Epidemiology

Bibliographic informationStudy type and evidence levelNumber of patientsPatient characteristicsIntervention and comparisonFollow-up and outcome measuresEffect sizeReviewer comments
Bohme M; Svensson A; Kull I; Nordvall SL; Wahlgren CF;

2001 Jun

149
Study Type: Case-control

Evidence level: 2-
320 (221 cases, 99 controls)Part of a community- based birth cohort of 2256 children (the BAMSE study).
Cases (those with an itchy rash for 2 weeks or more) first seen at the clinic before 25 months of age were included.
At about 2 years (median 25 months, range 20–29 months) children with atopic eczema were systematically re- examined.
Controls were also examined at about 2 years (median 27 months, range 23–32 months). They had no history of eczema at 1 or 2 years (questionnaire and telephone interview respectively).
Intervention: Cases - children with atopic eczema

Comparison: Control group - no atopic eczema
Follow-up period:

Outcome Measures: 1) Sensitisation*

2) Sensitisation and severity of AE (SCORAD)
1) 27% had at least one positive skin prick reaction. Positive reactions: 21% to hen’s egg white, 15% peanut, 8% cow’s milk, 2% cod, 2% wheat, 1% soya.

The IgE test result was positive in 15%.

2) No data, but it was reported that there was no significant difference in objective SCORAD scores in sensitised and non-sensitised cases with ongoing eczema.
Funding: Swedish Asthma and Allergy Association, the Swedish Foundation for Health Care Sciences and Allergy Research.

All skin examinations were carired out by the same dermatologist.

The Hanifin and Rajka criteria were used to diagnose atopic eczema.

*Specific IgE to inhalants and foods were measured in 212 cases (96%). Results were recorded as positive or negative (not defined).
Skin prick testing was done in 97% of cases. A positive reaction was defined as a reaction at least half the diameter of the reaction to the positive control, and not less than 3mm in diameter.
Bieber T;

2002

114
Study Type: Systematic review - meta- analysis

Evidence level: 3
30 studies (26 in children)Adults and childrenIntervention: Search of Medline (1966 to August 2000) and Embase (1977 to August 2000) Study type not restricted. English language only.
Prevalence of atopic eczema

Comparison: NA
Follow-up period:

Outcome Measures: Prevalence
30 studies published between 1990 and 2000 (26 in children).

In UK (5 studies):
14% (n=322) aged 1–4 years (history and examination by trained observer in 1992).
10.7% (n=413) in 1 year olds (dermatologist examination, 1993)
11.7% (n=693) in 3–11 year olds, dermatologists examination, 1994)
8.5% (n=695) in 3–11 year olds, dermatologists examination, 1995)
14.2% (n=260) in 4 year olds (dermatologists examination, 1996)

12-month period prevalence 16.5% (by history and dermatologists examination in 1 to 5 year olds, n = 695)
Williams H;

2000

115
Study Type: Systematic review - meta- analysis

Evidence level: 3
8 studiesAdults and childrenIntervention: Epidemiological data

Comparison: N/A
Follow-up period:

Outcome Measures: Age of onset
Location
Severity
Long term prognosis
Concurrent asthma, hay fever and allergic rhinitis
8 studies identified based in hospital patients or specialist clinics.
The age of onset of atopic eczema was before 1 year of age in between 42% (n = 100) and 88% (n = 121) of the children.

The review also found two studies investigating the age of onset of atopic eczema in the community. One a historical cohort study based in the UK found 66% developed atopic eczema by the age of 7 years (n = 6877, up to the age of 16). The second study, a retrospective questionnaire, found 63% developed atopic eczema by the age of 7 years (n = 694, aged 14 years).

Severity of atopic eczema reported in 5 studies. “65 to 90% of cases in the community being mild severity and 1 to 2% classified as severe”

25 studies investigated the long-term prognosis of atopic eczema; 22 included children aged under 12 years at study inception (studies were reported between 1930 and 1997). Data for studies that included children at inception are reported here. The countries in which the studies were conducted were not clear. Most of the studies included individuals who had been treated as hospital inpatients or outpatients. Data were gathered by questionnaire and/or physical examination; losses to follow- up were common, ranging from about 3% to 73% (median 31%). The studies suggest that atopic eczema is a chronic condition, with a 10-year clearance rate of 50–70%, although a wide range of clearance rates over varying follow-up periods have been reported (11–92%). Several studies found that individuals who were apparently clear of atopic eczema subsequently experienced a relapse at a later point, which may reflect differences in use of terms such as clearance and remission.

6 studies reported concurrent or subsequent asthma, hay fever or allergic rhinitis:
Asthma in 10 to 53%
Hay fever in 33 to 78%
Allergic rhinitis in 12 to 28%.
The author was contacted for methodological details of this review. He confirmed that this was conducted as a systematic review, although the search strategy, inclusion/exclusion criteria etc were not specified in the chapter and so the review cannot easily be replicated/updated using information from the book chapter alone, and therefore the review has been assigned an evidence level of 3 (as a narrative review)
Vicencio JCA; Gonzalez-Andaya AM;

2005

150
Study Type: Cross-sectional

Evidence level: 3
50Children aged 2 months to 16 years (mean 3.5 years), diagnosed with atopic eczema using Hanifin and Rajka criteria. 66% of the children had mild atopic eczema, 28% moderate and 6% severe (measured using the SASSAD scale).

