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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 F3, 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 for Biomedical Research and Innovation, 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
7National Pediatric Healthcare System, Torino, Italy
8Pediatric Clinic of Medicine and Surgery, University of Parma, Parma, Italy

J Investig Allergol Clin Immunol 2020; Vol 30(2) : 108-116
doi: 10.18176/jiaci.0409

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in childhood. Few data are available about AD phenotypes and their nationwide distribution.
Methods: We performed a cross-sectional multicenter study involving some of the main Italian pediatric allergy centers from 9 Italian cities. A structured questionnaire was administered to 371 children with AD. Patients were divided in 2 groups: preschool children (aged ≤5 years) and schoolchildren (aged 6-14 years). A latent class analysis was used to detect AD phenotypes and to investigate their association with risk factors and other atopic diseases.
Results: Latent class analysis identified 5 AD phenotypes in preschoolers (“moderate-severe AD, high comorbidity”, 8%; “moderatesevere AD, low comorbidity”, 35%; “mild AD, low comorbidity”, 20%; “mild AD, respiratory comorbidity”, 32%; “mild AD, food-induced comorbidity”, 5%) and 4 AD phenotypes in schoolchildren (“moderate-severe AD, high comorbidity”, 24%; “moderate-severe AD, low comorbidity”, 10%; “mild AD, low comorbidity”, 16%; “mild AD, respiratory comorbidity”, 49%). Parental history of asthma and eczema, early day-care attendance, and exposure to molds were significantly associated with the “moderate-severe AD, high comorbidity” phenotype in preschool children (P<.05). The “moderate-severe AD” phenotypes were also associated with the highest burden in terms of medication use and limitations in daily activities.
Conclusions: The detection of different AD phenotypes highlights the need for a stratified approach to the management of this complex disease and for further studies to predict the course of AD and to develop more efficient therapeutic strategies.

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

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