Under-diagnosis of atopic dermatitis in Puerto Rican children.

Abstract

BACKGROUND:

Little is known about atopic dermatitis (AD) among children in Puerto Rico.

OBJECTIVE:

To examine risk factors and identify approaches to better diagnose AD in Puerto Rican children.

METHODS:

Case-control study of AD among 540 children aged 6-14 years in San Juan, Puerto Rico. AD was defined as: 1) physician-diagnosed AD, 2) RAST-AD: AD symptoms plus ≥1 positive IgE to allergens, and 3) STR-AD: AD-symptoms and skin test reactivity to ≥1 allergen. Logistic regression was used for the multivariable analysis. We also evaluated the diagnostic performance of various approaches by comparing their sensitivity, specificity, positive predicted value [PPV], negative predictive value [NPV], and area under curve [AUC]).

RESULTS:

Of the 70 children with STR-AD, only 5 (7.1%) had PD-AD. In children without asthma, a positive IgE to Dermatophagoides (D.) pteronyssinus and signs of mold/mildew at home were significantly associated with 3.3 and 5 times increased odds of STR-AD, respectively. Among children with asthma, private/employer-based health insurance and a positive IgE to D. pteronyssinus were each significantly associated with approximately twofold increased odds of STR-AD. A combination of current eczema symptoms and a positive IgE to D. pteronyssinus yielded a sensitivity ≥ 70%, specificity and NPV ≥ 95%, PPV ≥ 88%, and an AUC ≥ 0.85 for STR-AD. Replacing a positive IgE to D. pteronyssinus with a positive IgE to ≥1 allergen slightly increased sensitivity without affecting other parameters.

CONCLUSIONS:

AD is markedly under-diagnosed by physicians in Puerto Rico. This could be improved by assessing eczema symptoms and measuring IgEs to common allergens.

• Authors: Ge Yang, Yueh-Ying Han, Erick Forno, Edna Acosta-Pérez, Angel Colón-Semidey, María Alvarez, Glorisa Canino, Wei Chen, Juan C Celedón
• Journal: The World Allergy Organization journal (World Allergy Organ J) Vol. 12 Issue 1 Pg. 100003 ( 2019) ISSN: 1939-4551 [Print] United States
• PMID: 30937128 (Publication Type: Journal Article)