Asthma and lower airway disease
Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: A prospective cohort study over 4 decades

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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 asthma.

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 new-onset 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 asthma.

Section snippets

Study population and data collection

This analysis is based on participants who attended the recent laboratory study of the TAHS. Details of the methods and some results from this study have been reported elsewhere.20, 21 In brief, TAHS commenced in 1968, when 8583 Tasmanian children, then 7 years of age, were surveyed for respiratory problems and then underwent clinical examination and lung function measurements. Parents completed a questionnaire about their child’s illnesses and other exposures. The cohort comprised 98.9% of

Results

Of 1389 laboratory study participants, 1383 (99.6%) had data available on atopy status. One thousand three hundred twenty (95.4%) had complete data on childhood allergic diseases and adult asthma and atopy and were included in the analyses.

In total, 380 (27.5%) laboratory substudy participants had current asthma at age 44 years, with 263 (69.2%) also found to be atopic. The proportion of participants with childhood asthma was highest among those with remitted asthma at age 44 years

Discussion

Our study is the first to examine at the population level the relative contribution of eczema and rhinitis, individually and in combination, with respect to persistent childhood asthma and new-onset asthma later in life, especially with regard to the differential effects on atopic and nonatopic phenotypes of asthma. We found that childhood eczema, especially in association with childhood rhinitis, is strongly associated with current atopic asthma in middle age. Additionally, childhood eczema

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    Funding for this project was obtained from the Australian National Health & Medical Research Council, the Clifford Craig Foundation, and Asthma Foundations in Tasmania, Victoria, and Queensland and the University of Melbourne. P.E.M. is an Australian Postgraduate Award scholar, K.J.A. is a Viertel Senior Medical Research Fellow, and L.G., M.C.M., A.J.L., and S.C.D. hold National Health & Medical Research Council Awards.

    Disclosure of potential conflict of interest: N. Osborne receives research support from the Australian Egg Corporation. M. J. Abramson was part of the Landmark Symposium for GlaxoSmithKline and receives research support from Reckitts Benckiser. E. H. Walters receives research support from the National Health and Research Council and the Royal Hobart Hospital Research Foundation. The rest of the authors have declared that they have no conflict of interest.

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