergel

. The atopic march: critical evidence and clinical relevance. Ann Allergy Asthma Immunol. 2018;120(2):131-137.doi:10.1016/j.anai.2017.10.037

Carlsten

Dimich-Ward

Ferguson

et al. Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors. Ann Allergy Asthma Immunol. 2013;110(1):24-28.doi:10.1016/j.anai.2012.10.005

Gustafsson

Sjöberg

Foucard

. Development of allergies and asthma in infants and young children with atopic dermatitis: a prospective follow-up to 7 years of age. Allergy. 2000;55(3):240-245.doi:10.1034/j.1398-9995.2000.00391.x

Belgrave

DCM.

Granell

Simpson

et al. Developmental profiles of eczema, wheeze, and rhinitis: two population-based birth cohort studies. PLoS Med. 2014;11(10):e1001748.doi:10.1371/journal.pmed.1001748

Paller

AS.

Spergel

JM.

Mina-Osorio

Irvine

. The atopic march and atopic multimorbidity: many trajectories, many pathways. J Allergy Clin Immunol. 2019;143(1):46-55.doi:10.1016/j.jaci.2018.11.006

Muraro

Werfel

Hoffmann-Sommergruber

et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008-1025.doi:10.1111/all.12429

Tsakok

Marrs

Mohsin

et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016;137(4):1071-1078.doi:10.1016/j.jaci.2015.10.049

Gray

CL.

Levin

ME.

Zar

et al. Food allergy in South African children with atopic dermatitis. Pediatr Allergy Immunol. 2014;25(6):572-579.doi:10.1111/pai.12270

Alduraywish

SA.

Lodge

CJ.

Campbell

et al. The March from early life food sensitization to allergic disease: a systematic review and meta-analyses of birth cohort studies. Allergy. 2016;71(1):77-89.doi:10.1111/all.12784

10.

Hill

DJ.

Hosking

. Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol. 2004;15(5):421-427.doi:10.1111/j.1399-3038.2004.00178.x

11.

Loo

EXL.

Shek

LP-C.

Goh

et al. Atopic dermatitis in early life: evidence for at least three phenotypes? Results from the GUSTO study. Int Arch Allergy Immunol. 2015;166(4):273-279.doi:10.1159/000381342

12.

Kelleher

MM.

Dunn-Galvin

Gray

et al. Skin barrier impairment at birth predicts food allergy at 2 years of age. J Allergy Clin Immunol. 2016;137(4):1111-1116.doi:10.1016/j.jaci.2015.12.1312

13.

Beyer

Teuber

. Food allergy diagnostics: scientific and unproven procedures. Curr Opin Allergy Clin Immunol. 2005;5(3):261-266.doi:10.1097/01.all.0000168792.27948.f9

14.

Lieberman

JA.

Sicherer

. The diagnosis of food allergy. Am J Rhinol Allergy. 2010;24(6):439-443.doi:10.2500/ajra.2010.24.3515

15.

Carr

Chan

Lavine

Moote

. CSACI position statement on the testing of food-specific IgG. All Asth Clin Immun. 2012;8(1):12.doi:10.1186/1710-1492-8-12

16.

Chan

ES.

Cummings

Atkinson

et al. Dietary exposures and allergy prevention in high-risk infants: a joint position statement of the Canadian Society of allergy and clinical immunology and the Canadian paediatric Society. All Asth Clin Immun. 2014;10(1):45.doi:10.1186/1710-1492-10-45

17.

Lau

Matricardi

PM.

Wahn

Lee

YA.

Keil

. Allergy and atopy from infancy to adulthood: messages from the German birth cohort MAS. Ann Allergy Asthma Immunol. 2019;122(1):25-32.doi:10.1016/j.anai.2018.05.012

18.

Mortz

CG.

Andersen

KE.

Dellgren

Barington

Bindslev-Jensen

. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy. 2015;70(7):836-845.doi:10.1111/all.12619

19.

Ekbäck

Tedner

Devenney

et al. Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years. PLoS One. 2014;9(6):e99609.doi:10.1371/journal.pone.0099609

20.

Amat

Soria

Tallon

et al. New insights into the phenotypes of atopic dermatitis linked with allergies and asthma in children: an overview. Clin Exp Allergy. 2018;48(8):919-934.doi:10.1111/cea.13156

21.

Price

Bjermer

Bergin

Martinez

. Asthma referrals: a key component of asthma management that needs to be addressed. J Asthma Allergy. 2017;10:209-223.doi:10.2147/JAA.S134300

22.

Nissen

SP.

Kjaer

HF.

Høst

Nielsen

Halken

. The natural course of sensitization and allergic diseases from childhood to adulthood. Pediatr Allergy Immunol. 2013;24(6):549-555.doi:10.1111/pai.12108

23.

Chen

JJ.

Applebaum

DS.

Sun

GS.

