Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis

BACKGROUND: Atopic diseases are common in children and adolescents. However, epidemiological knowledge is sparse for hand eczema and allergic contact dermatitis in this age group. Furthermore, no population-based studies have evaluated the prevalence of atopic diseases and hand and contact dermatitis in the same group of adolescents. OBJECTIVES: To assess prevalence measures of atopic dermatitis (AD), asthma, allergic rhinitis and hand and contact dermatitis in adolescents in Odense municipality, Denmark. METHODS: The study was carried out as a cross-sectional study among 1501 eighth grade school children (age 12-16 years) and included questionnaire, interview, clinical examination and patch testing. RESULTS: The lifetime prevalence of AD was 21.3% (girls 25.7% vs. boys 17.0%, P < 0.001) using predefined questionnaire criteria. The 1-year period prevalence of AD was 6.7% and the point prevalence 3.6% (Hanifin and Rajka criteria). In the interview the lifetime prevalence of inhalant allergy was estimated as 17.7% (6.9% allergic asthma, 15.7% allergic rhinitis). The lifetime prevalence of hand eczema based on the questionnaire was 9.2%, the 1-year period prevalence was 7.3% and the point prevalence 3.2%, with a significant predominance in girls. A significant association was found both between AD and inhalant allergy, and between AD and hand eczema using lifetime prevalence measures. The point prevalence of contact allergy was 15.2% (girls 19.4% vs. boys 10.3%, P < 0.001), and present or past allergic contact dermatitis was found in 7.2% (girls 11.3% vs. boys 2.5%). Contact allergy was most common to nickel (8.6%) and fragrance mix (1.8%). CONCLUSIONS: High prevalence figures were found for atopic diseases, hand eczema and allergic contact dermatitis, and the diseases were closely associated. A considerable number of adolescents still suffers from AD, and a considerable sex difference was noted for hand eczema and allergic contact dermatitis. Nickel allergy and perfume allergy were the major contact allergies. In the future this cohort of eighth grade school children will be followed up with regard to the course and development of atopic diseases, hand eczema and contact dermatitis.     

Atopic neurodermatitis after childhood stage; follow-up study of 121 cases

121 patients suffering from atopic dermatitis (AD) who had been treated in the years 1967 to 1970, being then up to the age of 10, now have been controlled by means of questionnaires. 62 of them were additionally checked by way of personal interrogation and reexamination. The checking comprised of the course of the disease as well as allergies of the respiratory system (AR). The infantile phase of AD began in 55.4 percent of the patients already during the first trimenon, in 88.3 percent in the course of the first year. The average age of manifestation was at 5.5 months. At the time of the control, 58 percent of all patients and 62 percent of the reexamined patients still suffered from AD. Only 7.4 percent were free of cutaneous atopic manifestations after the infantile period. In 31.4 percent of the cases, the diseases cleared up after the infantile phase but reappeared at the age of 5 +/- 2.5 years. 61.2 percent of the patients developed a continuous transition from the infantile to the childhood phase of AD. 54.5 percent of all patients showed the following variations of AR: 33.1 percent suffered from hay fever, 28.1 percent from bronchial asthma, and 11.6 percent from perennial rhinitis. According to statistics, bronchial asthma revealed a prevalence to alternate with AD and occurred at the average age of 4.4 +/- 3.3 years, whereas rhinitis showed itself significantly later. Treatment with hyposensitization on account of AR seldom influenced the course of AD. The prognosis of AD turned out to be worse, if the disease had begun early (within the first or second trimenon), if it occurred with firstborn or single children, or if the patients also had allergies of the respiratory system.     

