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Is eczema really on the increase worldwide?

Published:January 03, 2008DOI:https://doi.org/10.1016/j.jaci.2007.11.004

      Background

      It is unclear whether eczema prevalence is truly increasing worldwide.

      Objective

      We sought to investigate worldwide secular trends in childhood eczema.

      Methods

      Children (n = 302,159) aged 13 to 14 years in 105 centers from 55 countries and children aged 6 to 7 years (n = 187,943) in 64 centers from 35 countries were surveyed from the same study centers taking part in Phase One and Three of the International Study of Asthma and Allergies in Childhood by using identical validated and translated questionnaires. Eczema was defined as an itchy, relapsing, flexural skin rash in the last 12 months, and it was termed severe eczema when it was associated with 1 or more disturbed nights per week.

      Results

      Annual prevalence changes in relation to average prevalence across Phase One and Three were generally small and differed in direction according to the age of the participants and world region. For children 13 to 14 years old, eczema symptom prevalence decreased in some previously high-prevalence centers from the developed world, such as the United Kingdom and New Zealand, whereas centers with previously high prevalence rates from developing countries continued to increase. In the children 6 to 7 years old, most centers showed an increase in current eczema symptoms. Similar patterns to these were present for severe eczema at both ages.

      Conclusion

      The epidemic of eczema seems to be leveling or decreasing in some countries with previously high prevalence rates. The picture elsewhere is mixed, with many formerly low-prevalence developing countries experiencing substantial increases, especially in the younger age group.

      Key words

      Abbreviation used:

      ISAAC (International Study of Asthma and Allergies in Childhood)
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      References

        • Johansson S.G.
        • Bieber T.
        • Dahl R.
        • Friedmann P.S.
        • Lanier B.Q.
        • Lockey R.F.
        • et al.
        Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003.
        J Allergy Clin Immunol. 2004; 113: 832-836
        • McNally N.
        • Phillips D.
        Geographical studies of atopic eczema.
        in: Williams H.C. Atopic dermatitis—the epidemiology, causes and prevention of atopic eczema. Cambridge University Press, Cambridge2000: 71-84
        • Williams H.C.
        • Robertson C.F.
        • Stewart A.W.
        • ISAAC Steering Committee
        Worldwide variations in the prevalence of atopic eczema symptoms.
        J Allergy Clin Immunol. 1999; 103: 125-138
        • Verboom P.
        • Hakkaart-Van L.
        • Sturkenboom M.
        • De Zeeuw R.
        • Menke H.
        • Rutten F.
        The cost of atopic dermatitis in the Netherlands: an international comparison.
        Br J Dermatol. 2002; 147: 716-724
        • Kemp A.S.
        Cost of illness of atopic dermatitis in children: a societal perspective.
        Pharmacoeconomics. 2003; 21: 105-113
        • Schultz Larsen F.
        • Hanifin J.M.
        Secular change in the occurrence of atopic dermatitis.
        Acta Derm Venereol Suppl (Stockh). 1992; 176: 7-12
        • O'Connell E.J.
        The burden of atopy and asthma in children.
        Allergy. 2004; 59: 7-11
        • Sturgill S.
        • Bernard L.A.
        Atopic dermatitis update.
        Curr Opin Pediatr. 2004; 16: 396-401
        • Williams H.C.
        Is the prevalence of atopic dermatitis increasing?.
        Clin Exp Dermatol. 1992; 17: 385-391
        • von Mutius E.
        The rising trends in asthma and allergic disease.
        Clin Exp Allergy. 1998; 28: 45-49
        • Diepgen T.L.
        Is the prevalence of atopic dermatitis increasing?.
        in: Williams H.C. Atopic dermatitis—the epidemiology, causes and prevention of atopic eczema. Cambridge University Press, Cambridge2000: 96-112
        • Schultz Larson F.
        • Holm N.V.
        • Henningsen K.
        Atopic dermatitis—a genetic-epidemiological study in a population-based twin sample.
        J Am Acad Dermatol. 1986; 15: 487-494
        • Barbee R.A.
        • Kaltenborn W.
        • Lebowitz M.D.
        • Burrows B.
        Longitudinal changes in allergen skin test reactivity in a community population sample.
        J Allergy Clin Immunol. 1987; 79: 16-24
        • Braback L.
        • Hjern A.
        • Rasmussen F.
        Trends in asthma, allergic rhinitis and eczema among Swedish conscripts from farming and non-farming environments. A nationwide study over three decades.
        Clin Exp Allergy. 2004; 34: 38-43
        • Heinrich J.
        • Hoelscher B.
        • Frye C.
        • Meyer I.
        • Wjst M.
        • Wichmann H.E.
        Trends in prevalence of atopic diseases and allergic sensitization in children in Eastern Germany.
        Eur Respir J. 2002; 19: 1040-1046
        • Yura A.
        • Shimizu T.
        Trends in the prevalence of atopic dermatitis in school children: longitudinal study in Osaka Prefecture, Japan, from 1985 to 1997.
        Br J Dermatol. 2001; 145: 966-973
        • Kalyoncu A.F.
        • Selcuk Z.T.
        • Enunlu T.
        • Demir A.U.
        • Coplu L.
        • Sahin A.A.
        • et al.
        Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart.
        Pediatr Allergy Immunol. 1999; 10: 261-265
        • Nystad W.
        • Magnus P.
        • Gulsvik A.
        • Skarpaas I.J.
        • Carlsen K.H.
        Changing prevalence of asthma in school children: evidence for diagnostic changes in asthma in two surveys 13 yrs apart.
        Eur Respir J. 1997; 10: 1046-1051
        • Asher M.I.
        • Keil U.
        • Anderson H.R.
        • Beasley R.
        • Crane J.
        • Martinez F.
        • et al.
        International study of asthma and allergies in childhood (ISAAC): rationale and methods.
        Eur Respir J. 1995; 8: 483-491
        • Asher M.I.
        • Bjorksten B.
        • Lai C.K.W.
        • Strachan D.P.
        • Weiland S.K.
        • Williams H.C.
        • et al.
        Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phase Three multicountry cross-sectional survey.
        Lancet. 2006; 368: 733-743
        • The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee
        Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC.
        Lancet. 1998; 351: 1225-1232
        • ISAAC Steering Committee
        Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC).
        Eur Respir J. 1998; 12: 315-335
        • Strachan D.
        • Sibbald B.
        • Weiland S.
        • Ait-Khaled N.
        • Anabwani G.
        • Anderson H.
        • et al.
        Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC).
        Pediatr Allergy Immunol. 1997; 8: 161-176
        • Weiland S.K.
        • Björkstén B.
        • Brunekreef B.
        • Cookson W.O.
        • von Mutius E.
        • Strachan D.P.
        • et al.
        Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods.
        Eur Respir J. 2004; 24: 406-412
        • Ellwood P.
        • Asher M.I.
        • Beasley R.
        • Clayton T.O.
        • Stewart A.W.
        • the ISAAC Steering Committee
        The International Study of Asthma and Allergies in Childhood (ISAAC): Phase Three rationale and methods.
        Int J Tuberc Lung Dis. 2005; 9: 10-16
      1. ISAAC Steering Committee. International Study of Asthma and Allergies in Childhood Manual. Auckland/Münster; 1993. Available at: http://isaac.auckland.ac.nz/PhaseOne/Manual/ManFrame.html. Accessed December 3, 2007.

