Atopic Dermatitis in Early Life: Evidence for at Least Three Phenotypes? Results from the GUSTO Study

Background: Atopic dermatitis (AD) has been highlighted as a likely first step in the 'atopic march', emphasizing the need to define predisposing factors. Methods: We evaluated AD risk factors and phenotypes in an Asian mother-offspring cohort. We defined three phenotypes of doctor-diagnosed AD based on the time of onset of the disease: early AD occurring within the first 6 months of life, AD occurring between 6 and 12 months and late-onset AD starting after the age of 12 months. Results: Maternal allergic history was associated with an increased risk of developing early-onset AD (adjusted odds ratio (aOR) 20.46, 95% confidence interval (CI) 2.73-153.15, p < 0.01). Maternal allergic history and attendance at a daycare centre increased the odds of the development of AD between 6 and 12 months (aOR 4.19, 95% CI 1.01-17.45, p = 0.049 and aOR 11.42, 95% CI 1.49-87.50, p = 0.02, respectively). Risk factors associated with increased odds of late-onset AD from 12 months were the consumption of probiotics between the age of 9 and 12 months and antibiotic treatment in the first 6 months of life (aOR 4.32, 95% CI 1.07-17.45, p = 0.04 and aOR 3.11, 95% CI 1.10-8.76, p = 0.03, respectively). Early-onset AD was associated with an increased risk of developing allergic sensitization (aOR 46.51, 95% CI 3.44-628.81, p < 0.01). Conclusion: We found that early-onset AD was mainly associated with familial factors, while late-onset AD was associated with the consumption of antibiotics or probiotics. The findings support the concept that different phenotypes of AD exist in young children. (C) 2015 S. Karger AG, Basel