42% had a personal history of atopy (52% asthma, 19% allergic rhinitis, 24% asthma and allergic rhinitis, 5% urticaria).
Intervention: Sensitisation to different allergens at different ages

Comparison: N/A
Follow-up period:

Outcome Measures: 1) Sensitisation

2) Relationship between atopic eczema and sensitisation
1) Positive skin prick test: 64% (51.5% of those with mild atopic eczema, 88.2% with moderate-severe).

2) A significant association between sensitisation to food and/or inhalants and the severity of atopic eczema was reported (p=0.033).

Odds of developing moderate/severe eczema was 4.4 times greater in children who developed sensitisation to any one of the allergens than in those who did not (95% CI 1.06–18.2).
Funding: none declared.
Skin Prick Tests; in children 2 years or younger the following allergens were tested: cow’s milk, egg white and yolk, shellfish, soya, tuna, peanut, HDM, cat pelt, dog epithelium, Bermuda grass and Kapok.

Children older than 2 years were tested for the following allergens
Cow’s milk, egg yolk and white, fish, soy, tuna, peanut, wheat, cocoa bean, HDM, cat pelt, dog epithelium, Bermuda grass, Acacia, Kapok, mixed moulds, and cock roach.

A positive skin test was given by a wheal size that measured at least 3 mm in diameter, or a wheal that was larger than the negative control (saline).
Bibliographic informationStudy type and evidence levelAim of studyNumber of patients and patient characteristicsPopulation characteristicsOutcome measuresResults and commentsReviewer comment
Ben-Gashir MA; Seed PT; Hay RJ;

2004 Mar

133
Study Type: Other

Evidence Level: 3
Intervention: Survey of children with atopic eczema from general practices, involving an interview and clinical examination.
Looked at atopic eczema:
Severity using SCORAD
Age at first presentation
Concurrent conditions

Comparison:
137Children aged 5 to 10 years old who were diagnosed with eczema1) Severity

2) Age at first presentation

3) Concurrent conditions
1) Mild (SCORAD ≤ 15) in 80%,
Moderate (SCORAD 16–40) in 18%
Severe (SCORAD >40) in 2%

2) < 1 year 68% (93/137)
1–2 years 16% (21/137)
2–6 years 13% (18/137)
≥7 years 3% (4/137)

Odds ratio for severity:
If onset was during first year of life: non adjusted 2.1 95% CI 1.2–3.3, p = 0.006
Adjusted 2.1 95% CI 1.2–3.2, p = 0.008

3) Asthma: 43% (59/137)
Hay fever: 45% (62/137)
Asthma and/or Hay fever: 64% (87/137)

Odds ratio for severity:
If child also had Asthma: non adjusted 1.95 95% CI 1.34–3.34, p = 0.016
Adjusted 2.0 95% CI 1.1–3.6, p = 0.021
If child also had Hay fever: non adjusted 2.49 95% CI 1.44–4.3, p = 0.001
Adjusted 2.42 95% CI 1.39–4.2, p = 0.002
As only children aged 5–10 years old were included in the study the children who developed atopic eczema at a later age would not have been included, leading to an increased number of children developing eczema at an early age. Likewise the study would have missed the children who developed asthma or hay fever at a later age, leading to an underestimate in the children who had concurrent asthma and hay fever.
Broberg A; Svensson A; Borres MP; Berg R;

2000 Nov

534
Study Type: Other

Evidence Level: 3
Intervention: Questionnaire asked:
1. Has your child ever had eczema?
2. Does your child have active eczema?

Clinical examination performed by dermatologist
Severity

Comparison:
1961Children scheduled for a health visit at 5.5 years of age, 1219 in Goteborg and 742 in Kristianstad SwedenPrevalenceParental reporting:
Active eczema 16%, 167/1219 in Goteborg and 16%, 119/742 in Kristianstad
Eczema any time 37%, 447/1219 in Goteborg and 33%, 243/742 in Kristianstad (overall 690/1961, 35.2%)
Never had eczema 63%, 772/1219 in Goteborg and 67%, 499/742 in Kristianstad
Of children reported to have active eczema by parents, on examination by a dermatologist the point prevalence was 8.5% (95% CI 7.0, 10.1) in Goteberg, and 11.5% (9.2, 13.8) in Kristianstad.

Severity of visible eczema (In 155/157 children with visible eczema at examination):
Mean SCORAD score 20.5 (95% CI 18.7 to 22.3), median 19.6
Funding: Swedish Asthma Allergy Association
Emerson RM; Williams HC; Allen BR;

1998

123
Study Type: Other

Evidence Level: 3
Intervention: Questionnaire survey

Comparison: N/A
1760Children aged 1–5 years from general practices in Nottingham1) 12 month period prevalence

2) Referral rate

3)
1) 16.5%

2) 6% (17/290; 11 to hospital dermatologist, 4 to private dermatologist, 2 to paediatrician, and 6 to accident and emergency)

Referral rate was higher in severe disease (43%) than moderate (15%) or mild (3%).
Funding: Novartis

AE diagnosed by a dermatologist.

Reasons for referral were not given.
Burr ML; Butland BK; King S; Vaughan-Williams E;

1989 Oct

535
Study Type: Other

Evidence Level: 3
Intervention: Surveys undertaken in 1973 and 1988.