        • Weiland S.K.
        • Kugler J.
        • von Mutius E.
        • Schmitz N.
        • Fritzsch C.
        • Wahn U.
        • et al.
        Die Sprache asthmakranker Kinder. Eine Untersuchung zur Symptombeschreibung.
        Monatsschrift fur Kinderheilkunde. 1993; 141: 878-882
        • Williams H.C.
        What is atopic dermatitis and how should it be defined in epidemiological studies?.
        in: Williams H.C. Atopic dermatitis—the epidemiology, causes and prevention of atopic eczema. Cambridge University Press, Cambridge2000: 3-24
        • Gupta R.
        • Sheikh A.
        • Strachan D.P.
        • Anderson H.R.
        Time trends in allergic disorders in the UK.
        Thorax. 2007; 62: 91-96
        • Williams H.C.
        Atopic eczema—why we should look to the environment.
        BMJ. 1995; 311: 1241-1242
        • Akdis C.A.
        • Akdis M.
        • Bieber T.
        • Bindslev-Jensen C.
        • Boguniewicz M.
        • Eigenmann P.
        • et al.
        Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report.
        J Allergy Clin Immunol. 2006; 118: 152-169
        • Morar N.
        • Willis-Owen S.A.
        • Moffatt M.F.
        • Cookson W.O.
        The genetics of atopic dermatitis.
        J Allergy Clin Immunol. 2006; 118: 24-34
        • Flohr C.
        • Johansson S.G.O.
        • Wahlgren C.F.
        • Williams H.C.
        How “atopic” is atopic dermatitis?.
        J Allergy Clin Immunol. 2004; 114: 150-158
        • Palmer C.N.
        • Irvine A.D.
        • Terron-Kwiatkowski A.
        • Zhao Y.
        • Liao H.
        • Lee S.P.
        • et al.
        Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis.
        Nat Genet. 2006; 38: 441-446
        • Morar N.
        • Cookson W.O.
        • Harper J.I.
        • Moffatt M.F.
        Filaggrin mutations in children with severe atopic dermatitis.
        J Invest Dermatol. 2007; 127: 1667-1672
        • Cork M.J.
        • Robinson D.A.
        • Vasilopoulos Y.
        • Ferguson A.
        • Moustafa M.
        • MacGowan A.
        • et al.
        New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions.
        J Allergy Clin Immunol. 2006; 118: 3-21
        • Irvine A.D.
        Fleshing out filaggrin phenotypes.
        J Invest Dermatol. 2007; 127: 504-507
      2. Soap and other detergents, except specialty cleaners (SIC 2841).
        in: Gale Encyclopedia of American Industries. The Gale Group, Inc, 2005 (Available at:) (Accessed August 3, 2007)
        • Sherriff A.
        • Golding J.
        • Alspac Study Team
        Hygiene levels in a contemporary population cohort are associated with wheezing and atopic eczema in preschool infants.
        Arch Dis Child. 2002; 87: 26-29
        • Chalmers D.A.
        • Todd G.
        • Saxe N.
        • Tolosano S.
        • Ngcelwane P.N.
        • Hlaba B.N.
        • et al.
        Validation of the United Kingdom Working Party diagnostic criteria for atopic eczema in an African setting.
        Br J Dermatol. 2007; 156: 111-116
        • Flohr C.
        Dirt, worms and atopic dermatitis.
        Br J Dermatol. 2003; 148: 871-877
        • Mar A.
        • Marks R.
        Prevention of atopic dermatitis.
        in: Williams H.C. Atopic dermatitis—the epidemiology, causes and prevention of atopic eczema. Cambridge University Press, Cambridge2000: 205-220
        • Williams H.C.
        Atopic Dermatitis.
        N Engl J Med. 2005; 352: 2314-2324
        • Brown S.
        • Reynolds N.J.
        Atopic and non-atopic eczema.
        BMJ. 2006; 332: 584-588