Pflugfelder

. Atopic keratoconjunctivitis: a review. J Am Acad Dermatol. 2014;70(3):569-575.doi:10.1016/j.jaad.2013.10.036

24.

Luo

Liang

. Recalcitrant atopic keratoconjunctivitis in children: a case report and literature review. Pediatrics. 2018;141(Suppl 5):S470-S474.doi:10.1542/peds.2016-2069

25.

Govind

Whang

Khanna

Scott

AW.

Kwatra

. Atopic dermatitis is associated with increased prevalence of multiple ocular comorbidities. J Allergy Clin Immunol. 2019;7(1):298-299.doi:10.1016/j.jaip.2018.10.009

26.

Wollenberg

Barbarot

Bieber

et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol. 2018;32(6):850-878.doi:10.1111/jdv.14888

27.

Brémond-Gignac

Nischal

KK.

Mortemousque

Gajdosova

Granet

DB.

Chiambaretta

. Atopic keratoconjunctivitis in children: clinical features and diagnosis. Ophthalmology. 2016;123(2):435-437.doi:10.1016/j.ophtha.2015.07.012

28.

Borkar

DS.

Gonzales

JA.

Tham

et al. Association between atopy and herpetic eye disease: results from the Pacific ocular inflammation study. JAMA Ophthalmol. 2014;132(3):326-331.doi:10.1001/jamaophthalmol.2013.6277

29.

Hill

DA.

Grundmeier

RW.

Ramos

Spergel

. Eosinophilic esophagitis is a late manifestation of the allergic March. J Allergy Clin Immunol. 2018;6(5):1528-1533.doi:10.1016/j.jaip.2018.05.010

30.

Mohammad

AA.

SZ.

Ibrahim

et al. Prevalence of atopic comorbidities in eosinophilic esophagitis: a case-control study of 449 patients. J Am Acad Dermatol. 2017;76(3):559-560.doi:10.1016/j.jaad.2016.08.068

31.

Liacouras

CA.

Spergel

Gober

. Eosinophilic esophagitis: clinical presentation in children. Gastroenterol Clin North Am. 2014;43(2):219-229.doi:10.1016/j.gtc.2014.02.012

32.

Giordano-Labadie

Rancé

Pellegrin

Bazex

Dutau

Schwarze

. Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases. Contact Dermatitis. 1999;40(4):192-195.doi:10.1111/j.1600-0536.1999.tb06032.x

33.

Czarnobilska

Obtulowicz

Dyga

Wsolek-Wnek

Spiewak

. Contact hypersensitivity and allergic contact dermatitis among school children and teenagers with eczema. Contact Dermatitis. 2009;60(5):264-269.doi:10.1111/j.1600-0536.2009.01537.x

34.

Sung

CT.

McGowan

MA.

Jacob

. Allergic contact dermatitis evaluation: strategies for the Preschooler. Curr Allergy Asthma Rep. 2018;18(10):49.doi:10.1007/s11882-018-0803-9

35.

Karagounis

TK.

Gittler

JK.

Rotemberg

Morel

. Use of "natural" oils for moisturization: review of olive, coconut, and sunflower seed oil. Pediatr Dermatol. 2019;36(1):9-15.doi:10.1111/pde.13621

36.

Jacob

SE.

McGowan

Silverberg

et al. Pediatric contact dermatitis registry data on contact allergy in children with atopic dermatitis. JAMA Dermatol. 2017;153(8):765-770.doi:10.1001/jamadermatol.2016.6136

37.

Yaghmaie

Koudelka

CW.

Simpson

. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):428-433.doi:10.1016/j.jaci.2012.10.041

38.

Schans

Jvander.

Çiçek

de Vries

TW.

Hak

Hoekstra

. Association of atopic diseases and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. Neurosci Biobehav Rev. 2017;74(Pt A):139-148.doi:10.1016/j.neubiorev.2017.01.011

39.

Schmitt

Buske-Kirschbaum

Tesch

et al. Increased attention-deficit/hyperactivity symptoms in atopic dermatitis are associated with history of antihistamine use. Allergy. 2018;73(3):615-626.doi:10.1111/all.13326

40.

Chen

MH.

T-P.

Chen

Y-S

et al. Comorbidity of allergic and autoimmune diseases among patients with ADHD. J Atten Disord. 2017;21(3):219-227.doi:10.1177/1087054712474686

41.

Cheng

C-M.

Hsu

J-W.

Huang

K-L

et al. Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord. 2015;178:60-65.doi:10.1016/j.jad.2015.02.025

42.

Rønnstad

ATM.

Halling-Overgaard

A-S.

Hamann

CR.

Skov

Egeberg

Thyssen

. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. J Am Acad Dermatol. 2018;79(3):448-456.doi:10.1016/j.jaad.2018.03.017

43.

Patel

KR.

Immaneni

Singam

Rastogi

Silverberg

. Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol. 2019;80(2):402-410.doi:10.1016/j.jaad.2018.08.063

44.

