Development of atopic dermatitis according to age of onset and association with early-life exposures

Published:April 23, 2012DOI:


      Environmental factors can affect the development of atopic dermatitis, and this was described to be already effective during pregnancy and in early life. An important early postnatal exposure is nutrition, although its association with allergic disease remains unclear.


      We sought to determine prospectively whether early postnatal exposures, such as the introduction to complementary food in the first year of life, are associated with the development of atopic dermatitis, taking into account the reverse causality.


      One thousand forty-one children who participated in the Protection Against Allergy–Study in Rural Environments birth cohort study were included in the current study. Atopic dermatitis was defined by a doctor's diagnosis reported by the parents of children up to 4 years of age, by questionnaires, and/or by positive SCORAD scores from 1 year of age and according to the age of onset within or after the first year of life. Feeding practices were reported by parents in monthly diaries between the 3rd and 12th months of life.


      The diversity of introduction of complementary food in the first year of life was associated with a reduction in the risk of having atopic dermatitis with onset after the first year of life (adjusted odds ratio for atopic dermatitis with each additional major food item introduced, 0.76; 95% CI, 0.65-0.88). The introduction of yogurt in the first year of life also reduced the risk for atopic dermatitis (adjusted odds ratio, 0.41; 95% CI, 0.23-0.73).


      As early-life exposure, the introduction of yogurt and the diversity of food introduced in the first year of life might have a protective effect against atopic dermatitis.

      Key words

      Abbreviations used:

