Under-diagnosis of atopic dermatitis in Puerto Rican children
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 def...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-01-01
|
| Series: | World Allergy Organization Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1939455119300481 |
| _version_ | 1818309576353644544 |
|---|---|
| author | Ge Yang Yueh-Ying Han Erick Forno Edna Acosta-Pérez Angel Colón-Semidey María Alvarez Glorisa Canino Wei Chen Juan C. Celedón |
| author_facet | Ge Yang Yueh-Ying Han Erick Forno Edna Acosta-Pérez Angel Colón-Semidey María Alvarez Glorisa Canino Wei Chen Juan C. Celedón |
| author_sort | Ge Yang |
| collection | DOAJ |
| description | 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. Keywords: Atopic dermatitis, Under-diagnosis, Puerto Rico, Children |
| first_indexed | 2024-12-13T07:32:22Z |
| format | Article |
| id | doaj.art-14ce90d2897e4cb386b5d2704686cef2 |
| institution | Directory Open Access Journal |
| issn | 1939-4551 |
| language | English |
| last_indexed | 2024-12-13T07:32:22Z |
| publishDate | 2019-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Allergy Organization Journal |
| spelling | doaj.art-14ce90d2897e4cb386b5d2704686cef22022-12-21T23:55:09ZengElsevierWorld Allergy Organization Journal1939-45512019-01-01121Under-diagnosis of atopic dermatitis in Puerto Rican childrenGe Yang0Yueh-Ying Han1Erick Forno2Edna Acosta-Pérez3Angel Colón-Semidey4María Alvarez5Glorisa Canino6Wei Chen7Juan C. Celedón8Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neonatology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Third Xiangya Hospital, Central South University, Changsha, Hunan, 410083, ChinaDivision of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USADivision of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USABehavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto RicoBehavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico; Department of Pediatrics, University of Puerto Rico, San Juan, Puerto RicoBehavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico; Department of Pediatrics, University of Puerto Rico, San Juan, Puerto RicoBehavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico; Department of Pediatrics, University of Puerto Rico, San Juan, Puerto RicoDivision of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USADivision of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA; Corresponding author. Division of Pediatric Pulmonary Medicine, Children's Hospital of Pittsburgh of UPMC 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.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. Keywords: Atopic dermatitis, Under-diagnosis, Puerto Rico, Childrenhttp://www.sciencedirect.com/science/article/pii/S1939455119300481 |
| spellingShingle | Ge Yang Yueh-Ying Han Erick Forno Edna Acosta-Pérez Angel Colón-Semidey María Alvarez Glorisa Canino Wei Chen Juan C. Celedón Under-diagnosis of atopic dermatitis in Puerto Rican children World Allergy Organization Journal |
| title | Under-diagnosis of atopic dermatitis in Puerto Rican children |
| title_full | Under-diagnosis of atopic dermatitis in Puerto Rican children |
| title_fullStr | Under-diagnosis of atopic dermatitis in Puerto Rican children |
| title_full_unstemmed | Under-diagnosis of atopic dermatitis in Puerto Rican children |
| title_short | Under-diagnosis of atopic dermatitis in Puerto Rican children |
| title_sort | under diagnosis of atopic dermatitis in puerto rican children |
| url | http://www.sciencedirect.com/science/article/pii/S1939455119300481 |
| work_keys_str_mv | AT geyang underdiagnosisofatopicdermatitisinpuertoricanchildren AT yuehyinghan underdiagnosisofatopicdermatitisinpuertoricanchildren AT erickforno underdiagnosisofatopicdermatitisinpuertoricanchildren AT ednaacostaperez underdiagnosisofatopicdermatitisinpuertoricanchildren AT angelcolonsemidey underdiagnosisofatopicdermatitisinpuertoricanchildren AT mariaalvarez underdiagnosisofatopicdermatitisinpuertoricanchildren AT glorisacanino underdiagnosisofatopicdermatitisinpuertoricanchildren AT weichen underdiagnosisofatopicdermatitisinpuertoricanchildren AT juancceledon underdiagnosisofatopicdermatitisinpuertoricanchildren |