Children with a high burden of infections through age three face an increased risk of developing atopic dermatitis during childhood, according to a study published July 29 in JAMA Dermatology. Researchers tracked hundreds of pediatric patients across Danish and US cohorts to establish this dose-response relationship.
A high frequency of early-life infections increases a child’s susceptibility to atopic dermatitis (AD), according to a study published online July 29 in JAMA Dermatology. The research establishes a link between infection frequency during the first three years of life and subsequent diagnoses of the chronic skin condition.
Findings From the Danish COPSAC2010 Birth Cohort
The study was led by Nicklas Brustad, MD, PhD, of Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. Researchers utilized data from 663 children enrolled in the Danish Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2010) birth cohort, monitoring participants from birth through age 10 between November 2008 and November 2010. Parents recorded daily infections—including common colds, acute otitis media, tonsillitis, pneumonia, gastroenteritis, and fever—through the children’s first three years of life.
Data analysis revealed that Danish children in the upper tertile of infection episodes faced an adjusted odds ratio (AOR) of 1.63 for developing AD compared with those in the lower tertile (P = .02). Children in the upper tertile for total infection days faced an AOR of 1.80 (P < .001). Furthermore, each additional infection episode was associated with a modest increase in AD risk (AOR, 1.02; P = .03), demonstrating a dose-response relationship.
Replication in the US VDAART Cohort
To test whether these findings extended beyond the Danish population, researchers replicated the study using data from 707 children in the US VDAART cohort, followed to age six. VDAART tracked common colds, respiratory infections, otitis media, and fever, with physician-diagnosed AD serving as a primary outcome through age six.
The US cohort mirrored the Danish results. Children in the upper infection-episode tertile showed an increased risk for AD with an odds ratio of 1.76 (P = .01). Additionally, each individual infection episode raised the odds of an AD diagnosis by a factor of 1.03 (P = .002).
Specific Respiratory Infection Subtypes Linked to AD
When breaking down the data by specific illness types, researchers found that respiratory infection subtypes and otitis media were strongly linked to an AD diagnosis.
- Common colds: AOR, 1.71; P = .01
- Tonsillitis: AOR, 1.61; P = .03
- Pneumonia: AOR, 1.73; P = .01
- Acute otitis media: AOR, 1.98; P = .002
The study authors noted that early common infection burden, particularly upper respiratory infections, was associated with childhood AD, suggesting a long-term relationship that previous inconsistent findings had left unclear.
Study Design Limitations and Funding Disclosures
The authors noted several limitations in their work, pointing to the observational study design and a modest sample size that limited conclusions about temporal associations between infections and atopic dermatitis. Additionally, the study did not adjust for antibiotic exposure.
The Independent Research Fund Denmark and the LEO Foundation funded the research. Three study authors disclosed receiving personal fees, speaker fees, grants, and advisory fees from organizations including ALK, Thermo Fisher Scientific, Stallergenes Greer, LEO Foundation, TruDiagnostic, Toto, Calico, and Antipode. One author also reported a pending patent.
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