Association between atopic eczema and childhood asthma in schoolchildren from the north east of England

Background Respiratory epidemiologists have special international interest in the sequential progression of multiple allergic conditions (allergic march). Individuals who develop an allergic disease are at increased risk of developing further allergic conditions.Many large studies have estimated the prevalence of eczema, asthma and allergic rhinitis which are common and useful in reducing the co-morbidity associated with these disorders. However, the progression and the association between these conditions remain understudied. The aims of the study is to investigate the association between atopic eczema and childhood asthma. Methods We studied 600 schoolchildren, aged 6-7 and 13-14 years, from the north east of England. We used the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and illustrative manual of childhood eczema developed by ISAAC group. Results Atopic eczema was the most common allergic disease of girls, with a lifetime prevalence of 27%. There was a negative association between maternal smoking and eczema (p<0.05). History of current eczema was associated with current wheeze (OR, 2.73; 95% CI, 1.75 to 4.26; p<0.001). Eczema was reported by 46% of boys and girls with asthma. Curent chronic rash was reported by 22% and 28% of boys and girls with asthma, respectively. Indices related to lifetime diagnosis of eczema increased in boys and girls. In the 13-14 years of age:  girls were significantly  (p<0.001) more likely to report atopic eczema or chronic rash than boys. 32%, 37%, and 34% of boys, girls and all children with asthma had eczema, respectively. There was a negative associations between paternal smoking and both current chronic rash (p<0.001), and lifetime chronic rash (p<0.05). There was a negative association between maternal smoking and eczema (p<0.01). History of current eczema was significantly associated with current wheeze and severe wheezing attacks (OR: 3.00, CI: 2.0 to 5.70). Eczema was reported by 32% of boys and 37% of girls with asthma. Current chronic rash was reported by 20% and 32% of boys and girls with asthma, respectively. Indices related to lifetime diagnosis of eczema increased in boys and girls. Conclusion Eczema in children is a major public health problem in developing as well as developed countries and has important public health implications. Children with atopic eczema are at risk of developing asthma and airway inflammation has been shown to be present before the onset of clinical asthma.