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Atopic Dermatitis and Association of Risk for Henoch – Sch ö nlein Purpura (IgA Vasculitis) and Renal Involvement Among Children

View Article: PubMed Central - PubMed

ABSTRACT

Elevation of Th2 cytokine-driven inflammatory mediators has been reported in acute stage of Henoch–Schönlein purpura (HSP). However, the temporal interaction between Th2-mediated allergic diseases and HSP with renal involvement remains unknown. Herein, we conducted a population-based cohort analysis to investigate the risk of HSP and renal involvement in children with atopic dermatitis (AD) as 1 of the first steps in the atopic march.

From 2000 to 2007, 95,208 children with newly diagnosed AD and 190,416 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of HSP in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and confidence intervals (CIs) were measured. Comparison of renal involvement in HSP between children with and without AD was analyzed.

The incidence of HSP during the study period was 1.75-fold greater (95% CI: 1.27–2.42) in the AD cohort than in the non-AD cohort (14.2 vs 8.11 per 100,000 person-years). The AD to non-AD HR of HSP was greater for girls (1.92, 95% CI: 1.18–3.13), children older than 6 years (2.54, 95% CI: 1.15–5.59), and those living in less urbanized area (2.74, 95% CI: 1.10–6.82). Concurrent allergic rhinitis or asthma did not increase the HR of HSP further. The HR for HSP in AD children increased from 0.67 (95% CI: 0.41–1.11) for those with ≤2 AD-related visits to 9.77 (95% CI: 6.44–14.8) for those with >4 visits (P < 0.0001, by the trend test). The risk of developing HSP in the AD cohort was highest within first year after AD diagnosis (HR: 3.99; 95% CI: 1.61–9.89). AD cohort with HSP had higher occurrence rate of renal involvement, particular hematuria, than non-AD cohort with HSP.

AD children had a greater risk of developing HSP and HSP with renal involvement. Further research is needed to clarify the role of allergy in the pathogenesis of HSP and renal involvement.

No MeSH data available.


Flow diagram of participant selection.
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Figure 1: Flow diagram of participant selection.

Mentions: AD is a chronic, relapsing, inflammatory skin disorder. Hence, AD was defined as at least 1 inpatient claim record or 2 ambulatory claims containing ICD-9-CM code 691.8 in the primary diagnosis field. A total of 95,208 patients (ages <18 years) newly diagnosed with AD between 2000 and 2007 were identified as the AD cohort. The baseline index date was the date of AD diagnosis. For each child with AD, we randomly selected 2 children without AD (never having ICD-9-CM code 691.8 in any diagnosis field) matched by sex, age (within 1 year), urbanized residence area, parental occupation, and baseline year. We used the method of 1:2 matching to increase statistical power and to control for potential confounders. Children with missing data regarding sex or date of birth and those with preexisting HSP (ICD-9-CM 287.0) before or within 1 month after the baseline index date were excluded. We also identified and compared the differences of the subjects who were diagnosed with allergic rhinitis (ICD-9 code: 477) and asthma (ICD-9 code: 493) in both the AD and non-AD cohorts. Diagnoses of HSP were based on clinical manifestations, including nonthrombocytopenic purpura located predominantly on dependent areas, such as the lower extremities and buttocks, and at least 1 of the following findings: arthralgia or arthritis, abdominal pain, or nephritis, according to the 1990 criteria of the American College of Rheumatology (ACR). In this study, IgA vasculitis and allergic diseases were diagnosed by physicians and were defined as at least 1 inpatient claim record or 2 ambulatory claims in any diagnosis field with the respective ICD-9-CM codes. IgA vasculitis with renal involvement was defined as occurrence of any 1 of the following: hematuria, proteinuria, nephritis, and nephrotic syndrome (ICD-9 codes 599.7, 791.0, and 580–585) within 1 year after IgA vasculitis was diagnosed. Each child was followed from the index date until the development of IgA vasculitis, withdrawal of insurance, or conclusion of follow-up on December 31, 2008. This study's design is summarized in the flow chart shown in Figure 1.


