アトピーマーチの予測

1 歳時に 3 歳時のアレルギー疾患をある程度予測できるという論文です。

背景
アトピーマーチは乳児期のアトピー性皮膚炎から後期小児期の喘息・アレルギー性鼻炎へと進行すると言われている。カナダの出生コホートにおいてアレルギー感作が 3 歳時のアレルギー疾患へ進展するか否かを調査した。

方法
1 歳時に皮膚プリック試験を行った。１０の吸入または食物抗原に対して陰性コントロールよりも膨疹径が 2mm 以上大きければ感作されているとした。アトピー性皮膚炎は英国 WorkingPartyの診断基準を使用して評価した。3 歳時に気管支喘息、アレルギー性鼻炎、食物アレルギー、アトピー性皮膚炎があるかを評価した。2311 人の小児のデータで解析した。

結果

アレルギー感作のないアトピー性皮膚炎は交絡因子を調整後では 3 歳時の喘息リスクの上昇とは関連しなかった(relative risk [RR],0.46; 95% CI, 0.11-1.93)。逆にアレルギー感作のあるアトピー性皮膚 炎 は 付 加 (relative excess risk due to interaction, 5.06; 95% CI,1.33-11.04)と multiplicative (ratio of RRs, 5.80; 95% CI, 1.20-27.83)スケー
ルで喘息リスクと関連していた。食物アレルギーリスクにおけるこれらの効果でのアトピー性皮膚炎とアレルギー感作との陽性付加的な相合作用がみられた(relative excess risk due to interaction, 15.11; 95% CI, 4.19-35.36)。

結論
アレルギー感作がないアトピー性皮膚炎は喘息リスクと関連しなかった。ア
トピー性皮膚炎とアレルギー感作は 3 歳時のアトピー性皮膚炎と食物アレルギーと強い相合効果があった。

1 歳時のアレルギー感作は 3 歳時の喘息・食物アレルギーをある程度予測出来る可能性がある。

1歳時のアレルギー感作のないアトピー性皮膚炎は3歳時の喘息のリスクと関連しない

相対危険度

3歳時の喘息RERI: Relative excess risk due to interaction

1歳時のアトピー性皮膚炎とアレルギー感作は3歳時の食物アレルギーの相対リスクがある

相対危険度

3歳時の食物アレルギー
RERI: Relative excess risk due to interaction

J Allergy Clin Immunol. 2018 Feb;141(2):601-607.e8. doi:
10.1016/j.jaci.2017.08.024. Epub 2017 Nov 15.

Predicting the atopic march: Results from the
Canadian Healthy Infant Longitudinal
Development Study.

Tran MM1, Lefebvre DL1, Dharma C1, Dai D1, Lou WYW2, Subbarao P3,Becker AB4, Mandhane PJ5, Turvey SE6, Sears MR7; Canadian Healthy
Infant Longitudinal Development Study investigators.

Collaborators (41)
Subbarao P, Turvey SE, Anand SS, Azad M, Becker AB, Befus AD,Brauer M, Brook JR, Chen E, Cyr M, Daley D, Dell SD, Denburg JA, Duan
Q, Eiwegger T, Grasemann H, HayGlass K, Hegele RG, Holness DL,Hystad P, Kobor M, Kollmann TR, Kozyrskyj AL, Laprise C, Lou WYW,Macri J, Mandhane PJ, Miller G, Moraes TJ, Paré P, Ramsey C, Ratjen F,Sandford A, Scott JA, Scott J, Sears MR, Silverman F, Simons E, TakaroT, Tebbutt S, To T.

Author information
1
Department of Medicine, McMaster University, Hamilton, Ontario,Canada.
2
Dalla Lana School of Public Health, University of Toronto, Toronto,Ontario, Canada.
3

Department of Pediatrics, University of Toronto and Hospital for Sick
Children, Toronto, Ontario, Canada.
4
Department of Pediatrics & Child Health, University of Manitoba,Winnipeg, Manitoba, Canada.
5
Department of Pediatrics, University of Alberta, Edmonton, Alberta,
Canada.
6
Department of Pediatrics, University of British Columbia, Vancouver,
British Columbia, Canada.
7
Department of Medicine, McMaster University, Hamilton, Ontario,
Canada. Electronic address: searsm@mcmaster.ca.

Abstract
BACKGROUND:
The atopic march describes the progression from atopic
dermatitis during infancy to asthma and allergic rhinitis in laterchildhood. In a Canadian birth cohort we investigated whether

concomitant allergic sensitization enhances subsequentdevelopment of these allergic diseases at age 3 years.
METHODS:Children completed skin prick testing at age 1 year. Children
were considered sensitized if they produced a wheal 2 mm orlarger than that elicited by the negative control to any of 10
inhalant or food allergens. Children were also assessed foratopic dermatitis by using the diagnostic criteria of the UK
Working Party. At age 3 years, children were assessed forasthma, allergic rhinitis, food allergy, and atopic dermatitis.
Data from 2311 children were available.
RESULTS:
Atopic dermatitis without allergic sensitization was not
associated with an increased risk of asthma at age 3 years
after adjusting for common confounders (relative risk [RR],0.46; 95% CI, 0.11-1.93). Conversely, atopic dermatitis withallergic sensitization increased the risk of asthma more than
7-fold (RR, 7.04; 95% CI, 4.13-11.99). Atopic dermatitis andallergic sensitization had significant interactions on both theadditive (relative excess risk due to interaction, 5.06; 95% CI,1.33-11.04) and multiplicative (ratio of RRs, 5.80; 95% CI,
1.20-27.83) scales in association with asthma risk. There wasalso a positive additive interaction between atopic dermatitis
and allergic sensitization in their effects on food allergy risk
(relative excess risk due to interaction, 15.11; 95% CI,
4.19-35.36).
CONCLUSIONS:
Atopic dermatitis without concomitant allergic sensitization
was not associated with an increased risk of asthma. In
combination, atopic dermatitis and allergic sensitization had
strong interactive effects on both asthma and food allergy risk
at age 3 years.