Pediatr Allergy Respir Dis.  2011 Sep;21(3):186-196.

Comparison of Prevalence and Risk Factors of Atopic Dermatitis by Physical Examination and Questionnaire Survey in Elementary School Children

• Lee JH
• Kim EH
• Cho J
• Kim HY
• Suh J
• Ahn K
• Cheong HK
• Lee SI

Abstract

PURPOSE
The present study aimed to evaluate the accuracy of determining the prevalence of atopic dermatitis (AD) with a questionnaire by diagnosing AD with both a questionnaire and pediatricians' physical examinations and to determine the possible risk factors for AD.
METHODS
A survey was conducted from December 2008 to February 2009 in four elementary schools. The Korean version of the International Study of Asthma and Allergies in Childhood written questionnaire (WQ) was used to identify AD ever and AD during the last 12 months. Current AD was diagnosed by well-trained pediatricians according to the Hanifin and Rajka's diagnostic criteria. A total of 2,729 children who completed the questionnaire and underwent a physical examination by pediatricians were included in this analysis.
RESULTS
According to the WQ, the prevalence of AD in the entire life and in the last 12 months was 18.4% and 12.9%, respectively. The prevalence of clinically diagnosed AD by pediatricians was 8.8%. There was a significant positive relationship between the prevalence of AD diagnosed by physical examination and past history of allergic rhinitis (adjusted odds ratio [aOR], 1.45), allergy history of the mother (aOR, 2.48), and AD history of the mother (aOR, 1.61). According to the WQ, there was also a significant positive relationship between the prevalence of AD in the last 12 months and past history of asthma (aOR, 2.55) and AD history of the mother (aOR, 1.71).
CONCLUSION
Prevalence and risk factors of AD were different according to the survey methods. When prevalence of AD is determined with a questionnaire in the future, more careful attention should be used, because the result can be overestimated compared to the actual prevalence.

Keyword

Atopic dermatitis; Prevalence; Children; Risk factors; ISAAC

MeSH Terms

Asthma
Child
Dermatitis, Atopic
Humans
Hypersensitivity
Mothers
Odds Ratio
Physical Examination
Prevalence
Surveys and Questionnaires
Rhinitis
Rhinitis, Allergic, Perennial
Risk Factors

Figure

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  Fig. 1. Scheme of subject eligibility for this study. AD, atopic dermatitis.

Reference

References

1. Sturgill S, Bernard LA. Atopic dermatitis update. Curr Opin Pediatr. 2004; 16:396–401.

2. Barnetson RS, Rogers M. Childhood atopic eczema. BMJ. 2002; 324:1376–9.

3. Sears MR. Epidemiology of childhood asthma. Lancet. 1997; 350:1015–20.

4. Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR. International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008; 121:947–54.e15.

5. Purvis DJ, Thompson JM, Clark PM, Robinson E, Black PN, Wild CJ, et al. Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age. Br J Dermatol. 2005; 152:742–9.

6. Hong SJ, Ahn KM, Lee SY, Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008; 51:343–50.

7. Kim YH, Kim JW, Houh W. A study on incidence and genetic background of atopic dermatitis. Korean J Dermatol. 1979; 17:105–10.

8. Kim SH, Kim SJ, Park HS, Lee CH, Yoon HS. A survey of the distribution of allergic diseases in low grade children on primary school. J Korean Pediatr Soc. 1988; 31:1290–300.

9. Ahn YM, Choi EY. The result of skin prick tests with 9 common aeroallergen in Korea and RAST reactivity to D. farinae in a community school children. Allergy. 1990; 10:213–25.

10. Shin TS, Lee GJ, Yoon HS. A survey of the distribution of allergic diseases in primary schoolchildren. Allergy. 1990; 10:201–12.

11. Kim JW, Lee WC, Lee SC, Byun DG. The prevalence and clinical features of atopic dermatitis in kindergarten children in Puchon city, Kyonggi-Do. Allergy. 1995; 15:639–49.

12. Lee SC, Byun DG, Lee WC, Kim JW. The prevalence and some minor clinical features of atopic dermatitis. Korean J Dermatol. 1995; 33:1–7.