Comparison: N/A
965Children aged 12 years in South Wales.Eczema prevalence (‘ever’)4.8% in 1973
15.9% in 1988 (difference 11.1, 95% CI 8.4, 13.8)
The main aim of the study was to record asthma prevalence but some data for eczema were also reported.
Williams H; Robertson C; Stewart A; it-Khaled N; Anabwani G; Anderson R; Asher I; Beasley R; Bjorksten B; Burr M; Clayton T; Crane J; Ellwood P; Keil U; Lai C; Mallol J; Martinez F; Mitchell E; Montefort S; Pearce N; Shah J; Sibbald B; Strachan D; von ME; Weiland SK;

1999 Jan

124
Study Type: Other

Evidence Level: 3
Intervention:

Comparison:
Aoki T; Fukuzumi T; Adachi J; Endo K; Kojima M;

1992

135
Study Type: Other

Evidence Level: 3
Intervention: Evaluation of which parts of the body are affected by atopic eczema

Comparison: N/A
1012 (812 [80.2%] of whom had an atopic history)Infants and children aged less than 10 years with possible AE attending dermatology clinic, January 1989–December 1990.Area affected by atopic eczemain infants aged 3–5 months, 81% cheeks, 62% forehead, 61% scalp, 42% chin. On trunk, 67% chest, 64% back, 59% abdomen

IN children aged 5–9 years, 50% neck, 38% nape, 16% scalp, 25% perioral, 33% forehead, 40% cheeks.
52 skin regions were examined for the presence of lesions

Data for change in incidence by age were shown in graphs. Involvement of the cheeks, forehead, scalp, chin, periauricular regions, and ankle regions decreased with age. Involvement of inguinal regions, buttocks, para-axillar regions, hips, cubital and popliteal fossae, knees and elbows increased with age.

Only areas with highest % shown in this table.
Harris JM;

2007

127
Study Type: Other

Evidence Level: 3
Intervention: Epidemiological data

Comparison: N/A
592Children aged 8 years from a birth cohort in Kent.1) Lifetime prevalence

2) Annual period prevalence (range)
1) 25.3% at age 8 (56.7% identified before age 2 years).

2) 8.3–10.6%
Funding: Colt Foundation

UK Working party criteria were used to diagnose AE.

Recruitment to the cohort started in November 1993.
Ninan TK; Russell G;

1992 Apr 4 116
Study Type: Other Survey

Evidence Level: 3
Intervention: Questionnaire survey of parents, regarding asthma, eczema, hay fever
Comparison: N/A
2510 in 1964 and 3403 in 1989Children aged 8–13 years attending primary schools in Aberdeen.

Questionnaires were administered to parents and guardians of the children.
1) Point prevalence of atopic eczema1) 5.3% in 1964, and 12% in 1989Funding: Astra Pharmaceuticals, A&H, National Asthma Canpaign
Kulig M; Bergmann R; Klettke U; Wahn V; Tacke U; Wahn U;

1999 Jun

140
Study Type: Other

Evidence Level: 3
Intervention: Prevalence and incidence rates of allergic sensitisation

Comparison: N/A
216A sub-cohort of children from the German MAS study (Bergmann 1994139) - those with complete specific IgE data at the ages of 1, 2, 3, 5, and 6 years.1) Point prevalence of allergic sensitisation to at least one of the tested allergens

2) Annual incidence rates of sensitisation
1) 11% (95% CI 7, 15) at 1 year, and 30% (24, 36) at 6 years

To inhalant allergens: 1.5% (95% CI 0, 3) at 1 year, and 26% (20, 32) at 6 years

To food allergens: 10% (95% CI 6, 14) at 1 and 6 years

2) To one of four food allergens: 10% (6, 14) at 1 year, and 3% (1, 5) at 6 years.

To at least 1 inhalant allergen: 1.5% (0, 3) at 1 year, and 8% (4, 12) at 6 years.

From age 3 years specific IgE to inhalant allergens were significantly higher than specific IgE levels to food allergens in children of the same age, p<0.006.
Funding: As for Bergmann.139

The incidence rate was defined as the proportion of children with sensitisation (specific IgE level of 0.7 or more) in the group of children at risk (children originally free of sensitisation in whom it could have developed during the period).

Prevalence = the proportion of sensitised children (specific IgE of 0.7 ku/l or more) in the total group at the respective time point).
Wang IJ;Lin YT;Yang YH;Chen CL;Tsai YH;Chiang BL;Hwang KC;

2004 Oct

146
Study Type: OtherCross-sectional study

Evidence Level: 3
Intervention: Sensitisation to inhalant and food allergens

Comparison: N/A
262Children aged 0–16 years with atopic eczema. 10% were aged under 2 years, 52% aged 2–5 years, and 39% aged more than 5 years.

Severity was assessed in 31%, using SCORAD; 19% had mild eczema, 55 moderate, and 26% severe.
1) Sensitisation

2) Association between allergens and age (sex-adjusted OR)

3) Risk of concomitant asthma and allergic rhinitis
1) 57% had elevated total IgE levels.

2) Food allergy: 2.58 (1.07, 6.21) in those aged <2 years; 1.09 (0.58, 2.05) in children aged 2–5 years, and 0.57 (0.29, 1.13) in children older than 5 years.

Inhalant allergens: Der pteronyssinus 0.02 (0.002, 0.142) in those aged <2 years; 0.72 (0.44, 1.91) in children aged 2–5 years, and 4.28 (2.41, 7.59) in children older than 5 years. Der farinae 0.02 (0.003, 0.159) in those aged <2 years; 0.72 (0.44, 1.18) in children aged 2–5 years, and 4.02 (2.30, 7.05) in children older than 5 years. Cockroach; no data for those under age 2 years, 0.45 (0.18, 1.10) in children aged 2–5 years, and 3.53 (1.45, 8.61) in children older than 5 years.

3) Asthma: no data for those aged <2 years; 0.58 (0.34, 0.99) in children aged 2–5 years, and 3.26 (1.88, 5.65) in children older than 5 years.