      OR (Odds ratio), PASTURE (Protection Against Allergy–Study in Rural Environments), SCFA (Short-chain fatty acid)
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        • Kay J.
        • Gawkrodger D.J.
        • Mortimer M.J.
        • Jaron A.G.
        The prevalence of childhood atopic eczema in a general population.
        J Am Acad Dermatol. 1994; 30: 35-39
        • Riedler J.
        • Braun-Fahrlander C.
        • Eder W.
        • Schreuer M.
        • Waser M.
        • Maisch S.
        • et al.
        Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey.
        Lancet. 2001; 358: 1129-1133
        • Ege M.J.
        • Frei R.
        • Bieli C.
        • Schram-Bijkerk D.
        • Waser M.
        • Benz M.R.
        • et al.
        Not all farming environments protect against the development of asthma and wheeze in children.
        J Allergy Clin Immunol. 2007; 119: 1140-1147
        • Pfefferle P.I.
        • Buchele G.
        • Blumer N.
        • Roponen M.
        • Ege M.J.
        • Krauss-Etschmann S.
        • et al.
        Cord blood cytokines are modulated by maternal farming activities and consumption of farm dairy products during pregnancy: the PASTURE Study.
        J Allergy Clin Immunol. 2010; 125 (e1-3): 108-115
        • Perkin M.R.
        • Strachan D.P.
        Which aspects of the farming lifestyle explain the inverse association with childhood allergy?.
        J Allergy Clin Immunol. 2006; 117: 1374-1381
        • Waser M.
        • Michels K.B.
        • Bieli C.
        • Floistrup H.
        • Pershagen G.
        • von Mutius E.
        • et al.
        Inverse association of farm milk consumption with asthma and allergy in rural and suburban populations across Europe.
        Clin Exp Allergy. 2007; 37: 661-670
        • Zutavern A.
        • Brockow I.
        • Schaaf B.
        • Bolte G.
        • von Berg A.
        • Diez U.
        • et al.
        Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization: results from a prospective birth cohort study.
        Pediatrics. 2006; 117: 401-411
        • Zutavern A.
        • Brockow I.
        • Schaaf B.
        • von Berg A.
        • Diez U.
        • Borte M.
        • et al.
        Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA.
        Pediatrics. 2008; 121: e44-e52
        • Agostoni C.
        • Decsi T.
        • Fewtrell M.
        • Goulet O.
        • Kolacek S.
        • Koletzko B.
        • et al.
        Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition.
        J Pediatr Gastroenterol Nutr. 2008; 46: 99-110
        • Tarini B.A.
        • Carroll A.E.
        • Sox C.M.
        • Christakis D.A.
        Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease.
        Arch Pediatr Adolesc Med. 2006; 160: 502-507
        • Kull I.
        • Bergstrom A.
        • Lilja G.
        • Pershagen G.
        • Wickman M.
        Fish consumption during the first year of life and development of allergic diseases during childhood.
        Allergy. 2006; 61: 1009-1015
        • Alm B.
        • Aberg N.
        • Erdes L.
        • Mollborg P.
        • Pettersson R.
        • Norvenius S.G.
        • et al.
        Early introduction of fish decreases the risk of eczema in infants.
        Arch Dis Child. 2009; 94: 11-15
        • Nwaru B.I.
        • Erkkola M.
        • Ahonen S.
        • Kaila M.
        • Haapala A.M.
        • Kronberg-Kippila C.
        • et al.
        Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years.
        Pediatrics. 2010; 125: 50-59
        • Snijders B.E.
        • Thijs C.
        • van Ree R.
        • van den Brandt P.A.
        Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: the KOALA Birth Cohort Study.
        Pediatrics. 2008; 122: e115-e122
        • Katz Y.
        • Rajuan N.
        • Goldberg M.R.
        • Eisenberg E.
        • Heyman E.
        • Cohen A.
        • et al.
        Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy.
        J Allergy Clin Immunol. 2010; 126 (e1): 77-82
        • Sariachvili M.
        • Droste J.
        • Dom S.
        • Wieringa M.
        • Hagendorens M.
        • Stevens W.
        • et al.
        Early exposure to solid foods and the development of eczema in children up to 4 years of age.
        Pediatr Allergy Immunol. 2010; 21: 74-81
        • von Mutius E.
        • Schmid S.
        The PASTURE project: EU support for the improvement of knowledge about risk factors and preventive factors for atopy in Europe.
        Allergy. 2006; 61: 407-413
        • Roduit C.
        • Wohlgensinger J.
        • Frei R.
        • Bitter S.
        • Bieli C.
        • Loeliger S.
        • et al.
        Prenatal animal contact and gene expression of innate immunity receptors at birth are associated with atopic dermatitis.
        J Allergy Clin Immunol. 2011; 127 (e1): 179-185
        • Sunyer J.
        • Anto J.M.
        • Harris J.
        • Torrent M.
        • Vall O.
        • Cullinan P.
        • et al.
        Maternal atopy and parity.
        Clin Exp Allergy. 2001; 31: 1352-1355
        • Alfven T.
        • Braun-Fahrlander C.
        • Brunekreef B.
        • von Mutius E.
        • Riedler J.
        • Scheynius A.
        • et al.
        Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle—the PARSIFAL study.
        Allergy. 2006; 61: 414-421
        • Schuttelaar M.L.
        • Kerkhof M.
        • Jonkman M.F.
        • Koppelman G.H.
        • Brunekreef B.
        • de Jongste J.C.
        • et al.
        Filaggrin mutations in the onset of eczema, sensitization, asthma, hay fever and the interaction with cat exposure.
        Allergy. 2009; 64: 1758-1765
        • Bisgaard H.
        • Simpson A.
        • Palmer C.N.
        • Bonnelykke K.
        • McLean I.
        • Mukhopadhyay S.
        • et al.
        Gene-environment interaction in the onset of eczema in infancy: Filaggrin loss-of-function mutations enhanced by neonatal cat exposure.
        PLoS Med. 2008; 5: e131
        • Shaheen S.O.
        • Adcock I.M.
        The developmental origins of asthma: does epigenetics hold the key?.
        Am J Respir Crit Care Med. 2009; 180: 690-691
        • Ege M.J.
        • Mayer M.
        • Normand A.C.
        • Genuneit J.
        • Cookson W.O.
        • Braun-Fahrlander C.
        • et al.
        Exposure to environmental microorganisms and childhood asthma.
        N Engl J Med. 2011; 364: 701-709
        • Bisgaard H.
        • Li N.
        • Bonnelykke K.
        • Chawes B.L.
        • Skov T.
        • Paludan-Muller G.
        • et al.
        Reduced diversity of the intestinal microbiota during infancy is associated with increased risk of allergic disease at school age.
        J Allergy Clin Immunol. 2011; 128 (e1-5): 646-652
        • Prescott S.L.
        • Smith P.
        • Tang M.
        • Palmer D.J.
        • Sinn J.
        • Huntley S.J.
        • et al.
        The importance of early complementary feeding in the development of oral tolerance: concerns and controversies.
        Pediatr Allergy Immunol. 2008; 19: 375-380
        • Kalliomaki M.
        • Salminen S.
        • Arvilommi H.
        • Kero P.
        • Koskinen P.
        • Isolauri E.
        Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.
        Lancet. 2001; 357: 1076-1079
        • Kuitunen M.
        • Kukkonen K.
        • Juntunen-Backman K.
        • Korpela R.
        • Poussa T.
        • Tuure T.
        • et al.
        Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.
        J Allergy Clin Immunol. 2009; 123: 335-341
        • Rizkalla S.W.
        • Luo J.
        • Kabir M.
        • Chevalier A.
        • Pacher N.
        • Slama G.
        Chronic consumption of fresh but not heated yogurt improves breath-hydrogen status and short-chain fatty acid profiles: a controlled study in healthy men with or without lactose maldigestion.
        Am J Clin Nutr. 2000; 72: 1474-1479
        • Matsumoto M.
        • Aranami A.
        • Ishige A.
        • Watanabe K.
        • Benno Y.
        LKM512 yogurt consumption improves the intestinal environment and induces the T-helper type 1 cytokine in adult patients with intractable atopic dermatitis.
        Clin Exp Allergy. 2007; 37: 358-370
        • Tedelind S.
        • Westberg F.
        • Kjerrulf M.
        • Vidal A.
        Anti-inflammatory properties of the short-chain fatty acids acetate and propionate: a study with relevance to inflammatory bowel disease.
        World J Gastroenterol. 2007; 13: 2826-2832
        • Maslowski K.M.
        • Vieira A.T.
        • Ng A.
        • Kranich J.
        • Sierro F.
        • Yu D.
        • et al.
        Regulation of inflammatory responses by gut microbiota and chemoattractant receptor GPR43.
        Nature. 2009; 461: 1282-1286
        • De Filippo C.
        • Cavalieri D.
        • Di Paola M.
        • Ramazzotti M.
        • Poullet J.B.
        • Massart S.
        • et al.
        Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa.
        Proc Natl Acad Sci U S A. 2010; 107: 14691-14696
        • Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC
        The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee.
        Lancet. 1998; 351: 1225-1232
        • Loss G.
        • Apprich S.
        • Waser M.
        • Kneifel W.
        • Genuneit J.
        • Buchele G.
        • et al.
        The protective effect of farm milk consumption on childhood asthma and atopy: the GABRIELA study.
        J Allergy Clin Immunol. 2011; 128 (e4): 766-773
        • Bieli C.
        • Eder W.
        • Frei R.
        • Braun-Fahrlander C.
        • Klimecki W.
        • Waser M.
        • et al.
        A polymorphism in CD14 modifies the effect of farm milk consumption on allergic diseases and CD14 gene expression.
        J Allergy Clin Immunol. 2007; 120: 1308-1315