CHANGES IN THE REPORTED PREVALENCE OF CHILDHOOD ECZEMA SINCE THE 1939-45 WAR

doi:10.1016/S0140-6736(84)92805-8

The Lancet

Volume 324, Issue 8414, 1 December 1984, Pages 1255-1257

https://doi.org/10.1016/S0140-6736(84)92805-8 Get rights and content

Abstract

Rates of reported eczema during early childhood were studied in 3 national cohorts of children born in 1946, 1958, and 1970. Overall rates rose from 5·1% in children born in 1946, to 7·3% in those born in 1958, to 12·2% in the 1970 cohort. In the 1958 and 1970 cohorts there was a positive association between eczema and breastfeeding. This relationship remained significant after allowing for parental history of allergy and socioeconomic status. Social classes I and II children born in 1946 were less likely to be reported as having eczema, compared with children from lower social classes, whereas children born into higher social classes in 1958 and 1970 had higher rates. These findings may reflect secular changes in the diagnosis of eczema or may represent a real increase in the disorder. The positive association with breastfeeding in the more recent cohorts suggests a new environmental agent may be crossing in breast-milk. The agent(s) may well be in other infant foods, since the rate of reported eczema in non-breastfed children rose from 5·7% in the 1946 and 1958 cohorts to 11·1% of children born in 1970.

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How does parental history of atopic disease predict the risk of atopic dermatitis in a child? A systematic review and meta-analysis
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Parental history of atopic disease is a well-established risk factor for the development of atopic dermatitis (AD), but several aspects of this association remain unclear.
We sought to determine the association of parental history of atopic disease with AD in offspring.
We searched PubMed and EMBASE through June 2018 for relevant records and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (ORs) with 95% CI were calculated using random-effects models.
A total of 163 records covering 149 unique studies were included. Of these, 119 studies were included in the meta-analysis. Individuals with parental history of atopic disease had increased odds of AD (OR, 1.81; 95% CI, 1.65-1.99). Parental asthma (OR, 1.56; 95% CI, 1.18-2.05) and allergic rhinitis (OR, 1.68; 95% CI, 1.34-2.11) had a smaller effect than AD (OR, 3.30; 95% CI, 2.46-4.42). The effect of maternal and paternal history was comparable for all atopic diseases. An increase in odds was observed when comparing the effect of having 1 (OR, 1.30; 95% CI, 1.15-1.47) or 2 atopic parents (OR, 2.08; 95% CI, 1.83-2.36), as well as having a parent with 1 (OR, 1.49; 95% CI, 1.28-1.74) or more atopic diseases (OR, 2.32; 95% CI, 1.92-2.81).
This study provides evidence-based risk estimates that may guide physicians who counsel parents with a history of atopic disease about their children’s risk of AD. This information is of particular importance for future efforts toward establishing prophylactic interventions for AD on a general population level.
Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife
2019, Journal of Allergy and Clinical Immunology
Citation Excerpt :
The data come from 2 large community-based cohorts broadly representative of the UK general population. Consistent with previous reports and international trends,33-35 we found that the overall prevalence of atopic eczema increased between 1958 and 1970, but there did not appear to be a difference in trends across calendar years (see Fig E1 in this article's Online Repository at www.jacionline.org). Two population-based mail surveys in the United States and Italy also found high rates of adult-onset disease (54% and 60% of the population respectively)6,7 but have been questioned because of the possibility for poor recall of childhood disease or migration to new climates.16
Atopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial.
We sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset.
We conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave.
The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease.
Rates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.
Skin care for healthy babies at term: A systematic review of the evidence
2018, Midwifery
Citation Excerpt :
Clinical care and advice should be based on evidence-based recommendations about suitable topical agents which do not adversely alter or affect the skin barrier. This cautionary attitude is necessary in view of the increasing prevalence of childhood atopic eczema (Gupta et al., 2004; Taylor et al., 1984), affecting over 20% of children (Flohr and Mann, 2014). This is not caused solely by genetic predisposition, but may be associated with environmental factors including the use of topically applied natural and/or commercial skin care products (Danby et al., 2013; 2011; Danby and Cork, 2011).
to identify what skin practices are important for the protection of baby skin in healthy term babies (0–6 months) and generate evidence-based conclusions to inform health professionals and parents.
eleven databases were searched for all empirical quantitative and qualitative research published between 2000–2015 which explored baby skin care for bathing and cleansing, nappy care, hair and scalp care, management of dry skin or baby massage, for healthy term babies up to 6 months old. Papers not published in English were excluded. A total of 3062 papers were identified. Pairs of reviewers assessed all citations and extracted data independently. There were 26 included papers: 16 RCTs, 3 non-randomised experimental studies, 1 mixed-methods study and 6 qualitative studies. Primary and secondary outcome measures were analysed using meta-analysis or narrative descriptive statistics. Synthesis of qualitative data was not possible due to disparity of the evidence.
from the small numbers of studies with comparable data, there was no evidence of any significant differences between tested wash products and water or tested baby wipes and water. There was some evidence to suggest that daily use of full-body emollient therapy may help to reduce the risk of atopic eczema in high risk babies with a genetic predisposition to eczema; however, the use of olive oil or sunflower oil for baby dry skin may adversely affect skin barrier function. There was no evidence about hair/scalp care or baby massage. Qualitative research indicates that parents and health professionals believe that water alone is best.
meta-analysis was restricted due to the lack of consistency of study outcome measures. Although there is considerable RCT evidence comparing the use of specific products against water alone, or another product, for bathing, cleansing and nappy care, the power of this evidence is reduced due to inconsistency of outcome measures in terms of outcome, treatment site or time-point. The development of a core outcome measure set is advocated for trials assessing skin care practices.
this review offers health professionals best evidence available on which to base their advice. Of those studies with comparative outcomes, the evidence indicates no difference between the specific products tested and water alone; offering parents a choice in their baby skin care regimen.
Protocol available: http://www.crd.york.ac.uk/PROSPEROFILES/28054_PROTOCOL_20151009.pdf
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EpidemiologyCHANGES IN THE REPORTED PREVALENCE OF CHILDHOOD ECZEMA SINCE THE 1939-45 WAR

Abstract

J Pediatr

Lancet

Lancet

Breast feeding, eczema, asthma, and hayfever

J Epidemiol Community Health

Maternity in Great Britain

The 1946 British Birth Survey: An account ofthe origins, progress and results of the National Survey of Health and Development

Perinatal mortality

Perinatal problems

The National Child Development Study

Epidemiology
CHANGES IN THE REPORTED PREVALENCE OF CHILDHOOD ECZEMA SINCE THE 1939-45 WAR