The excess of atopic eczema in East Germany is related to the intrinsic type

BACKGROUND: Prevalence data for atopic eczema based on a dermatological examination have not so far been available for East and West Germany. Possible differences in the proportions of extrinsic and intrinsic types of eczema, and how far these could explain differences in the prevalence of eczema, need to be clarified. OBJECTIVES: To compare the prevalence of atopic eczema in pre-school children between different locations in East and West Germany, and over a period of 7 years, at three time points. Additionally, to determine the proportions of intrinsic and extrinsic types of eczema by taking skin prick test reactivity into account. METHODS: Repeated cross-sectional studies in 1991, 1994 and 1997 in 5-6-year-old pre-school children at five different locations in West Germany (n = 2075) and six in East Germany (n = 1926) were carried out. Individuals with eczema were identified by an examination performed by physicians of the Department of Dermatology. In addition, a skin prick test and a standardized questionnaire were used. RESULTS: The overall prevalence of atopic eczema in these children was 10.4%. At all three times of investigation (1991, 17.5% vs. 11.2%; 1994, 12.6% vs. 8.7%; 1997, 11.2% vs. 4.5%) and in the total group (12.9% vs. 8.2%), the prevalence was significantly higher in East than in West Germany. After controlling for influences of sex, parental history of atopic diseases, observer and socio-economic status in multiple logistic regression analyses, these differences remained significant for 1991, 1994 and for the overall group (odds ratio, OR 1.78, 95% confidence interval, CI 1. 43-2.21). Girls (OR 1.56, 95% CI 1.27-1.92) and children whose parents had a higher level of school education (OR 1.17, 95% CI 1. 00-1.37) were affected more frequently. Of all children, 26.6%, and of those with eczema, 41.9% exhibited at least one reaction in the prick test (OR 2.21, 95% CI 1.75-2.80; sensitization in eczema vs. no eczema). Whereas 50.4% of the children with eczema in West Germany were sensitized, only 36.5% of the diseased children in East Germany reacted positively in the prick test (OR 1.77, 95% CI 1.12-2. 79). CONCLUSIONS: These results are in accordance with findings regarding allergic sensitization and hay fever and might indicate that factors other than allergy are responsible for the higher prevalence of atopic eczema in East Germany.     

Atopic dermatitis in adolescent boys is associated with greater psychological morbidity compared with girls of the same age: the Young-HUNT study

BACKGROUND: Having atopic dermatitis (AD) as well as other chronic diseases is often associated with reduced mental health. Adolescents with AD are thought to be especially vulnerable, but few studies have included an ample number of young people. OBJECTIVES: To study self-reported mental distress among boys and girls 13-19 years of age with AD compared with mental distress among healthy adolescents as well as mental distress among adolescents with other chronic diseases or complaints, such as headache, neck or shoulder pain, asthma, allergy and rhinitis. METHODS: The Young-HUNT study was conducted as a cross-sectional, population-based survey in 1995-97. All students in Nord-Trondelag County, Norway, aged 13-19 years were invited, and some 89% participated. A questionnaire on mental and somatic health, life-style and social conditions was completed during one school hour. RESULTS: A total of 4384 girls and 4433 boys participated. The prevalence of mental distress was higher among older teenagers, and more than every fourth girl aged 17-19 reported mental distress. Although more girls than boys reported mental distress, AD, headache and neck or shoulder pain, the odds for reporting both AD and mental distress were higher for boys [odds ratio (OR) = 2.1 (1.6-2.9)] compared with girls [OR = 1.3 (1.1-1.6)]. A corresponding sex difference in reporting mental distress was also seen for some other chronic diseases or complaints. CONCLUSIONS: In adolescents aged 13-19 years there was a strong and significant association between self-reported mental distress and AD as well as headache and neck or shoulder pain for both sexes. Although boys reported fewer complaints as AD, they perceived the complaints a heavier burden than did the girls.     

Is the prevalence of atopic dermatitis increasing?

Several studies have suggested that the prevalence of atopic dermatitis has increased over the last three decades, and similar trends have been reported with asthma and hay fever. However, in common with other 'allergic' disease, the definition and measurement of atopic dermatitis in populations has been fraught with problems and has led to difficulties in separating any real changes in disease prevalence from secular changes in diagnosis. In this article, the evidence surrounding the claims of an increased prevalence of atopic dermatitis is examined, and possible reasons for such a change are suggested.     

