Abstract
BACKGROUND: Studies have examined the development of asthma in children with atopic dermatitis (AD); however, none have looked at the association of asthma or the frequency of wheeze with respect to persistence or difficulty in achieving AD clinical improvement in children. OBJECTIVE: To determine whether children with AD who have asthma and increasing frequency of wheezing have more persistent AD. METHODS: This is a cohort study using the Pediatric Eczema Elective Registry (PEER) database, which includes data obtained at enrollment and 3 years later. The AD outcome was the persistence of skin symptoms. Our covariates of interest were asthma diagnosis and wheezing symptoms, which were measured at enrollment and again at year 3 of the study. Multivariate logistic regression models assessed the magnitude of associations among AD symptoms, asthma diagnosis, and the frequency of wheeze. All models were adjusted for sex, age, and ethnicity. RESULTS: A total of 2104 children were enrolled in the PEER study and had at least 3 years of follow-up at the time of this study. At enrollment, an asthma diagnosis decreased the likelihood of being rash free in the preceding 6 months by 30% (odds ratio, 0.70; 95% confidence interval, 0.59-0.84). At year 3, having asthma decreased the likelihood by 40% (odds ratio, 0.60; 95% confidence interval, 0.49-0.72). Increasing frequency of wheezing also decreased the likelihood that a child was rash free (P < .001). CONCLUSION: For children with AD, a history of asthma and an increasing frequency of wheezing correlate strongly with more persistent AD.