Becker-Haimes

EM.

Diaz

KI.

Haimes

BA.

Ehrenreich-May

Anxiety

E-MJ

. Anxiety and atopic disease: comorbidity in a youth mental health setting. Child Psychiatry Hum Dev. 2017;48(4):528-536.doi:10.1007/s10578-016-0678-8

45.

Nicholas

MN.

Gooderham

. Atopic dermatitis, depression, and suicidality. J Cutan Med Surg. 2017;21(3):237-242.doi:10.1177/1203475416685078

46.

Sandhu

JK.

KK.

Bui

T-L.

Armstrong

. Association between atopic dermatitis and suicidality: a systematic review and meta-analysis. JAMA Dermatol. 2019;155(2):178-187.doi:10.1001/jamadermatol.2018.4566

47.

Chang

Y-S.

Chiang

B-L

. Sleep disorders and atopic dermatitis: a 2-way street? J Allergy Clin Immunol. 2018;142(4):1033-1040.doi:10.1016/j.jaci.2018.08.005

48.

Rea

CJ.

Tran

KD.

Jorina

Wenren

LM.

Hawryluk

EB.

Toomey

. Associations of eczema severity and parent knowledge with child quality of life in a pediatric primary care population. Clin Pediatr. 2018;57(13):1506-1514.doi:10.1177/0009922818787295

49.

Ersser

SJ.

Cowdell

Latter

et al. Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev. 2014;2014(1):CD004054.

50.

Patel

Clayton

PE.

Jenney

ME.

Ferguson

JE.

David

. Adult height in patients with childhood onset atopic dermatitis. Arch Dis Child. 1997;76(6):505-507.doi:10.1136/adc.76.6.505

51.

Patel

Clayton

PE.

Addison

GM.

Price

DA.

David

. Linear growth in prepubertal children with atopic dermatitis. Arch Dis Child. 1998;79(2):169-172.doi:10.1136/adc.79.2.169

52.

Silverberg

JI.

Greenland

. Eczema and cardiovascular risk factors in 2 us adult population studies. J Allergy Clin Immunol. 2015;135(3):721-728.doi:10.1016/j.jaci.2014.11.023

53.

Silverberg

. Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies. Allergy. 2015;70(10):1300-1308.doi:10.1111/all.12685

54.

VY.

Chen

T-J.

Yeh

C-M

et al. Atopic dermatitis and risk of ischemic stroke: a nationwide population-based study. Ann Med. 2014;46(2):84-89.doi:10.3109/07853890.2013.870018

55.

Standl

Tesch

Baurecht

et al. Association of atopic dermatitis with cardiovascular risk factors and diseases. J Invest Dermatol. 2017;137(5):1074-1081.doi:10.1016/j.jid.2016.11.031

56.

Andersen

YMF.

Egeberg

Gislason

GH.

Hansen

PR.

Skov

Thyssen

. Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis. J Allergy Clin Immunol. 2016;138(1):310-312.doi:10.1016/j.jaci.2016.01.015

57.

Silverberg

JI.

Becker

Kwasny

Menter

Cordoro

KM.

Paller

. Central obesity and high blood pressure in pediatric patients with atopic dermatitis. JAMA Dermatol. 2015;151(2):144-152.doi:10.1001/jamadermatol.2014.3059

58.

Silverberg

. Atopic disease and cardiovascular risk factors in US children. J Allergy Clin Immunol. 2016;137(3):938-940.doi:10.1016/j.jaci.2015.09.012

59.

Zhang

Silverberg

. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol. 2015;72(4):606-616.doi:10.1016/j.jaad.2014.12.013

60.

Mohan

GC.

Silverberg

. Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol. 2015;151(5):522-528.doi:10.1001/jamadermatol.2014.3324

61.

Pedullá

Fierro

Papacciuolo

Alfano

Ruocco

. Atopy as a risk factor for thyroid autoimmunity in children affected with atopic dermatitis. J Eur Acad Dermatol Venereol. 2014;28(8):1057-1060.doi:10.1111/jdv.12281

62.

Schmitt

Schwarz

Baurecht

et al. Atopic dermatitis is associated with an increased risk for rheumatoid arthritis and inflammatory bowel disease, and a decreased risk for type 1 diabetes. J Allergy Clin Immunol. 2016;137(1):130-136.doi:10.1016/j.jaci.2015.06.029

63.

Tsai

J-D.

Wang

I-C.

Shen

T-C.

Lin

C-L.

Wei

C-C

. A 8-year population-based cohort study of irritable bowel syndrome in childhood with history of atopic dermatitis. J Investig Med. 2018;66(4):755-761.doi:10.1136/jim-2017-000631

64.

Ress

Annus

Putnik

Luts

Uibo

. Celiac disease in children with atopic dermatitis. Pediatr Dermatol. 2014;31(4):483-488.doi:10.1111/pde.12372