Abstract
IMPORTANCE: Patterns of incidence and factors associated with remission of atopic dermatitis (AD) from birth to adulthood remain understudied. OBJECTIVES: To examine incidence of AD, its remission probability and trajectories, and early-life factors associated with it in a prospective study from birth to 30 years. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the population-based Multicenter Allergy Study (MAS), which recruited full-term newborns from 5 German cities in 1990. Generally healthy newborns were enrolled; the sample was slightly enriched for allergy risk, with more than a third of participants born with 2 parents or siblings with allergies. Until age 30 years, participants were assessed by parental or self-report questionnaires (20 times) and clinical evaluations, including serum samples (9 times). EXPOSURES: Age, sex, age of AD onset, parental allergy status, early-life sensitization against common food and aero-allergens, rhinitis during ages 3 to 5 years, and asthma at age 6 years. MAIN OUTCOMES AND MEASURES: AD was determined by standardized questionnaire and doctor's diagnoses. AD remission was defined as being symptom-free for at least 12 months. RESULTS: Among 1314 recruited participants, 707 (57%) had 1 or 2 allergic parents. Overall, 482 (37%) participated at the 30-year follow-up. The cumulative incidence of AD during the first 5 years was 57% (402 participants) with 1 or 2 allergic parents and 43% (225 participants) with nonallergic parents. The yearly rate of new AD cases declined from age 2 until 13 years and increased slightly thereafter. Among 529 participants with AD onset in the first 5 years of life, 459 (87%) reported no symptoms at age 20 and 30 years. Using data from 658 participants, 4 remission trajectories were identified: early childhood, early school age, substantial adolescence, and partial adulthood remission. Onset within first 2 years of life (adjusted risk ratio [aRR], 1.59; 95%- CI, 1.12-2.26), female sex (aRR, 1.56; 95% CI, 1.23-2.00), early allergic sensitization against at least 1 common aero- or food allergen (aRR, 1.95; 95% CI, 1.25-3.05), asthma at age 6 years (aRR, 2.22; 95% CI, 1.70-2.89), and allergic rhinitis at ages 3 to 5 years (aRR, 1.54; 95% CI, 1.21-1.95) were associated with the persistent phenotype. CONCLUSIONS AND RELEVANCE: In this cohort study of children with allergic diseases, AD before school age was generally associated with a favorable long-term prognosis. However, remission was less likely in female participants, those with onset before age 2 years, those with specific serum antibodies to common allergens before school age, or those with allergic comorbidity, highlighting the need for increased clinical attention and further investigation into underlying mechanisms.