Impact of Food Allergy on the Atopic March Progression From Atopic Dermatitis in Early Childhood to Other Atopic Disorders at School Age
Robert S. Zeiger, Michael Schatz, Botao Zhou, Julie Stern, Qiaowu Li, Sanah Basrai, Richard H. Stanford, Marissa Shams, Hernan Avella, Arun Subramaniam, Wansu Chen
Abstract
BACKGROUND: 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 to 11 years need further study. OBJECTIVE: To analyze the progression of AD with and without FA from infants and toddlers to other atopic disorders from ages 5 to 11 years. METHODS: Using electronic health records, we identified 10,688 children with AD onset (two separate International Classification of Diseases, Ninth and 10th Revisions coded AD visits and two separate AD dispensed medications) from birth to 36 months. Atopic disorders were determined based on International Classification of Diseases, Ninth and 10th Revisions coded visits. Moderate to severe asthma was defined as Global Initiative for Asthma step care level of 3 or greater for 4 or more years from ages 5 to 11 years. Unadjusted and adjusted risk ratios (aRRs) for moderate to severe asthma, allergic rhinitis (AR) plus aeroallergen sensitization, and anaphylaxis in children at aged 5 to 11 years with FA (FA+) and without FA (FA-) by age 36 months were determined by using robust Poisson regression. RESULTS: Compared with FA- (n = 8,415), FA+ (n = 2,273) children were significantly more likely (P < .001) to be male, of Asian or Pacific Islander ethnicity, have an earlier onset of AD, have more physician visits and dispensed medications for AD, and have a higher incidence of asthma visits by age 36 months. Multivariate analysis revealed increased aRRs and 99% CIs (P < 001) for the prevalences of moderate to 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). CONCLUSIONS: Early-onset FA in infants and toddlers with AD enhances the atopic march by increasing the risk from ages 5 to 11 years for future moderate to severe asthma, AR, and anaphylaxis.