Atopic Dermatitis and Association of Risk for Henoch – Sch ö nlein Purpura (IgA Vasculitis) and Renal Involvement Among Children
Flow diagram of participant selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998291&req=5

Figure 1: Flow diagram of participant selection.
Mentions: AD is a chronic, relapsing, inflammatory skin disorder. Hence, AD was defined as at least 1 inpatient claim record or 2 ambulatory claims containing ICD-9-CM code 691.8 in the primary diagnosis field. A total of 95,208 patients (ages <18 years) newly diagnosed with AD between 2000 and 2007 were identified as the AD cohort. The baseline index date was the date of AD diagnosis. For each child with AD, we randomly selected 2 children without AD (never having ICD-9-CM code 691.8 in any diagnosis field) matched by sex, age (within 1 year), urbanized residence area, parental occupation, and baseline year. We used the method of 1:2 matching to increase statistical power and to control for potential confounders. Children with missing data regarding sex or date of birth and those with preexisting HSP (ICD-9-CM 287.0) before or within 1 month after the baseline index date were excluded. We also identified and compared the differences of the subjects who were diagnosed with allergic rhinitis (ICD-9 code: 477) and asthma (ICD-9 code: 493) in both the AD and non-AD cohorts. Diagnoses of HSP were based on clinical manifestations, including nonthrombocytopenic purpura located predominantly on dependent areas, such as the lower extremities and buttocks, and at least 1 of the following findings: arthralgia or arthritis, abdominal pain, or nephritis, according to the 1990 criteria of the American College of Rheumatology (ACR). In this study, IgA vasculitis and allergic diseases were diagnosed by physicians and were defined as at least 1 inpatient claim record or 2 ambulatory claims in any diagnosis field with the respective ICD-9-CM codes. IgA vasculitis with renal involvement was defined as occurrence of any 1 of the following: hematuria, proteinuria, nephritis, and nephrotic syndrome (ICD-9 codes 599.7, 791.0, and 580–585) within 1 year after IgA vasculitis was diagnosed. Each child was followed from the index date until the development of IgA vasculitis, withdrawal of insurance, or conclusion of follow-up on December 31, 2008. This study's design is summarized in the flow chart shown in Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Elevation of Th2 cytokine-driven inflammatory mediators has been reported in acute stage of Henoch&ndash;Sch&ouml;nlein purpura (HSP). However, the temporal interaction between Th2-mediated allergic diseases and HSP with renal involvement remains unknown. Herein, we conducted a population-based cohort analysis to investigate the risk of HSP and renal involvement in children with atopic dermatitis (AD) as 1 of the first steps in the atopic march.

From 2000 to 2007, 95,208 children with newly diagnosed AD and 190,416 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of HSP in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and confidence intervals (CIs) were measured. Comparison of renal involvement in HSP between children with and without AD was analyzed.

The incidence of HSP during the study period was 1.75-fold greater (95% CI: 1.27&ndash;2.42) in the AD cohort than in the non-AD cohort (14.2 vs 8.11 per 100,000 person-years). The AD to non-AD HR of HSP was greater for girls (1.92, 95% CI: 1.18&ndash;3.13), children older than 6 years (2.54, 95% CI: 1.15&ndash;5.59), and those living in less urbanized area (2.74, 95% CI: 1.10&ndash;6.82). Concurrent allergic rhinitis or asthma did not increase the HR of HSP further. The HR for HSP in AD children increased from 0.67 (95% CI: 0.41&ndash;1.11) for those with &le;2 AD-related visits to 9.77 (95% CI: 6.44&ndash;14.8) for those with &gt;4 visits (P&#8202;&lt;&#8202;0.0001, by the trend test). The risk of developing HSP in the AD cohort was highest within first year after AD diagnosis (HR: 3.99; 95% CI: 1.61&ndash;9.89). AD cohort with HSP had higher occurrence rate of renal involvement, particular hematuria, than non-AD cohort with HSP.

AD children had a greater risk of developing HSP and HSP with renal involvement. Further research is needed to clarify the role of allergy in the pathogenesis of HSP and renal involvement.

No MeSH data available.