Zeiger Robert S, Schatz Michael, Zhou Botao, Stern Julie A, Li Qiaowu, Basrai Sanah, Stanford Richard H, Shams Marissa, Avella Hernan, Subramaniam Arun, Chen Wansu
Department of Allergy Kaiser Permanente Southern California (KPSC), San Diego, CA, USA; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA; Department of Research and Evaluation, KPSC, Pasadena, CA, USA.
Department of Allergy Kaiser Permanente Southern California (KPSC), San Diego, CA, USA.
J Allergy Clin Immunol Pract. 2025 May 7. doi: 10.1016/j.jaip.2025.05.001.
The relationship between food allergy (FA) in children with atopic dermatitis (AD) aged birth to 36 months and the prevalence of other atopic disorders at ages 5-11 years needs further study.
To analyze the progression of AD with and without FA from infancy/toddlers to other atopic disorders from ages 5-11 years.
Using electronic health records, 10,688 children with AD onset (2 separate ICD-9/10 coded AD visits and 2 separate AD dispensed medications) from birth to 36 months were identified. Atopic disorders were determined based on ICD-9/10 coded visits. Moderate-severe asthma was defined as GINA-step care level of ≥3 for ≥4 years from ages 5-11 years. Unadjusted and adjusted risk ratios for moderate-severe asthma, allergic rhinitis (AR) plus aeroallergen sensitization, and anaphylaxis in children at aged 5-11 years with FA (FA+) and without FA (FA-) by age 36 months were determined by using Robust Poisson Regression.
Compared to FA- (N=8,415), FA+ (N=2,273) children were significantly more likely (P<.001) to be male, of Asian/Pacific Islander ethnicity, have an earlier onset of AD, have more physician visits and dispensed medications for AD, and have higher incidence of asthma visits by age 36 months. Multivariate analysis revealed increased adjusted risk ratios (aRR, 99% CI) (P<.001) for the prevalences of moderate-severe asthma (aRR:1.42, 1.14-1.76), AR (aRR:1.34, 1.19-1.51), and anaphylaxis (aRR: 1.69, 1.33-2.15).
Early-onset FA in infants/toddlers with AD enhances the atopic march by increasing the risk from ages 5-11 years for future moderate-severe asthma, AR, and anaphylaxis.
出生至36个月大的特应性皮炎（AD）患儿的食物过敏（FA）与5至11岁时其他特应性疾病的患病率之间的关系有待进一步研究。
分析5至11岁时患或未患FA的AD患儿从婴幼儿期到其他特应性疾病的病情进展。
利用电子健康记录，识别出10688名出生至36个月大时首次出现AD（有2次独立的ICD-9/10编码的AD就诊记录和2次独立的AD配药记录）的儿童。根据ICD-9/10编码的就诊记录确定特应性疾病。中度至重度哮喘定义为5至11岁期间连续4年及以上GINA分级护理水平≥3级。采用稳健泊松回归法确定36个月大时患FA（FA+）和未患FA（FA-）的5至11岁儿童患中度至重度哮喘、过敏性鼻炎（AR）加吸入性过敏原致敏以及过敏反应的未调整和调整风险比。
与FA-组（N = 8415）相比，FA+组（N = 2273）儿童更有可能（P <.001）为男性、亚裔/太平洋岛民种族、AD发病更早、因AD看医生和配药的次数更多，且36个月大时哮喘就诊发生率更高。多变量分析显示，中度至重度哮喘（调整风险比[aRR]：1.42，99%可信区间[CI]：1.14 - 1.76）、AR（aRR：1.34，1.19 - 1.51）和过敏反应（aRR：1.69，1.33 - 2.15）的患病率调整风险比升高（P <.001）。
婴幼儿期AD患儿的早发性FA通过增加5至11岁时未来患中度至重度哮喘、AR和过敏反应的风险，加剧了特应性进程。
