Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: A prospective cohort study over 4 decades
Martin, PE and Matheson, MC and Gurrin, L and Burgess, JA and Osborne, N and Lowe, AJ and Morrison, S and Meszaros, D and Giles, GG and Abramson, MJ and Walters, EH and Allen, KJ and Dharmage, SC, Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: A prospective cohort study over 4 decades, Journal of Allergy and Clinical Immunology, 127, (6) pp. 1473-1479. ISSN 0091-6749 (2011) [Refereed Article]
Background: The evidence on whether the atopic march
observed in childhood (ie, the progression from eczema to
allergic rhinitis and asthma) extends to adulthood is sparse, and
there is no evidence on whether the progression leads to a
specific phenotype of asthma.
Objective: We sought to assess whether childhood eczema and
rhinitis are risk factors for specific phenotypes of adult
Methods: Participants of the Tasmanian Longitudinal Health
Study recruited in 1968 (age range, 6.0-7.0 years) were followed
up at age 44 years. The risk of current atopic or nonatopic
asthma in middle age characterized by sensitization to
aeroallergens given childhood eczema, rhinitis, or both was
calculated by using multinomial logistic regression.
Results: No association was found between childhood eczema or
rhinitis and nonatopic adult asthma. In contrast, childhood
eczema and rhinitis in combination predicted both new-onset
atopic asthma by middle age (adjusted multinomial odds ratio
[aMOR], 6.3; 95% CI, 1.7-23.2) and the persistence of childhood
asthma to adult atopic asthma (aMOR, 11.7; 95% CI, 3.6-37.9).
Participants with childhood eczema alone were at increased risk
of new-onset atopic asthma (aMOR, 4.1; 95% CI, 1.9-8.8),
whereas rhinitis alone predicted the persistence of childhood
asthma to atopic asthma (aMOR, 2.7; 95% CI, 1.3-5.6). Of all
asthma, 29.7% of persistent atopic asthma and 18.1% of newonset
atopic asthma could be attributed to having childhood
eczema and rhinitis.
Conclusion: Childhood eczema and rhinitis are strongly
associated with the incidence and persistence of adult atopic
Eczema, asthma, rhinitis, population, childhood, adulthood, epidemiology, atopy, atopic march