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In Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology

BACKGROUND : The heterogeneity of childhood atopic dermatitis (AD) underscores the need to understand latent phenotypes that may inform risk stratification and disease prognostication.

OBJECTIVE : To identify AD trajectories across the first 8 years of life, investigate risk factors associated with each trajectory and their relationships with other comorbidities.

METHODS : Data were collected prospectively from 1152 mother-offspring dyads in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort from ages 3 months to 8 years. AD was defined based on parent-reported doctor's diagnosis. An unsupervised machine learning technique was used to determine AD trajectories.

RESULTS : Three AD trajectories were identified: early onset transient (6.3%), late onset persistent (6.3%) and early onset persistent (2.1%), alongside a no AD/reference group (85.2%). Early onset transient AD was positively associated with male gender, family history of atopy, house dust mite sensitization and some measures of wheezing. Early onset persistent AD was associated with antenatal/intrapartum antibiotic use, food sensitization and some measures of wheezing. Late onset persistent AD was associated with a family history of atopy, some measures of house dust mite sensitization and some measures of allergic rhinitis and wheezing.

CONCLUSION AND CLINICAL RELEVANCE : Three AD trajectories were identified in this birth cohort, with different risk factors and prognostic implications. Further work is needed to understand the molecular and immunological origins of these phenotypes.

Suaini Noor H A, Yap Gaik Chin, Tung Bui Do Phuong, Loo Evelyn Xiu Ling, Eng Neo Goh Anne, Oon Hoe Teoh, Tan Kok Hian, Godfrey Keith M, Lee Bee Wah, Shek Lynette Pei-Chi, Van Bever Hugo, Chong Yap Seng, Tham Elizabeth Huiwen


atopic dermatitis, machine learning, rhinitis, trajectories, wheezing