| Summary: | We challenge 3 prevailing concepts in understanding atopic
dermatitis using data from epidemiologic studies. First, we
show that although atopy is associated with atopic dermatitis to
some degree, its importance is not likely to be a simple causeand-
effect relationship, especially at a population level. Our
epidemiologic data do not exclude a contributory role for IgEmediated
immunologic processes, especially in those with
existing and severe disease. Second, evidence is presented that
does not support a straightforward inverse relationship
between infections and atopic dermatitis risk. A link, if present,
is likely to be more complex, depending critically on the timing
and type of infectious exposure. Third, recent evidence suggests
that the risk of subsequent childhood asthma is not increased in
children with early atopic dermatitis who are not also early
wheezers, suggesting a comanifestation of phenotypes rather
than a progressive atopic march. Collectively, these
observations underline the importance of epidemiologic studies
conducted at a population level to gain a more balanced
understanding of the enigma of atopic dermatitis.
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