Belgrave Danielle C M, Granell Raquel, Simpson Angela, Guiver John, Bishop Christopher, Buchan Iain, Henderson A John, Custovic Adnan
Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom; Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
PLoS Med. 2014 Oct 21;11(10):e1001748. doi: 10.1371/journal.pmed.1001748. eCollection 2014 Oct.
The term "atopic march" has been used to imply a natural progression of a cascade of symptoms from eczema to asthma and rhinitis through childhood. We hypothesize that this expression does not adequately describe the natural history of eczema, wheeze, and rhinitis during childhood. We propose that this paradigm arose from cross-sectional analyses of longitudinal studies, and may reflect a population pattern that may not predominate at the individual level.
Data from 9,801 children in two population-based birth cohorts were used to determine individual profiles of eczema, wheeze, and rhinitis and whether the manifestations of these symptoms followed an atopic march pattern. Children were assessed at ages 1, 3, 5, 8, and 11 y. We used Bayesian machine learning methods to identify distinct latent classes based on individual profiles of eczema, wheeze, and rhinitis. This approach allowed us to identify groups of children with similar patterns of eczema, wheeze, and rhinitis over time. Using a latent disease profile model, the data were best described by eight latent classes: no disease (51.3%), atopic march (3.1%), persistent eczema and wheeze (2.7%), persistent eczema with later-onset rhinitis (4.7%), persistent wheeze with later-onset rhinitis (5.7%), transient wheeze (7.7%), eczema only (15.3%), and rhinitis only (9.6%). When latent variable modelling was carried out separately for the two cohorts, similar results were obtained. Highly concordant patterns of sensitisation were associated with different profiles of eczema, rhinitis, and wheeze. The main limitation of this study was the difference in wording of the questions used to ascertain the presence of eczema, wheeze, and rhinitis in the two cohorts.
The developmental profiles of eczema, wheeze, and rhinitis are heterogeneous; only a small proportion of children (∼ 7% of those with symptoms) follow trajectory profiles resembling the atopic march. Please see later in the article for the Editors' Summary.
“特应性进程”一词用于表示儿童期一系列症状从湿疹自然发展为哮喘和鼻炎的过程。我们推测，这种表述并不能充分描述儿童期湿疹、喘息和鼻炎的自然病程。我们认为，这种模式源于纵向研究的横断面分析，可能反映的是一种群体模式，在个体层面上可能并不占主导。
来自两个基于人群的出生队列中的9801名儿童的数据，用于确定湿疹、喘息和鼻炎的个体特征，以及这些症状的表现是否遵循特应性进程模式。在1岁、3岁、5岁、8岁和11岁时对儿童进行评估。我们使用贝叶斯机器学习方法，根据湿疹、喘息和鼻炎的个体特征识别不同的潜在类别。这种方法使我们能够识别出随时间推移具有相似湿疹、喘息和鼻炎模式的儿童群体。使用潜在疾病特征模型，数据最适合用八个潜在类别来描述：无疾病（51.3%）、特应性进程（3.1%）、持续性湿疹和喘息（2.7%）、持续性湿疹伴迟发性鼻炎（4.7%）、持续性喘息伴迟发性鼻炎（5.7%）、短暂性喘息（7.7%）、仅湿疹（15.3%）和仅鼻炎（9.6%）。对两个队列分别进行潜在变量建模时，得到了相似的结果。高度一致的致敏模式与不同的湿疹、鼻炎和喘息特征相关。本研究的主要局限性在于，用于确定两个队列中湿疹、喘息和鼻炎存在情况的问题措辞有所不同。
湿疹、喘息和鼻炎的发展特征是异质性的；只有一小部分儿童（约占出现症状儿童的7%）遵循类似于特应性进程的轨迹特征。编者总结见本文后文。
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