Association factors for atopic dermatitis in nursery school children in Ishigaki islands - Kyushu University Ishigaki Atopic Dermatitis Study (KIDS)

Atopic dermatitis (AD) is a multifactorial disease that usually decreases the quality of life of affected patients. The purpose of this study was to evaluate the associated factors for atopic dermatitis, asthma, rhinitis, and food allergy by physical examination of the skin and a questionnaire in nursery school children in Ishigaki Island, Okinawa, Japan. Enrolled in this study were 460 children from 0 to 6 years of age. Physical examination of skin symptoms and blood tests were performed. Information on past history and family history of atopic dermatitis, asthma, rhinitis, and food allergy were collected by questionnaire. The prevalence of atopic dermatitis was 12.2% (56/460). The cumulative prevalence of asthma, rhinitis, and food allergy was 19.9% (91/458), 3.3% (15/457), and 5.5% (25/456), respectively. In multivariate analysis, maternal history of rhinitis, atopic dermatitis siblings, past history of asthma and food allergy, and elevation of total IgE were significantly related to atopic dermatitis. A high total IgE level was a strong risk factor specific for atopic dermatitis in this population.     

徐州市泉山区小学生特应性皮炎发病情况及发育状况调查

目的了解徐州市部分小学生特应性皮炎(AD)的发病情况及生长发育状况。方法对徐州市泉山区6～13岁年龄段的城市小学生进行问卷调查和身高体重的测量。结果调查有效的10714人中发现AD患者105例,其中男64例,女41例,总患病率为0.98%,男性患病率为1.11%,女性为0.83%,两者比较差异无统计学意义(P0.05)。各年龄组患病率与年龄无相关性(P0.05)。AD患者中哮喘和/或过敏性鼻炎的患病率为30.5%,非AD者哮喘和/或过敏性鼻炎的患病率为0.75%,两者比较差异有统计学意义(P0.005),AD患者中哮喘和/或过敏性鼻炎的患病率与年龄无相关性(P0.05)。各年龄组AD患者与正常学生的身高和体重比较身高差异无统计学意义(P0.05),仅7岁组、9岁组的男生及9岁组女生的体重比较,AD患者高于正常学生,差异有统计学意义(P0.05)。结论徐州市6～13岁年龄段男生与女生AD患病率没有差异,患病率与年龄无相关性,AD患者的生长发育水平与正常儿童没有差异。     

The effect of environmental tobacco smoke on eczema and allergic sensitization in children

BACKGROUND: The negative impact of environmental tobacco smoke (ETS) on airway diseases in children is well known. Whether there is an effect on atopic eczema is not clear. OBJECTIVES: To determine the impact of ETS on atopic eczema, allergic sensitization and allergic airway diseases in 1669 school beginners. METHODS: The prevalence of atopy-related health outcomes was assessed by questionnaire, dermatological examination, skin prick testing and specific immunoglobulin E measurement. Exposure assessments were based on measurement of cotinine [expressed as cotinine to creatine ratio (CCR)] in spot urine samples (n = 1220) together with questionnaire and interview data on smoking behaviour of the parents. RESULTS: In the total study group, prevalence of atopic eczema diagnosed on examination was significantly associated with urinary CCR values. The odds ratio (OR) and 95% confidence interval (CI), calculated for an increase of 100 ng mg-1 CCR was 1.97 (95% CI 1.23-3.16). The prevalence of skin manifestations according to questionnaire data as well as a history of asthma, wheezing, and hay fever were positively although not significantly associated with ETS exposure. When genetically predisposed children (defined by the presence of parental atopy) were compared with children whose parents had no atopy, the ORs of allergic outcome variables were generally higher in the first group. In the group of predisposed children, significant associations with urinary CCR were found for allergic sensitization against house dust mites as measured by skin prick test (OR 3.10, 95% CI 1.63-5.90). CONCLUSIONS: Children are at a higher risk of developing an atopic eczema when exposed to ETS and genetically predisposed children are at higher risk of developing a sensitization against house dust mites.     