13. Kim CW, Park CJ, Kim JW, Koo DW, Kim KW, Kim TY. Prevalence of atopic dermatitis in Korea. Acta Derm Venereol. 2000; 80:353–6.

14. Lee SI, Shin MH, Lee HB, Lee JS, Son BK, Koh YY, et al. Prevalences of symptoms of asthma and other allergic diseases in Korean children: a nationwide questionnaire survey. J Korean Med Sci. 2001; 16:155–64.

15. Oh JW, Kim KE, Pyun BY, Lee HR, Choung JT, Hong SJ, et al. Nationwide study for epidemiological change of atopic dermatitis in school aged children between 1995 and 2000 and kindergarten aged children in 2003 in Korea. Pediatr Allergy Respir Dis(Korea). 2003; 13:227–37.

16. Jee HM, Kim KW, Kim CS, Sohn MH, Shin DC, Kim KE. Prevalence of asthma, rhinitis and eczema in Korean children using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Pediatr Allergy Respir Dis(Korea). 2009; 19:165–72.

17. Lee HY, Lee JR, Roh JY. Epidemiological features of preschool childhood atopic dermatitis in Incheon. Korean J Dermatol. 2009; 47:164–71.

18. Popescu CM, Popescu R, Williams H, Forsea D. Community validation of the United Kingdom diagnostic criteria for atopic dermatitis in Romanian schoolchildren. Br J Dermatol. 1998; 138:436–42.

19. Kalyoncu AF, Selçuk ZT, Enünlü T, Demir AU, Cöplü L, Sahin AA, et al. Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart. Pediatr Allergy Immunol. 1999; 10:261–5.

20. Marks R, Kilkenny M, Plunkett A, Merlin K. The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis. Br J Dermatol. 1999; 140:468–73.

21. Laughter D, Istvan JA, Tofte SJ, Hanifin JM. The prevalence of atopic dermatitis in Oregon schoolchildren. J Am Acad Dermatol. 2000; 43:649–55.

22. Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE. Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The odense adolescence cohort study on atopic diseases and dermatitis. Br J Dermatol. 2001; 144:523–32.

23. Tay YK, Kong KH, Khoo L, Goh CL, Giam YC. The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children. Br J Dermatol. 2002; 146:101–6.

24. Werner S, Buser K, Kapp A, Werfel T. The incidence of atopic dermatitis in school entrants is associated with individual lifestyle factors but not with local environmental factors in Hannover, Germany. Br J Dermatol. 2002; 147:95–104.

25. Haileamlak A, Lewis SA, Britton J, Venn AJ, Woldemariam D, Hubbard R, et al. Validation of the International Study of Asthma and Allergies in Children (ISAAC) and U.K. criteria for atopic eczema in Ethiopian children. Br J Dermatol. 2005; 152:735–41.

26. Saeki H, Iizuka H, Mori Y, Akasaka T, Takagi H, Kitajima Y, et al. Prevalence of atopic dermatitis in Japanese elementary schoolchildren. Br J Dermatol. 2005; 152:110–4.

27. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980; 92:(. (Suppl):44–7.

28. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993; 186:23–31.

29. Choi SW, Ju YS, Kim DS, Kim JY, Kwon HJ, Kang DH, et al. Reliability and validity of the Korean version of ISAAC questionnaire. Korean J Prev Med. 1998; 31:361–71.

30. Topf M. Three estimates of interrater reliability for nominal data. Nurs Res. 1986; 35:253–5.

31. Vickers CF. The natural history of atopic eczema. Acta Derm Venereol. 1980; 92:113–5.

32. Schultz Larsen F. The epidemiology of atopic dermatitis. Monogr Allergy. 1993; 31:9–28.

33. Moore MM, Rifas-Shiman SL, Rich-Edwards JW, Kleinman KP, Camargo CA Jr, Gold DR, et al. Perinatal predictors of atopic dermatitis occurring in the first six months of life. Pediatrics. 2004; 113(3 Pt 1):468–74.

34. Kim H, Jang EY, Sim JH, Kim JH, Chung Y, park SH, et al. Effects of family history on the occurrence of atopic dermatitis in infants. Pediatr Allergy Respir Dis(Korea). 2009; 19:106–14.

35. Ministry of Environment. Health effect of environmental exposure in children. Gwacheon: Ministry of Environment. 2008.