Allergi rhinitis: 0.05 (0.01, 0.24) in those aged <2 years; 0.55 (0.33, 0.90) in children aged 2–5 years, and 4.63 (2.65, 8.09) in children older than 5 years.
Funding: none declared.

Asthma diagnosed if there were more than 4 attacks of wheezing in the past 12 months or 1–3 wheezing episodes in addition to night awakening for wheezing, nocturnal cough, and wheezing after exercise.

Sensitisation was defined as elevated IgE levels of at least one of the allergens tested (5 inhalant allergens, 6 food allergens). A specific IgE of more than 0.7ku/l and a total IgE level of more than 200ku/l was considered positive.
Wolkerstorfer A;Wahn U;Kjellman NI;Diepgen TL;De LM;Oranje AP;

2002 Jan

536
Study Type: OtherCase series (the placebo arm of the ETAC RCT).

Evidence Level: 3
Intervention: Sensitisation to cow’s milk and egg, and its relationship to the severity of atopic eczema.

Comparison: N/A
382Children in the placebo arm of the ETAC RCT.
Infants aged 1–2 years with a positive history of atopy and active symptoms of atopic eczema. Most had mild to moderate atopic eczema (mean SCORAD score of 20).
1) Proportion with sensitisation to cow’s milk and egg

2) Severity (mean SCORAD scores) according to sensitisation

3) Correlation between the severity of atopic eczema and degree of sensitisation at different follow-up visits (Spearman rank correlation)

4) Change in sensitisation (change in RAST class of at least one class) over time in relation to percentage improvement in objective SCORAD score
1) At inclusion (study start): 36% cow’s milk, 50% to egg. 88% of those sensitised to cow’s milk were also sensitised to egg. 33% were sensitised to egg only. ‘During the follow-up sensitisation remained stable for cow’s milk and decreased slightly for egg’ (no further details).

2) 17.9 (SD 10) in children with normal specific IgE. 18 (SD 10) in children with specific IgE to cow’s milk only, 20.5 (12) with specific IgE to egg only, and 23.1 (SD 12) with specific IgE to to both cow’s milk and egg.

High levels of specific IgE (17/5 ku/l or more) were reported to be more common in children with moderate to severe atopic eczema (data shown in graphs only).

3) Baseline 0.16 (cow’s milk), 0.22 (egg), p<0.005 for both
At 3 months: 0.09 (cow’s milk) and 0.15 (egg; p=NS and p<0.05 respectively)
At 12 months: 0.12 (cow’s milk) and 0.16 (egg), p<0.05 for both
At 18 months, 0.15 (cow’s milk) and 0.21 (egg), p<0.05 and p<0.005 respectively.

4) Sensitisation increased; mean improvement in objective SCORAD 35.8 (SD 58) cow’s milk, and 38.1 (54) egg.
Sensitisation unchanged: mean improvement in objective SCORAD 34.1 (SD 75) cow’s milk, and 33.2 (81) egg.
Sensitisation increased: mean improvement in objective SCORAD 9.5 (SD 75) cow’s milk, and −6.9 (71) egg.
Funding: none declared.

Specific IgE levels were determined using the Pharmacia CAP system. Sensitisation = an IgE level of 0.35ku/l or more.
Wuthrich B;Schmid-Grendelmeier P;

2002

145
Study Type: Other

Evidence Level: 3
Intervention: Natural history of AE

Comparison: N/A
22Children with AE seen at the age of 2–4 years, and re-evaluated at age 10–12 years.

No other demographic data
% with 1) AE

2) asthma

3) allergic rhinitis

4) positive skin prick test

5) elevated IgE levels (according to age values - no further details)

6) Sensitisation to foods (IgE test) - egg white, cow’s milk, cod, wheat, peanut, soy

7) Sensitisation to inhalant allergens (HDM, grass, tree pollen)
All results are for age 2–4 years then 10–12 years
1) 100% vs 68%

2) 9% vs 45%

3) 0% vs 41%

4) 54% vs 77%

5) 41% vs 81%

6) 41% vs 27%

7) 50% vs 80%
Funding: none declared

Swiss cohort.
Bohme M;Lannero E;Wickman M;Nordvall SL;Wahlgren CF;

2002

138
Study Type: Other

Evidence Level: 3
Intervention: Cohort of children recruited at their first visit to child health centre during first months of life. At the time of recruitment the parents filled in a questionnaire concerning environmental and heredity factors. At 1 or 2 years there was another questionnaire on atopic disease.

Atopic eczema Concurrent conditions
37911) Period prevalence
2) % with concurrent conditions
1) 25.1% atopic eczema during their first 2 years (952/3791)

2) Asthma: 2.9% (109/950).
Ratio of asthma in children with atopic eczema over those without atopic eczema: 1.45, 95% CI 1.16–1.80.
Allergic rhinoconjunctivitis 3.1% (115/936).
Ratio of allergic rhinoconjunctivitis in children with atopic eczema over those without atopic eczema: ratio 2.25, 95% CI 1.77–2.85.
Adverse reactions to food:10.7% (405/946).
Ratio of adverse reactions to food in children with atopic eczema over those without: 3.20, 95% CI 2.83–3.62.
Funding: none declared

Ratio adjusted for heredity
Bohme M;Wickman M;Lennart NS;Svartengren M;Wahlgren CF;

2003 Sep

537
Study Type: Other

Evidence Level: 3
Intervention:
Questionnaire:
Lifelong prevalence
4089 children born between Feb 1994 and 1996 aged 0–4Lifelong prevalence:
33% had symptoms of atopic eczema
Eigenmann PA;Sicherer SH;Borkowski TA;Cohen BA;Sampson HA;

1998

143
Study Type: Other

Evidence Level: 3
Intervention: Specific IgE antibody concentrations to 6 foods was evaluated.