上海某中学青少年特应性皮炎和鱼鳞病FLG基因型的研究

目的 探讨青少年FLG基因型、了解特应性疾病患病率、发展进程及其FLG基因的关系。 方法 上海某中学334例11 ~ 19岁青少年作为研究样本,进行鱼鳞病、特应性皮炎（AD）、哮喘、鼻炎等特应性疾病的临床病史及体征观察、记录。285例进行了外周血采样及FLG基因高频突变筛查。5年后,进行样本人群随访,观察并记录各特应性疾病的临床症状及体征。 结果 5年前,334例青少年中AD19例（5.69%）,寻常性鱼鳞病14例（4.19%）,过敏性鼻炎36例（10.78%）,哮喘4例（1.20%）。在完成FLG基因测序的285例样本中,携带FLG基因高频突变者24例（8.42%）。5年后完成随访265例,失访69例（20.66%）,AD、鱼鳞病、过敏性鼻炎及哮喘的患病人数分别为13例（4.89%）、15例（5.64%）、27例（10.15%）、1例（0.38%）,原19例AD中6例进入完全缓解期,13例SCORAD评分明显下降,原36例过敏性鼻炎中9例症状消失。单纯AD、单纯鱼鳞病、AD合并鱼鳞病的FLG基因高频突变率分别为10.0%、55.6%、40.0%,且患鱼鳞病与FLG基因突变有关（P < 0.001）。结论 青少年中,FLG基因高频突变率为8.42%。FLG基因是寻常性鱼鳞病的半显性遗传因素,中间丝聚合蛋白的表达受多因素影响。     

A family study of atopic dermatitis

Summary The history of 188 Caucasian patients with atopic dermatitis (AD) and of 2,151 family members has been analyzed. Of the AD patients 48% suffered from respiratory atopy (36% rhinitis, 28% asthma, and 15% both). AD showed by far the earliest onset of all atopic diseases: 50% of our patients had skin lesions before the age of 2 years and 60% before the age of 5 years. In contrast, symptoms of allergic asthma developed in 40% of AD patients before the age of 5 years in comparison with only 25% who had allergic rhinitis. AD affects females more frequently than males (male to female ratio 11.5), regardless of whether additional respiratory atopies are present or not. In contrast, respiratory atopies develop more frequently in males than in females (male to female ratio 1.51). Mothers with respiratory atopy more often have atopic children (26%) than do fathers with respiratory atopy (13%). Finally, risk figures for genetic counselling are given. In short, the general risk of developing AD (3%) and atopy (7%) increases by a factor of two with each first-degree family member already suffering from atopy.     

Patient Questionnaires in Atopic Dermatitis

An allergy questionnaire, directed to people suffering with atopic dermatitis, bronchial asthma or hay fever was analysed in 81 people (44 men, 37 women), proved to be less important for patients with atopic dermatitis than for those with bronchial asthma and hay fever.     

Epidemiology and Clinical Features of Atopic Dermatitis in Kerman,a Desert Area of Iran

Background

Epidemiologic studies of atopic dermatitis (AD) in desert areas are still lacking.

Objective

The aim of this study was to investigate the epidemiology of AD in children in Kerman city, a desert area in Iran.

Methods

We evaluated preschool children (age, 2 to 7 years) and primary school students (age, greater than 7 up to 12 years) in Kerman. We selected 865 students to estimate the prevalence and assess other features of AD such as distribution of lesions, personal history, family history of atopy, aggravating factors, associated symptoms, and morphological variants.

Results

The prevalence of AD was 9.1% in our study population. The prevalence of AD was 9.17% and 9.09% in males and females, respectively. The prevalence of AD in the age range of 2 to 7 years was 13.53% and 8.33% among children aged greater than 7 up to 12 years. In total, 82.27% of the patients were in chronic stage of the disease, and 31.6% had a personal history of other atopic diseases. At least one first-degree family member with atopy was seen in 46.83% of the patients. The most common sites of involvement were the head and neck. The most involved areas in the limbs were extensor surfaces. The most frequent morphological variant of AD was the common type.

Conclusion

The prevalence of AD in Kerman was higher than in other Iranian cities but lower than that in developed countries. Diversity in the clinical features of AD has been observed among different studies, and the diagnostic criteria of AD should be adapted in proportion to the studied area.     

