Clinical features and risk factors of IgE-independent atopic dermatitis in children

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Abstract

Relevance. Atopic dermatitis (AD) is an inflammatory disease characterized by a chronic course with periods of remissions and exacerbations. IgE-independent atopic dermatitis is a medical and social problem of our time, since the disease manifests itself most often in childhood and is one of the most frequent forms of dermatoses among the pediatric population. The prevalence of atopic dermatitis among children is up to 20 %, among adults - 2-8 %. Recently, there has been a significant increase in atopic diseases worldwide. The aim: to study specific features of IgE-independent atopic dermatitis in children living in a metropolis. Materials and Methods. A prospective cohort study was conducted, which included 451 children aged 5 to 14 years with a diagnosis of AD who applied for outpatient care at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology for the period 2020-2021. All parents (guardians) have given voluntary informed consent to the participation of children in the study and the publication of personal data. Examination of patients included general clinical methods, assessment of the SCORAD index and laboratory allergological examination (total and 73 specific IgE in blood serum with the most common food and aeroallergens). In 103 (22.8 %) children (57 (55.3 %) boys and 46 (44.7 %) girls), the results of the allergological analysis did not confirm concomitant allergic sensitization. Atopic dermatitis in these children was defined as IgE-independent. Results and Discussion. Predictors of the development of IgE-independent AD were hereditary predisposition [odds ratio (OR) 2.42; 95 % confidence interval (CI) 1.12-5.25], artificial feeding [OR 4.04; 95 % CI 1.46-11.20], comorbidities [OR 1.42; 95 % CI 0.57-3.52], late onset [OR 1.67; 95 % CI 0.81-3.41]. According to the SCORAD index, the majority of patients (75.7 %) had a moderate degree of AD and no seasonality. Features of skin rashes corresponded to the age periods of the course of AD: erythematous-squamous forms with lichenification foci prevailed. For the first time, the features of IgE-independent atopic dermatitis in children were shown. The role of risk factors for the development of IgE-independent atopic dermatitis in children has been shown for the first time. Conclusion. IgE-independent type of AD can be diagnosed in every fifth child with AD. The study of risk factors will allow predicting the development of this type of disease.

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Table 1. Reliability of differences in the nature of feeding children in the first year of life, depending on the presence  of a hereditary history aggravated by allergies

Сomparable sign

Group 1 (n=31)

Group 2 (n=72)

Significance  level

Frequency, %

DI, upperya facets ca

DI, lowerya facetsca

Chastota, %

DI, topnya facetsca

DI, lowerya facetsca

Exclusively breastfeeding feeding

36.7

31.5 %

42.5 %

43.1

40.4 %

47.6 %

0.01

breast feeding before 3 months

19.1

15.5 %

24.7 %

18.2

16.5 %

22.3 %

0.01

breast feeding before 6 months

13.2

8.8 %

16.4 %

14.8

8.5 %

12.9 %

0.01

breast feeding before 9 months

10.2

6.7 %

13.7 %

11.5

7.1 %

11.3 %

0.025

artificial feeding

18.3

4.0 %

9.8 %

27.8

5.0 %

8.6 %

0.025

mixed feeding

2.2

57.8 %

68.8 %

5.6

52.0 %

59.2 %

0.01

Table 2. Clinical characteristics of patients with IgE -independent AD

Index

Gender

Total

boys
N = 57

Girls
N = 46

Abs

%

Abs

%

Abs

%

Clinical and morpholo-g ical form

Erythematous- squamous

35

61.4

27

58.7

62

60

Erythematous- squamous with lichenification

22

38.6

19

41.3

41

40

Character inflammatory process

Spicy

9

15.8

7

15.2

16

16

subacute

14

24.6

13

28.3

27

26

Chronic

34

59.6

26

56.5

60

58

SCORAD

<25

16

28.1

9

19.6

25

24.3

25–50

41

71.9

37

80.4

78

75.7


Fig. 1. Consultability of patients with IgE — independent ATD during the year

Table 3. The relationship between the development of IgE -independent AD and the studied factors

Index

Regression coefficient

Standard error

p

OR (95 % CI)

Male

0.610

0.395

0.123

1.84
(0.84–3.99)

The only child in the family

-0.524

0.412

0.204

0.59
(0.26–1.33)

Artificial feeding

1.397

0.520

0.007

4.04
(1.46–11.20)

hereditary predisposition

0.884

0.395

0.025

2.42
(1.12–5.25)

Concomitant pathology

0.348

0.464

0.453

1.42
(0.57–3.52)

Late debut

0.510

0.365

0.162

1.67
(0.81–3.41)

Note: OR — odds ratio.

×

About the authors

Alaa A.M. Nemer

In-clinic

Author for correspondence.
Email: Dr.alaa.nemer@gmail.com
ORCID iD: 0000-0002-0909-482X
Moscow, Russian Federation

Olga V. Zhukova

Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology

Email: Dr.alaa.nemer@gmail.com
ORCID iD: 0000-0001-5723-6573
Moscow, Russian Federation

Galina P. Tereshchenko

Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology

Email: Dr.alaa.nemer@gmail.com
ORCID iD: 0000-0001-9643-0440
Moscow, Russian Federation

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1. Fig. 1. Consultability of patients with Ig E — independent ATD during the year

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Copyright (c) 2023 Nemer A.A., Zhukova O.V., Tereshchenko G.P.

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