Evolution of eczema, wheeze and rhinitis from infancy to early adulthood: four birth cohort studies
Evolution of eczema, wheeze and rhinitis from infancy to early adulthood: four birth cohort studies
Rationale: The relationship between eczema, wheeze or asthma, and rhinitis is complex, and epidemiology and mechanisms of their comorbidities is unclear. Objectives: To investigate within-individual patterns of morbidity of eczema, wheeze, and rhinitis from birth to adolescence/early adulthood. Methods: We investigated onset, progression, and resolution of eczema, wheeze, and rhinitis using descriptive statistics, sequence mining, and latent Markov modeling in four population-based birth cohorts. We used logistic regression to ascertain if early-life eczema or wheeze, or genetic factors (filaggrin [FLG] mutations and 17q21 variants), increase the risk of multimorbidity. Measurements and Main Results: Single conditions, although the most prevalent, were observed significantly less frequently than by chance. There was considerable variation in the timing of onset/remission/persistence/intermittence. Multimorbidity of eczema1wheeze1rhinitis was rare but significantly overrepresented (three to six times more often than by chance). Although infantile eczema was associated with subsequent multimorbidity, most children with eczema (75.4%) did not progress to any multimorbidity pattern. FLG mutations and rs7216389 were not associated with persistence of eczema/wheeze as single conditions, but both increased the risk of multimorbidity (FLG by 2- to 3-fold, rs7216389 risk variant by 1.4- to 1.7-fold). Latent Markov modeling revealed five latent states (no disease/low risk, mainly eczema, mainly wheeze, mainly rhinitis, multimorbidity). The most likely transition to multimorbidity was from eczema state (0.21). However, although this was one of the highest transition probabilities, only one-fifth of those with eczema transitioned to multimorbidity. Conclusions: Atopic diseases fit a multimorbidity framework, with no evidence for sequential atopic march progression. The highest transition to multimorbidity was from eczema, but most children with eczema (more than three-quarters) had no comorbidities.
asthma, atopic march, birth cohorts, eczema, wheeze
950-960
Haider, Sadia
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Fontanella, Sara
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Ullah, Anhar
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Turner, Stephen
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Simpson, Angela
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Roberts, Graham
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Murray, Clare S.
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Holloway, John W.
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Curtin, John A.
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Cullinan, Paul
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Arshad, Syed Hasan
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Hurault, Guillem
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Granell, Raquel
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Custovic, Adnan
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15 October 2022
Haider, Sadia
ed3296e0-288d-49b1-befb-fe4545a7278e
Fontanella, Sara
6c29b69f-edd6-4414-a8fd-c47241976aa5
Ullah, Anhar
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Turner, Stephen
a51d875a-66bb-4a18-b5b0-18ce3dc7d15c
Simpson, Angela
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Roberts, Graham
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Murray, Clare S.
aca69df6-149c-401c-842f-5b2d8042edf1
Holloway, John W.
4bbd77e6-c095-445d-a36b-a50a72f6fe1a
Curtin, John A.
b1f4f316-b8a3-438f-aeab-4c411ab41da2
Cullinan, Paul
71cec7a8-d4ce-401a-852d-2bbd094c8f13
Arshad, Syed Hasan
917e246d-2e60-472f-8d30-94b01ef28958
Hurault, Guillem
0b3fa989-49bc-49e8-b730-64a628dda4f7
Granell, Raquel
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Custovic, Adnan
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Haider, Sadia, Fontanella, Sara, Ullah, Anhar, Turner, Stephen, Simpson, Angela, Roberts, Graham, Murray, Clare S., Holloway, John W., Curtin, John A., Cullinan, Paul, Arshad, Syed Hasan, Hurault, Guillem, Granell, Raquel and Custovic, Adnan
(2022)
Evolution of eczema, wheeze and rhinitis from infancy to early adulthood: four birth cohort studies.
American Journal of Respiratory and Critical Care Medicine, 206 (8), .
(doi:10.1164/rccm.202110-2418OC).