Comparison: N/A
63Children and adults with atopic eczema aged 0.4–19.4 years, median age 2.8 years who were referred to a dermatologist.
Patients had persistent eczematous rash in two or more predilection sites despite the use of topical corticosteroids and who presented to the dermatology clinic.

Median SCORAD score 41 (range 6.5–94.5), mean 43.
1) IgE levels

2) Results of DBPCFC (n=19 of 41 with a positive IgE result)
1) 65% (41/63) of children with eczema had positive IgE values (more than 0.7ku/l) to at least 1 of 6 foods tested

2) 18 positive challenges in 11 patients. There were no reactions to placebo.
Group who were tested were a select group may not be representative of all children with atopic eczema.

Positive IgE test: more than 0.7 ku/l (i.e. these were considered to be allergic to foods (this was then tested by DBPCFC). The foods tested were milk, egg, peanuts, fish, soya, wheat.
George S;Berth-Jones J;Graham-Brown RA;

1997 Apr

129
Study Type: Other

Evidence Level: 3
Intervention: Parents of children interviewed at 1 year of age about atopic eczema.

Point and lifetime Prevalence of atopic eczema
Severity of atopic eczema (mean SASSAD score)
Consultations by general practitioner and referral to a dermatologist
499 children from a cohort of 18001) Point prevalence of atopic eczema

2) Severity of atopic eczema (mean SASSAD score)
1) Asian children: 12/134 (9%)
Non-Asian children: 32/279 (11.5%), p = 0.55 95% CI −3.8% to 8.9%
Lifetime prevalence atopic eczema:
Asian children: 21/134 (15.7%)
Non-Asian children: 43/279 (15.4%), p = 0.94 95% CI −7% to 7%

2) Asian children: 6.3 SD 3.7
Non-Asian children: 7.3 SD 3.5
Funding: Leicester Dermatology Research Foundation
Halkjaer LB;Loland L;Buchvald FF;Agner T;Skov L;Strand M;Bisgaard H;

2006 May

538
Study Type: Other

Evidence Level: 3
Intervention: Prevalence of atopic eczema411 infants. Children followed from birth to 3 years, visits every 6 monthsCumulative incidence44% (155/356) at 3 years (Hanifin and Rajka criteria).

Severity of eczema (SCORAD) was assessed every 6 months. The proportions with mild, moderate or severe eczema changed as follows from age 6 months to 3 years:
mild 43% –81%
moderate 56% - 17%
severe 2% – 2%

Prevalence shown in graphs only. This peaked at 2 years in boys and 2.5 years in girls.
Funding: none declared.

Study undertaken in Copenhagen
Heinrich J;Hoelscher B;Frye C;Meyer I;Wjst M;Wichmann H;

2002
118
Study Type: Other

Evidence Level: 3
Intervention: Three cross-sectional regional surveys in 1992–1993, 1995–1996 and 1998–1999. Some children participated in two or three surveys investigating the prevalence of atopic eczema.7632 children aged 5–14 years recruited form Schools in Germany1) Adjusted prevalence1) Survey 1992–1993

Children aged 12 at survey (born 1981) 9.6%

Children aged 9 at survey (born 1984) 8.6%

Children aged 6 at survey (born 1987) 8.6%
Survey 1995–1996
Children aged 12 at survey (born 1984) 9.1%
Children aged 9 at survey (born 1987) 9.9%
Children aged 6 at survey (born 1990) 11.0%

Survey 1998–1999
Children aged 12 at survey (born 1987) 10.2%
Children aged 9 at survey (born 1990) 11.8%
Children aged 6 at survey (born 1993) 13.0%
No statistical analysis given and some children participated in two or three surveys.
Hill DJ;Hosking CS;

2004

144
Study Type: Other

Evidence Level: 3
Intervention: Epidemiological data

Comparison: N/A
487 (those with complete data from questionnaires, of n=620)Infants aged up to 120 months from the Melbourne Atopy Cohort study (commenced in 1990). They were recruited on the basis of one or more parents or siblings having either atopic eczema, asthma, hay fever, or severe reactions to foods.1) Cumulative prevalence of atopic eczema

2) Prevalence of IgE mediated food allergy

3) Prevalence of IgE mediated food allergy linked to severity of AE
1) 28.9% (n=141)

2) 35% of those with AE, and 12% of those without AE, p<10(−6)

RR of AE because of IgE-mediated food allergy for children with AE = 3.1 (2.1, 4.4)

3) Increased with severity
Funding: Victorian Department of Human Services, Nestle and the Royal Children’s Hospital Melbourne.

Skin prick tests to common allergens and foods undertaken at 6 and 12 months of age.

Mothers were encouraged to delay the introduction of solids until after the age of 6 months when low allergen solids were introduced (not egg, peanut or fish).

Modified UK Working party diagnosis criteria used to diagnose eczema.

Negative skin prick test = no greater than control.

IgE mediated food allergy = if the mean wheal diameter to any of 3 food extracts was at least twice the histamine reference standard.
Illi S;von ME;Lau S;Nickel R;Gruber C;Niggemann B;Wahn U;Multicenter Allergy Study Group.;

2004 May

134
Study Type: Other

Evidence Level: 3
Intervention: Survey of children followed up aged 1,3,6,12,18 and 24 months and one a year up until 7 years old. Parents questions about atopic eczema symptoms and severity.

