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

Allergy. 2023 Aug;78(8):2181-2201. doi: 10.1111/all.15721. Epub 2023 Apr 16.

Authors

Laura Maintz^{1

2}, Marie-Therese Schmitz^{2

3}, Nadine Herrmann^{1

2}, Svenja Müller^{1

2}, Regina Havenith^{1

2}, Juliette Brauer^{1

2}, Claudio Rhyner^{2

4

5}, Anita Dreher^{2

5}, Eugen Bersuch^{2

6}, Danielle Fehr^{2

6

7}, Gertrud Hammel^{2

8

9}, Matthias Reiger^{2

8

9}, Daria Luschkova^{2

8

9}, Avidan Neumann^{2

8

9}, Claudia C V Lang^{2

6}, Ellen D Renner^{10

11}, Peter Schmid-Grendelmeier^{2

6}, Claudia Traidl-Hoffmann^{2

8

9}, Cezmi A Akdis^{2

4}, Roger Lauener^{2

12}, Marie-Charlotte Brüggen^{2

6

7

13}, Matthias Schmid³, Thomas Bieber^{1

2

5}

Affiliations

¹ Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany.
² Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
³ Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany.
⁴ Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
⁵ DavosBioSciences, Davos, Switzerland.
⁶ Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
⁷ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
⁸ Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
⁹ Institute of Environmental Medicine Helmholtz Zentrum München, German Research Center for Environmental Health, Augsburg, Germany.
¹⁰ Translational Immunology of Environmental Medicine, School of Medicine, Technical University of Munich, Munich, Germany.
¹¹ Department of Pediatrics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
¹² Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
¹³ Hochgebirgsklinik Davos, Davos, Switzerland.

PMID: 36946297
DOI: 10.1111/all.15721

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.

Keywords: adult-onset; associated factor; atopic dermatitis; childhood-onset; phenotype.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Age of Onset
Child
Cross-Sectional Studies
Dermatitis, Atopic* / complications
Dermatitis, Atopic* / etiology
Food Hypersensitivity* / complications
Humans
Infant
Risk Factors