Atopic dermatitis
AD was diagnosed prospectively at scheduled and acute care visits at age 0-6 years (prior to evaluation of our outcomes) according to Hanifin and Rajka’s criteria14 capturing age of debut and age of remission as previously detailed15,16. A diagnosis of AD required the presence of 3 of 4 major criteria and at least 3 of 23 minor signs. The following 4 minor signs were excluded: keratoconus and anterior sub-capsular cataracts, delayed blanch, and impaired cell-mediated immunity. The severity of AD was scored using the Scoring Atopic Dermatitis (SCORAD) index at scheduled and acute care visits17, ranging from 0 to 83 points (excluding the subjective components of pruritus and sleeplessness from the modified SCORAD index). As we saw the children at acute care visits whenever they had an AD flare-up, we were sure to capture the highest SCORAD value in the course of their disease.
Aeroallergen sensitization Assessment of sIgE levels in blood samples was done at age 6 and 12 years by an initial screening method (ImmunoCAP Phadiatop Infant™ and ImmunoCAP Phadiatop™, Thermo Fisher Scientific, Uppsala, Sweden)18 followed by analysis of individual allergen sIgE levels in screening positive samples towards birch, grass, mugwort, horse, dog, cat, house dust mites (D. pteronyssinus and D. farinae) and molds (Penicillium notatum, Cladosporium herbarum, Aspergillus fumigatus and Alternaria alternata). Sensitization was defined as values of sIgE ≥ 0.35 kUA/L13.