Comparison: N/A
1314 (of 7609 infants born in 1990).
1123 were analysed as they completed at least one follow up.
Birth cohort study1) Prevalence of atopic eczema

2) Scratching as a prognostic factor for AE

3) Any sensitisation (IgE 0.35ku/l or more) at age 2 years as a prognostic factor for AE

4) Having a cat in early childhood as a risk factor for AE
1) 13.4% in first year of life. Lifetime prevalence by the age of 2 years: 241/1123 (21.5%)

Of children with early manifestations of atopic eczema:
n =192
Of children with an onset in the first year of life, 43.2% were in complete remission after age 2 years
55.4% only had symptoms in the first year of life
18.7% had symptoms of atopic eczema every year up to the age 7 years
38% had an intermittent pattern of eczema up to 7 years

2) 72.2% of children with persistent AE reported frequent scratching with early AE compared with 35.6% of those with an intermittent pattern, and 14.5% of the children with complete remission after 2 years, adjusted cumulative odds ratio 5.86 95% CI 3.04–11.29

3) Cumulative OR 2.52 (1.62 to 3.90)

4) Cumulative OR 2.33 (0.85 to 6.38)
Funding: none declared.

German Multicenter Atopy Study (MAS). 499 of the children had risk factors for atopy (increased cord blood IgE [0.9ku/l or more], at least 2 atopic family members, or both), and 815 newborns with none.

AE diagnosed through questions on questionnaire.
Kuehr J;Frischer T;Karmaus W;Meinert R;Barth R;Urbanek R;

1992 Dec

539
Study Type: Other

Evidence Level: 3
Intervention: Questionnaire completed by parents asking about eczema1376Children aged 6–8 yearsPoint prevalence17.3%Funding: German Federal Ministry for Research and Technology
Kurukulaaratchy R;Fenn M;Matthews S;Hasan AS;

2003 Jun126
Study Type: Other

Evidence Level: 3
Intervention: Visit to research centre, telephone questionnaire or postal questionnaire:
Life long prevalence
Current incidence
Onset
1456All children born on the Isle of Wight between in January 1989 and February 1990
Aged 10 years old
1) Prevalence of atopic eczema

2) Onset of atopic eczema
1) 1 year old: 9.6% 132/1374
2 years old: 10.3% 127/1231
4 years old: 11.9% 145/1214
Life long prevalence at 10 years: 41.0%
Incidence in last year at 10 years:
13.7% 186/1358.

56.3% still had the condition at age 10 years.

2) 71.0% of children with current eczema developed it before the age of 4 years
The definition for atopic eczema unclear. For incidence of atopic eczema in the last year ‘itchy rash occurring in the last 12 months and had previously been given the diagnosis of eczema’.

The paper also considers risk actors for AE such as food allergy, and smoking. Data not reproduced here.
Lehtonen EP;Holmberg-Marttila D;Kaila M;

2003 Oct

540
Study Type: Other

Evidence Level: 3
Intervention: Retrospective chart review of children born in 1994. Data gathered for atopic eczema320Children born 1974 in Finland.1) Cumulative prevalence1) 16% at age 5 years (95% CI 12, 20).

49% were diagnosed between the ages of 6 to 24 months.

30% were recorded as having ‘food-related’ problems
Funding: none declared.

Data gathered by retrospective chart review. No specific diganostic criteria were used for AE (classified as AE if those words or words to that effect were used in the notes).
McNally NJ;Williams HC;Phillips DR;Strachan DP;

2000 Apr

128
Study Type: Other

Evidence Level: 3
Intervention: Data from the National Child Development Study, 1958 birth cohort. Parental reporting of eczema, from examination by a health visitor.

Comparison:
8278Children born in 1958n study who had information on presence or absence of visible eczema at all ages (7, 11 and 16 years).PrevalenceEczema prevalence (%) and adjusted odds ratio (OR (95%CI) p value)
Reported by 7 years:
North west: 5.3%, 1.00 (base)
Northern: 5.4%, 1.03 (0.67–1.59) p > 0.05
East and West Ridings: 7.8%, 1.50 (1.01–2.23) p > 0.05
North Midlands: 8.7%, 1.61 (1.08–2.41) p < 0.05
Eastern: 10.8%, 2.03 (1.41–2.93) p < 0.001
London and south East: 8.2%, 1.48 (1.05–2.09) p < 0.05
Southern: 10.1%, 1.89 (1.28–2.81) p < 0.01
South Western: 8.0%, 1.51 (1.00–2.28) p > 0.05
Midlands: 7.6, 1.45 (0.98–2.15) p > 0.05
Wales: 6.4%, 1.18 (0.73–1.91) p > 0.05
Scotland: 5.6%, 1.10 (0.74–1.62) p > 0.05
Eczema identified on examination:
North west: 2.3%, 1.00 (base)
Northern: 2.1%, 0.95 (0.49–1.83) p > 0.05
East and West Ridings: 2.3%, 0.98 (0.51–1.89) p > 0.05
North Midlands: 4.7%, 2.02 (1.15–3.56) p < 0.05
Eastern: 4.0%, 1.66 (0.94–2.91) p > 0.05
London and south East: 2.4%, 0.98 (0.57–1.70) p > 0.05
Southern: 4.7%, 2.00 (1.13–3.55) p < 0.05
South Western: 1.7%, 0.73 (0.34–1.55) p > 0.05
Midlands: 2.2, 0.97 (0.51–1.85) p > 0.05
Wales: 2.1%, 0.89 (0.41–1.94) p > 0.05
Scotland: 2.7%, 1.25 (0.71–2.20) p >0.05
Cohort of children born in 1958.