Abstract
Rationale: The relationship between eczema, wheeze or asthma, and rhinitis is complex, and epidemiology and mechanisms of their comorbidities is unclear. Objectives: To investigate within-individual patterns of morbidity of eczema, wheeze, and rhinitis from birth to adolescence/early adulthood. Methods: We investigated onset, progression, and resolution of eczema, wheeze, and rhinitis using descriptive statistics, sequence mining, and latent Markov modeling in four population-based birth cohorts. We used logistic regression to ascertain if early-life eczema or wheeze, or genetic factors (filaggrin [FLG] mutations and 17q21 variants), increase the risk of multimorbidity. Measurements and Main Results: Single conditions, although the most prevalent, were observed significantly less frequently than by chance. There was considerable variation in the timing of onset/remission/persistence/intermittence. Multimorbidity of eczema1wheeze1rhinitis was rare but significantly overrepresented (three to six times more often than by chance). Although infantile eczema was associated with subsequent multimorbidity, most children with eczema (75.4%) did not progress to any multimorbidity pattern. FLG mutations and rs7216389 were not associated with persistence of eczema/wheeze as single conditions, but both increased the risk of multimorbidity (FLG by 2- to 3-fold, rs7216389 risk variant by 1.4- to 1.7-fold). Latent Markov modeling revealed five latent states (no disease/low risk, mainly eczema, mainly wheeze, mainly rhinitis, multimorbidity). The most likely transition to multimorbidity was from eczema state (0.21). However, although this was one of the highest transition probabilities, only one-fifth of those with eczema transitioned to multimorbidity. Conclusions: Atopic diseases fit a multimorbidity framework, with no evidence for sequential atopic march progression. The highest transition to multimorbidity was from eczema, but most children with eczema (more than three-quarters) had no comorbidities.
Text
Blue-202110-2418OC.R1_Proof_hi[1][44]
- Accepted Manuscript
Text
Multimorbidity manuscript R1 clean
- Accepted Manuscript
More information
Accepted/In Press date: 9 June 2022
e-pub ahead of print date: 9 June 2022
Published date: 15 October 2022
Additional Information:
Funding Information:
Supported by the UK Medical Research Council (MRC) Programme grant MR/S025340/1 (UNICORN consortium); MRC grants G0601361 and MR/ K002449/1 (STELAR consortium); Wellcome Trust Strategic Award 108818/15/Z (R.G.); Asthma UK grants no. 301 (1995–1998), 362 (1998–2001), 01/012 (2001–2004), and 04/014 (2004–2007) (MAAS); BMA James Trust (2005), the JP Moulton Charitable Foundation (2004–2016), The North West Lung Centre Charity (1997–current), and MRC grant MR/L012693/1 (2014–2018) (MAAS); and the Isle of Wight Health Authority, the National Asthma Campaign, UK grant no. 364, and NIH grants R01 HL082925-01, R01 AI091905, and R01 AI121226 (IOW).
Funding Information:
Author Contributions: A.C., A.S., S.H., and S.F. conceived and planned the study and wrote the manuscript. S.H., S.F., and G.H. analyzed the data. All authors contributed to the interpretation of the results. All authors provided critical feedback and helped shape the research, analysis, and manuscript. A.S. and C.S.M. are supported by the National Institute for Health Research Manchester Biomedical Research Centre.
Publisher Copyright:
Copyright © 2022 by the American Thoracic Society.
Keywords:
asthma, atopic march, birth cohorts, eczema, wheeze
Identifiers
Local EPrints ID: 470032
URI: http://eprints.soton.ac.uk/id/eprint/470032
ISSN: 1073-449X
PURE UUID: 7932f275-1c49-45ed-ac1e-dd713c707e2c
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Date deposited: 30 Sep 2022 16:50
Last modified: 17 Mar 2024 07:23
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Contributors
Author:
Sadia Haider
Author:
Sara Fontanella
Author:
Anhar Ullah
Author:
Stephen Turner
Author:
Angela Simpson
Author:
Clare S. Murray
Author:
John A. Curtin
Author:
Paul Cullinan
Author:
Guillem Hurault
Author:
Raquel Granell
Author:
Adnan Custovic
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