Atopic dermatitis and skin disease
Does eczema in infancy cause hay fever, asthma, or both in childhood? Insights from a novel regression model of sibling data

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Background

The atopic march hypothesis proposes that eczema precedes the development of asthma and allergic rhinitis.

Objective

We sought to assess the evidence for a causal effect of infantile eczema on childhood hay fever, asthma, or both.

Methods

We used parental reports on infantile eczema and childhood asthma and hay fever for 3778 pairs of 7-year-olds matched to their sibling closest in age within 2 years from the Tasmanian Longitudinal Health Study. We analyzed paired sibling data using a logistic regression model that allowed inference about a causal effect of a familial predictor on a child's outcome by examining the change in association with their cosibling's predictor after adjusting for their own predictor status.

Results

Siblings were concordant for infantile eczema (tetrachoric correlation, 0.40). For having both hay fever and asthma by age 7 years, the association with cosibling's eczema was an odds ratio (OR) of 1.98 (95% CI, 1.37-2.86), which reduced after adjusting for own eczema to an OR of 1.65 (95% CI, 1.17-2.34). For having hay fever only, the association with cosibling's eczema was an OR of 1.68 (95% CI, 1.22-2.31) before and an OR of 1.59 (95% CI, 1.19-2.14) after adjusting for own eczema. There was no association between having asthma only and cosibling's eczema (OR, 1.00; 95% CI, 0.77-1.30).

Conclusions

Eczema in infancy might have a causal effect on hay fever in children with and perhaps without asthma. The association of infantile eczema on asthma in children without hay fever, which might be early transient wheeze, is unlikely to be causal or familial. These findings have implications for hay fever prevention.

Section snippets

Tasmania Longitudinal Health Study

The Tasmania Longitudinal Health Study (TAHS)4, 8, 9 commenced in 1968 when the parents of all Tasmanian schoolchildren (probands) born in 1961 were approached for a research study, the Tasmanian Asthma Study, a collaborative project involving the Asthma Foundation (as it was known then), Tasmanian School Medical Service staff, and researchers from the Universities of Queensland and New South Wales. Parents completed respiratory questionnaires for 8,583 probands (99%) and 21,043 of their

Results

Table I shows the characteristics of the paired siblings as individuals. It also shows that, within an individual, all 3 childhood conditions were associated with infantile eczema in decreasing order of strength from having hay fever and asthma, having asthma only, to having hay fever only. All conditions were also associated with having a parental history of the same condition. Having childhood asthma, with or without having a history of childhood hay fever, was more common in boys. After

Discussion

The most important finding of our study was that the relationships between eczema in infancy and having asthma with or without hay fever up to age 7 years seem to have different causes, as evident by Fig 1. Our data are consistent with the following scenarios. Eczema in infancy causes a substantial proportion, perhaps about 30%, of hay fever in children with a history of asthma and perhaps about 10% of hay fever in children without asthma in childhood. The approximate CIs based on bootstrapping

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    This study was conducted under the auspices of the Tasmanian Asthma Foundation, which is funded by the Department of Health Services and run by the school medical officers and school health nurses. Data entry of the 1968 baseline study was supported by the Victorian Asthma Foundation. M.C.M., A.J.L., L.C.G., S.C.D., and J.L.H. are currently supported by the National Health and Medical Research Council as a Career Development Award (CDA) Fellow, Post-doctoral Fellow, CDA Fellow, Senior Research Fellow, and Australia Fellow, respectively.

    Disclosure of potential conflict of interest: M. J. Abramson has received research support from Pfizer. The rest of the authors declare that they have no relevant conflicts of interest.

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