Pre 1975 county boundaries were used.

Funding: Department of Geography, University of Nottingham, and the British Skin Foundation.
Nnoruka EN;

2004 Oct

136
Study Type: Other

Evidence Level: 3
Intervention: Dermatological data from patients, children’s parents and relatives

Age of onset
Location of atopic eczema
Concurrent illness

Comparison: N/A
1019 patients with atopic eczema from 12013 patients with skin diseases seen at skin clinic from 1998 –2000.Age range 1 month to 59 years with average age of 13.8 years.
All patients were Black
Pattern of atopic eczemaAge of onset
1–6 weeks 12.7%, 129/1019
7–12 weeks 8.1%, 83/1019
13–18 weeks 5.7%, 58/1019
19–24 weeks 4.8%, 49/1019
25–30 weeks 3.0%, 31/1019
31–36 weeks 3.6%, 37/1019
37–42 weeks 2.7%, 28/1019
>42 weeks 1.3%, 13/1019

Concurrent diseases: (Adults and children)
Atopic eczema only 47.7%, 486/1019
Asthma 11.5%, 117/1019
Allergic rhinitis 4.1%, 42/1019
Conjunctivitis 1.3%, 13/1019
Concomitant respiratory allergies 35.6%, 363/1019

In a control group
Asthma 2.3%, 17/726
Allergic rhinitis 3.9%, 29/726
Conjunctivitis 0.7%, 5/726
Concomitant respiratory allergies 2.9%, 21/726

Location of atopic eczema
0–3 years (n = 298)
Wrist extensors 27.2%, 78/298
Wrist flexors 16.7%, 48/298
Elbow extensors 38.5%, 111/298
Elbow flexors 40.1%, 115/298
Knee extensors 37.4%, 108/298
Knee flexors 17.9%, 51/298

3–18 years (n = 373)
Wrist extensors 8.3%, 31/373
Wrist flexors 11.3%, 42/373
Elbow extensors 17.1%, 64/373
Elbow flexors 56.8%, 211/373
Knee extensors 15.6%, 58/373
Knee flexors 45.7%, 170/37
Adults and children included in the study, so data on concurrent illness not presented in test as unable to separate children and adult data
Olesen AB;Bang K;Juul S;Thestrup-Pedersen K;

2005

119
Study Type: Other

Evidence Level: 3
Intervention: Two different questionnaires sent to the different groups of children:
Life long prevalence Severity

Comparison: N/A
1060 children from a stratified sample of all children born between 1984 and 1986 in a maternity hospital in Denmark, surveyed in 1993.

10,000 children from a random sample of children born in Denmark from 1984 to 1994 from the Danish Medical Birth Register, surveyed in 1998.
Children aged 3 to 15 years1) Lifelong prevalence of atopic eczema

2) Severity of atopic eczema in children born between 1984–1994 (measured on a scale of 1–7)
1) 18.9% age 7 years in the group of children born between 1984–1986 (1993 study)
19.6% age 7 years in the group of children born between 1984–1994 (1998 study)

2) Mild 47.6% 660/1385
Moderate 33.1% 458/1385
Severe 12.8%, 177/1385 (data missing on 90/1385)
Funding: Univeristy of Aarhus.

Data collected by questionnaire.

Definition of atopic eczema in 1993 survey unclear; UK Working Party criteria were used in 1998.
Selnes A;Bolle R;Holt J;Lund E;

2002 Feb

120
Study Type:
Other

Evidence Level: 3
Intervention:
Prevalence of atopic eczema in Norway (with further analysis for those of Sami or Norse ethnicity)

Comparison: N/A
10,093 in 1985 study and 8676 in 1995 studySchoolchildren aged 7–13 years in Northern Norway.1) Cumulative incidence of AE1) 19.7% in 1995
13.2% in 1985
Funding: none declared.

AE if there was an itchy eruption lasting for more than 4 weeks combined with lesions on the face, elbow/knee flexures, or a high degree of itching and lesions elsewhere.
Vasar M;Julge K;Bjoksto B;
2000 May

541
Study Type: Other

Evidence Level: 3
Intervention: Physical examination and questionnaire298Healthy new born babies at term, followed up at 6, 12 and 24 months.Point prevalence4% (7/173) at 6 months
10.5% (23/220) at 12 months
15% (35/223) at 2 years
Criteria for AE diagnosis - Hanifin and Rajka
Wadonda-Kabondo N;Sterne JA;Golding J;Kennedy CT;Archer CB;Dunnill MG;ALSPAC Study Team.;

2003 Nov

131
Study Type: Other

Evidence Level: 3
Intervention: Postal questionnaire asking parents:
At the age of 6 and 18 months
1. Has the child had skin rash in joints and creases of her/his body (e.g. behind the knees, under the arms) since…?
2. Does she/he have this sort of rash now?
3. Has she/he had an itchy, dry oozing or crusted rash on the face, forearms or shins?
4. Does she/he have this sort of rash now? At the age of 30 and 42 months
5. Has the child had an itchy, dry skin rash in joints and creases of her/his body (e.g. behind the knees, elbows under the arms) since he/she was 18/30 months old?
6. Does he/she have this sort of rash now?

