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Paediatr Perinat Epidemiol. 2018 Nov;32(6):556-567. doi: 10.1111/ppe.12525. Epub 2018 Nov 21.

Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria-based assessment.

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Department of Medicine, McMaster University, Hamilton, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Department of Pediatrics, University of Toronto & Hospital for Sick Children, Toronto, Canada.
Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, Canada.



Persisting atopic dermatitis (AD) is known to be associated with more serious allergic diseases at later ages; however, making an accurate diagnosis during infancy is challenging. We assessed the diagnostic performance of questionnaire-based AD measures with criteria-based in-person clinical assessments at age 1 year and evaluated the ability of these diagnostic methods to predict asthma, allergic rhinitis and food allergies at age 5 years.


Data relate to 3014 children participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study who were directly observed in a clinical assessment by an experienced healthcare professional using the UK Working Party criteria. The majority (2221; 73.7%) of these children also provided multiple other methods of AD ascertainment: a parent reporting a characteristic rash on a questionnaire, a parent reporting the diagnosis provided by an external physician and a combination of these two reports.


Relative to the direct clinical assessment, the area under the Receiver Operating Characteristic curve for a parental report of a characteristic rash, reported physician diagnosis and a combination of both were, respectively, 0.60, 0.69 and 0.70. The strongest predictor of asthma at 5 years was AD determined by criteria-based in-person clinical assessment followed by the combination of parental and physician report.


These findings suggest that questionnaire data cannot accurately substitute for assessment by experienced healthcare professionals using validated criteria for diagnosis of atopic dermatitis. Combining the parental report with diagnosis by a family physician might sometimes be appropriate (eg to avoid costs of a clinical assessment).


accuracy; atopic dermatitis; diagnosis; eczema; epidemiology; questionnaire reports

[Indexed for MEDLINE]

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