Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria‐based assessment. Issue 6 (21st November 2018)

• Record Type: Journal Article
• Authors: Dharma, Christoffer; Lefebvre, Diana L.; Tran, Maxwell M.; Lu, Zihang; Lou, Wendy Y. W.; Subbarao, Padmaja; Becker, Allan B.; Mandhane, Piush J.; Turvey, Stuart E.; Moraes, Theo J.; Azad, Meghan B.; Sears, Malcolm R.
• Other Names: Anand SS investigator.; Befus AD investigator.; Brauer M investigator.; Brook JR investigator.; Chen E investigator.; Cyr MM investigator.; Daley D investigator.; Dell SD investigator.; Denburg JA investigator.; Duan QL investigator.; Eiwegger T investigator.; Grasemann H investigator.; HayGlass K investigator.; Hegele RG investigator.; Holness DL investigator.; Hystad P investigator.; Kobor M investigator.; Kollmann TR investigator.; Kozyrskyj AL investigator.; Laprise C investigator.; Macri J investigator.; Miller G investigator.; Paré P investigator.; Ramsey C investigator.; Ratjen F investigator.; Sandford A investigator.; Scott JA investigator.; Scott J investigator.; Silverman F investigator.; Simons E investigator.; Takaro T investigator.; Tebbutt SJ investigator.; To T investigator.;
• Is Part Of: Paediatric and perinatal epidemiology. Volume 32:Issue 6(2018:Nov.)
• Page Start: 556
• Page End: 567
• Publication Date: 2018-11-21
• Subjects: accuracy -- atopic dermatitis -- diagnosis -- eczema -- epidemiology -- questionnaire reports; Pediatrics -- Periodicals; Perinatology -- Periodicals; Pediatric epidemiology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; 618.92
• DOI: 10.1111/ppe.12525
• Languages: English
• ISSNs: 0269-5022

Abstract

Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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).