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Atopic dermatitis phenotypes in preschool and school-age children: a latent class analysis

Galli E1, Maiello N2, Cipriani F3, La Grutta S4, Fasola S4, Carello R1, Caminiti L5, Licari A6, Landi M4,7, Di Mauro D8, Ricci G3, Panel of the Italian Society of Pediatric Allergy and Immunology (SIAIP)

1Pediatric Allergy Unit, San Pietro Hospital - Fatebenefratelli, Rome, Italy
2Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università della Campania Luigi Vanvitelli, Naples, Italy
3Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
4Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
5Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
6S.C. Pediatria, University of Pavia, Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
7Paediatric National Healthcare System, Torino, Italy
8Pediatric Clinic of Medicine and Surgery, University of Parma, Parma, Italy

J Investig Allergol Clin Immunol 2020; Vol. 30(2)
doi: 10.18176/jiaci.0409

Background: Atopic dermatitis (AD) represents the most common chronic inflammatory skin disease in childhood. Few data are available about the different AD phenotypes and their nationwide distribution.
Methods: We performed a cross-sectional multicentre study involving some of the main Italian paediatric allergy centres in 9 Italian cities. A structured questionnaire was administered to 371 children with AD. Patients were divided in two groups: preschool children (aged <5 years) and schoolchildren (aged 6-14 years). A latent class analysis (LCA) was used to detect AD phenotypes and to investigate their association with risk factors and other atopic diseases.
Results: LCA identified five AD phenotypes in preschoolers group (8% “moderate-severe AD, high comorbidity”, 35% “moderate-severe AD, low comorbidity”, 20% “mild AD, low comorbidity”, 32% “mild AD, respiratory comorbidity”, 5% “mild AD, food-induced comorbidity”) and four AD phenotypes in schoolchildren (24% “moderate-severe AD, high comorbidity”, 10% “moderate-severe AD, low comorbidity”, 16% “mild AD, low comorbidity”, 49% “mild AD, respiratory comorbidity”). Parental history of asthma and eczema, early day-care attendance and mould exposure were associated significantly to the “moderate-severe AD, high comorbidity” phenotype in preschool children (p<0.05). The “moderate-severe AD” phenotypes showed also to have the higher burden in terms of medication use and daily activities limitation.
Conclusions: The detection of different AD phenotypes suggests the importance of a stratified approach to the management of this complex disease and the need of further studies to predict AD course and to develop more efficient therapeutic strategies.

Key words: Atopic dermatitis, Epidemiology, Pediatrics, Quality-of-life, Environment and hygiene hypothesis

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