Department of Medicine, McMaster University, Hamilton, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Clin Exp Allergy. 2018 Jan;48(1):48-59. doi: 10.1111/cea.13063. Epub 2017 Dec 15.
While allergic sensitization and atopic dermatitis (AD) are known to increase the risk for allergic diseases, the impact of different temporal and clinical patterns of sensitization and AD is less well defined.
We investigated patterns of sensitization and AD from early infancy to age 3, and the differential risk of developing allergic diseases within each pattern in a general cohort.
Children (n = 2629) from the Canadian Healthy Infant Longitudinal Development (CHILD) Study underwent skin prick tests and were assessed clinically for AD at ages 1 and 3 years. We applied an unsupervised latent class analysis (LCA) to the following 5 factors at these ages: AD, food sensitization, inhalant sensitization, poly-sensitization to foods and poly-sensitization to inhalants. The risks for developing asthma, allergic rhinitis and food allergy at 3 years were evaluated for each identified group.
Five distinct classes were revealed by LCA: healthy (81.8%), atopic dermatitis (7.6%), inhalant sensitization (3.5%), transient sensitization (4.1%) and persistent sensitization (3.2%). Using healthy children as the baseline, children in the "atopic dermatitis" group had the next lowest risk for all allergic outcomes at 3 years; those in the "inhalant sensitization" group had the highest risk for allergic rhinitis; children in the "transient sensitization" group were at an increased risk for food allergy; while children in the "persistent sensitization" group had the highest risk for all allergic diseases.
There is substantial heterogeneity among allergen-sensitized children. Researchers and clinicians need to be aware of the non-specificity associated with labelling children simply as "atopic" and "non-atopic" without considering the timing of their atopic history, type of sensitization and AD status. Children with AD who were poly-sensitized to foods at an early age appear to be at greatest risk of developing other allergic diseases.
虽然过敏致敏和特应性皮炎（AD）已知会增加过敏疾病的风险，但致敏和 AD 的不同时间和临床模式的影响尚未得到很好的定义。
我们研究了从婴儿早期到 3 岁时的致敏和 AD 模式，以及在一般队列中，每种模式下发展过敏疾病的差异风险。
来自加拿大健康婴儿纵向发展（CHILD）研究的儿童（n=2629）在 1 岁和 3 岁时接受了皮肤点刺试验，并进行了 AD 临床评估。我们在这两个年龄应用了一种无监督潜在类别分析（LCA），用于以下 5 个因素：AD、食物致敏、吸入物致敏、食物和吸入物多致敏。评估了每个识别组在 3 岁时发展哮喘、过敏性鼻炎和食物过敏的风险。
LCA 揭示了 5 个不同的类别：健康（81.8%）、特应性皮炎（7.6%）、吸入物致敏（3.5%）、一过性致敏（4.1%）和持续性致敏（3.2%）。以健康儿童为基线，“特应性皮炎”组的儿童在 3 岁时所有过敏结局的风险最低；“吸入物致敏”组的儿童患过敏性鼻炎的风险最高；“一过性致敏”组的儿童患食物过敏的风险增加；而“持续性致敏”组的儿童患所有过敏疾病的风险最高。
过敏致敏儿童之间存在很大的异质性。研究人员和临床医生需要意识到，简单地将儿童标记为“特应性”和“非特应性”而不考虑其特应性病史、致敏类型和 AD 状态的时间，与标签的非特异性有关。在早期对食物多致敏的 AD 儿童似乎患其他过敏疾病的风险最大。
