How epidemiology has challenged 3 prevailing concepts about atopic dermatitis

TY - JOUR

T1 - How epidemiology has challenged 3 prevailing concepts about atopic dermatitis

AU - Williams, Hywel

AU - Flohr, Carsten

N1 - Funding Information: Disclosure of potential conflict of interest: C. Flohr receives grants/research support from the Radcliffe Research Fellowship at University College, University of Oxford, and is employed by the University of Nottingham. H. Williams has declared that he has no conflict of interest.

PY - 2006/7

Y1 - 2006/7

N2 - We challenge 3 prevailing concepts in understanding atopic dermatitis using data from epidemiologic studies. First, we show that although atopy is associated with atopic dermatitis to some degree, its importance is not likely to be a simple cause-and-effect relationship, especially at a population level. Our epidemiologic data do not exclude a contributory role for IgE-mediated immunologic processes, especially in those with existing and severe disease. Second, evidence is presented that does not support a straightforward inverse relationship between infections and atopic dermatitis risk. A link, if present, is likely to be more complex, depending critically on the timing and type of infectious exposure. Third, recent evidence suggests that the risk of subsequent childhood asthma is not increased in children with early atopic dermatitis who are not also early wheezers, suggesting a comanifestation of phenotypes rather than a progressive atopic march. Collectively, these observations underline the importance of epidemiologic studies conducted at a population level to gain a more balanced understanding of the enigma of atopic dermatitis.

AB - We challenge 3 prevailing concepts in understanding atopic dermatitis using data from epidemiologic studies. First, we show that although atopy is associated with atopic dermatitis to some degree, its importance is not likely to be a simple cause-and-effect relationship, especially at a population level. Our epidemiologic data do not exclude a contributory role for IgE-mediated immunologic processes, especially in those with existing and severe disease. Second, evidence is presented that does not support a straightforward inverse relationship between infections and atopic dermatitis risk. A link, if present, is likely to be more complex, depending critically on the timing and type of infectious exposure. Third, recent evidence suggests that the risk of subsequent childhood asthma is not increased in children with early atopic dermatitis who are not also early wheezers, suggesting a comanifestation of phenotypes rather than a progressive atopic march. Collectively, these observations underline the importance of epidemiologic studies conducted at a population level to gain a more balanced understanding of the enigma of atopic dermatitis.

KW - atopic march

KW - Atopy

KW - eczema

KW - hygiene

UR - http://www.scopus.com/inward/record.url?scp=33745361150&partnerID=8YFLogxK

U2 - 10.1016/j.jaci.2006.04.043

DO - 10.1016/j.jaci.2006.04.043

M3 - Article

C2 - 16815157

AN - SCOPUS:33745361150

SN - 0091-6749

VL - 118

SP - 209

EP - 213

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

IS - 1

ER -