Study used definition of atopic eczema to be rash (from question 1, 3, or 5)
Period prevalence
Incidence

Comparison: N/A
8530 children aged 0 to 42 months born in 1990’s.1) Period prevalence

2) Incidence
1) 0–6 months: 21.0%, 1791/8530
6–18 months: 25.6%, 2183/8530
18-13 months: 23.2%, 1975/8530
30–42 months: 19.9%, 1701/8530

2) 0–6 months: 21.0%, 1791/8530
6–18 months: 11.2%, 757/6739
18-13 months: 3.8%, 229/5982

4949/8530 (58%) had a rash at least once
622/8530 (7.3%) reported a rash on all four occasions
Funding: several sources including the MRC.
Williams HC;Strachan DP;

1998

132
Study Type: Other

Evidence Level: 3
Intervention: Parents asked by health visitors, using structured questionnaires whether their child had an eczematous rash.
The presence of visible eczema was recorded by experienced school medical officers at ages 7, 11, and 16 years.

Comparison: N/A
1053UK 1958 Birth cohort study (those with data from birth and at ages 7, 11, 16, 23)PrognosisOf the 1053 with reported or examined eczema by age 23 years, 35% had onset in the first year of life, and 54% by aged 7 years.

Of 860 with reported or examined eczema by the age of 16 years, 43% had onset by age 1 year, and 66% by age 7 years.

Of those with reported or examined eczema by age 7 years, 35% still had it at 11 years, and 26% at 16 years, and 25% at 23 years. The apparent (short-term) clearance rates of 65% and 74% fell to 53% and 65% when adjusted for subsequent recurrences.
Funding: none declared.
Yura A;Shimizu T;

2001 Dec

121
Study Type: Other

Evidence Level: 3
Intervention: Lifetime prevalence
Prevalence in last year
In total about 4 millionPrimary school children aged 7 to 12 years. 7 population surveys carried out at 2 year intervals between 1985 and 1997 (460000–740000 per survey).1) Lifetime prevalence

2) Prevalence in last year
1) 1985: 15.0%
1987: 19.1%
1989: 20.9%
1991: 22.0%
1993: 24.1%
1995: 22.9%
1997: 22.9%

2) 1993: 6.8%
1995: 5.6%
1997: 5.7%
Paller AS;McAlister RO;Doyle JJ;Jackson A;

2002

95
Study Type: Other

Evidence Level: 3
Intervention: Survey of children or their parents
Prevalence
Age of onset

Comparison: N/A
429Children with atopic eczema aged 15 years old or younger members of the National Eczema Association for Science and Education.1) Prevalence of asthma in children with atopic eczema

2) Age of onset
1) 0–2 year olds: 17.4% 21/121
3–7 year olds: 39.4% 69/175

8–15 year olds: 42.4% 53/125

2) 93% diagnosed in first 2 years of life
Survey was also carried out on 2500 physicians from IMS Health (article did not state what IMS stood for) who were known to prescribes topical medications for treatment of atopic eczema. But only 303 (12% responded) so data not included here.

Other outcomes reported in paper but not reported here as not reported by age group.
Kay J;Gawkrodger DJ;Mortimer MJ;Jaron AG;

1994 Jan

122
Study Type: Other

Evidence Level: 3
Intervention: Interview by structured questionnaire

Comparison: N/A
1077Children aged 3–11 years in Birmingham.1) One-year period prevalence (documented AE though not necessarily within the past 12 months)

2) Lifetime prevalence

3) Age of onset

4) Prevalence of asthma (at any time point)
1) 11.5%

2) 20.2%

3) Median age 6 months (0–5 months in 48%, then 7–13% maximum in every 6 month period to age 5 years, and 1–3% in every 6 month period to 10 years).

4) 38%
Funding: none declared.

Atopic eczema was defined as an itchy often relapsing and lichenified dermatitis that tends to affect the face and hands in infants and also the popliteal and antecubital fossae in children aged 18 months or older.
Macharia WM

1993

137
Study Type: Other

Evidence Level: 3
Intervention:
Dermatological data from children aged 0–12 years

Age of onset Location of atopic eczema

Comparison: N/A
54 children with atopic eczema seen at a paediatric skin clinic in Kenya in 1985Age range 0.25 to 10.25 years with average age of 3.25 years.
All children were Black
Pattern of atopic eczemaAge of onset
1–3 months 58.5%; 31/53
4–7 months 5.6%; 3/53
8–11 months 17.0%; 9/53
12–23 months 1.9%; 1/53
>23 months 17.0%; 9/53

Location of atopic eczema at onset
0–11 months (n = 43)
Face only 51%, 22/43
Flexure only 5%, 2/43
Extensor site only 12%, 5/43
Multiple sites 26%, 11/43
Unknown 7%, 3/43

12–23 months (n = 1)
Face only 0%, 0/1
Flexure only 0%, 0/1
Extensor site only 100%, 1/1
Multiple sites 0%, 0/1
Unknown 0%, 0/1

>23 months (n=9)
Face only 0%, 0/9
Flexure only 56%, 5/9
Extensor site only 11%, 1/9
Multiple sites 33%, 3/9
Unknown 0%, 0/9

Location of atopic eczema at examination
0–11 months (n = 16)
Face, flexure and extensor 19%, 3/16
Face only 31%, 5/16
Flexure only 0%, 0/16
Extensor only 0%, 0/16
Other 50%, 8/16

12–23 months (n = 9)
Face, flexure and extensor 44%, 4/9
Face only 11%, 1/9
Flexure only 11%, 1/9
Extensor only 0%, 0/9
Other 33%, 3/9

> 23 months (n = 29)
Face, flexure and extensor 48%, 14/29
Face only 0%, 0/29
Flexure only 10%, 3/29
Extensor only 3%, 1/29
Other 38%, 11/29

From: Evidence tables

Cover of Atopic Eczema in Children
Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth up to the Age of 12 Years.
NICE Clinical Guidelines, No. 57.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Dec.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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