Burden of atopic dermatitis in Japanese adults: Analysis of data from the 2013 National Health and Wellness Survey

Atopic dermatitis is a chronic inflammatory skin disease. The objective of this study was to characterize the burden of atopic dermatitis in Japanese adult patients relative to the general population. Japanese adults (≥18 years) with a self‐reported diagnosis of atopic dermatitis and adult controls without atopic dermatitis/eczema/dermatitis were identified from the 2013 Japan National Health and Wellness Survey. Atopic dermatitis patients were propensity‐score matched with non‐atopic dermatitis controls (1:2 ratio) on demographic variables. Patient‐reported outcome data on comorbidities, mood and sleep disorders, health‐related quality of life, work productivity and activity impairment, and health‐care resource utilization were analyzed in atopic dermatitis patients and matched controls. A total of 638 Japanese adult patients with atopic dermatitis were identified, of whom 290 (45.5%) rated their disease as “moderate/severe” and 348 (54.5%) as “mild”. The analysis cohort comprised 634 atopic dermatitis patients and 1268 matched controls. Atopic dermatitis patients reported a significantly higher prevalence of arthritis, asthma, nasal allergies/hay fever, anxiety, depression and sleep disorders compared with controls (all P < 0.001). Atopic dermatitis patients also reported a significantly poorer health‐related quality of life, higher overall work and activity impairment, and higher health‐care resource utilization (all P < 0.001). Self‐rated disease severity was not associated with disease burden, except for a significantly higher overall work and activity impairment. In conclusion, Japanese adult patients with atopic dermatitis reported a substantial disease burden relative to adults without atopic dermatitis, suggesting an unmet need for effective strategies targeting disease management.     

Atopic diseases among schoolchildren in Nikel, Russia, an Arctic area with heavy air pollution

The objective of this study was to describe the prevalence rate of atopic diseases among schoolchildren living in the heavily polluted Arctic town of Nikel, Russia. A self-administered questionnaire was distributed to the parents of 1,800 children aged 8-17 years, 1,684 of whom (93.6%) completed and returned the questionnaire. Atopic diseases were reported in 508 (30.2%) of the children and prevalence was similar for both sexes. Atopic dermatitis occurred most frequently (15.5%), followed by allergic rhinoconjunctivitis (13.9%) and asthma (3.9%). The most pronounced influence on atopic diseases in children was having parents with asthma. Indoor dampness was a significant risk factor eliciting atopic diseases, whereas furred pets, passive smoking and carpets did not influence the prevalence of allergy. We conclude that although atopic diseases are a common health problem in Nikel, they are less prevalent than has been reported in recent studies of Northern European countries. Air pollution does not seem to be a major risk factor for the development of atopic diseases.     

Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age

BACKGROUND: The prevalence of atopic dermatitis (AD) is increasing in Western societies. The hygiene hypothesis proposes that this is due to reduced exposure to environmental allergens and infections during early life. OBJECTIVES: To examine factors associated with a diagnosis of AD at 3.5 years of age, especially those factors implicated by the hygiene hypothesis. METHODS: The Auckland Birthweight Collaborative study is a case-control study of risk factors for small for gestational age babies. Cases were born at term with birthweight < or = 10th centile; controls were appropriate for gestational age, with birthweight > 10th centile. The infants were assessed at birth, 1 year and 3.5 years of age. Data were collected by parental interview and examination of the child. AD was defined as the presence of an itchy rash in the past 12 months with three or more of the following: history of flexural involvement; history of generally dry skin; history of atopic disease in parents or siblings; and visible flexural dermatitis as per photographic protocol. Statistical analyses took into account the disproportionate sampling of the study population. RESULTS: Analysis was restricted to European subjects. Eight hundred and seventy-one children were enrolled at birth, 744 (85.4%) participated at 1 year, and 550 (63.2%) at 3.5 years. AD was diagnosed in 87 (15.8%) children seen at 3.5 years. The prevalence of AD did not differ by birthweight. AD at 3.5 years was associated with raised serum IgE > 200 kU L(-1), and wheezing, asthma, rash or eczema at 1 year. In multivariate analysis, adjusted for parental atopy and breastfeeding, AD at 3.5 years was associated with atopic disease in the parents: maternal atopy only, adjusted odds ratio (OR) 3.83, 95% confidence interval (CI) 1.20-12.23; paternal atopy only, adjusted OR 3.59, 95% CI 1.09-11.75; both parents atopic, adjusted OR 6.12, 95% CI 2.02-18.50. There was a higher risk of AD with longer duration of breastfeeding: < 6 months, adjusted OR 6.13, 95% CI 1.45-25.86; > or = 6 months, adjusted OR 9.70, 95% CI 2.47-38.15 compared with never breastfed. These findings remained significant after adjusting for environmental factors and a personal history of atopy. AD at 3.5 years was associated with owning a cat at 3.5 years (adjusted OR 0.45, 95% CI 0.21-0.97) but not with owning a dog at 3.5 years, pets at 1 year, nor with older siblings. Furthermore, AD at 3.5 years was not associated with gender, socioeconomic status, maternal smoking, parity, damp, mould, immunizations, body mass index or antibiotic use in first year of life. CONCLUSIONS: A personal and a parental history of atopic disease are risk factors for AD at 3.5 years. Duration of breastfeeding was associated with an increased risk of AD. No association was found with those factors implicated by the hygiene hypothesis. This study suggests that breastfeeding should not be recommended for the prevention of AD.     

Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007

To study the prevalence of atopic dermatitis, allergic rhinitis, and asthma in Taiwan, we analysed the claims data of a nationally representative cohort of 997,729 enrolees from the National Health Insurance register from 2000 to 2007. Overall, 66,446 patients were diagnosed with atopic dermatitis, and 49.8% of them had concomitant allergic rhinitis and/or asthma. The overall 8-year prevalences of atopic dermatitis, allergic rhinitis, and asthma were 6.7%, 26.3% and 11.9%, respectively. Children and adolescents had significantly higher prevalences of these atopic diseases. The prevalence of atopic dermatitis in females was lower than that in males before the age of 8 years, but became higher after that. Patients with atopic dermatitis were more likely to have allergic rhinitis and asthma. Those having both atopic dermatitis and allergic rhinitis possessed an even higher risk for asthma (odds ratio 9.04). The numbers of visits for atopic dermatitis were highest in late spring to mid-summer. These data suggest that atopic diseases are common in Taiwan.     

家族过敏史在遗传过敏性皮炎患者中的意义

为了解家族过敏史在遗传性过敏性皮炎(AD)患者临床及实验室方面所起的作用,我们将确诊为AD的年龄>2岁的158例患者按有无家族过敏史分成二组(89和69例),分别观察个人及家族过敏史、皮损形态和范围、五项伴发症状及某些实验室指标。结果显示有或无家族过敏史的患者发病年龄<2岁者分别占92.1%和84.1%,连续发病55.1%和43.5%,间断时间平均5.7年和9.6年,呼吸道过敏的平均发生年龄分别为哮喘4.1岁和6.2岁,过敏性鼻炎8.8岁和11.1岁。皮损范围和形态、五项伴发症状差异不大,个人及家族中以哮喘患病率高.并以Ⅰ、Ⅱ级亲属较高。个人及家族有呼吸道过敏史者其血清总IgE高于无过敏史者(P<0.01)。其他各项指标P>0.05。结论:有家族过敏史的AD患者比无家族过敏史者发病年龄较早.连续发病较多,间断时间较短,呼吸道过敏的平均发生年龄较早,个人及家族中以哮喘患病率高,近亲的过敏史比远亲更有价值,个人及家族有呼吸道过敏对患者总IgE有重要影响,并且总IgE升高与皮损严重度一致。     

The influence of cultural and educational factors on the validity of symptom and diagnosis questions for atopic eczema

Valid questions for atopic eczema are necessary to identify risk factors in epidemiological studies. We have examined the influence of cultural and educational factors on the validity of some questions on atopic eczema used in the International Study of Asthma and Allergies in Childhood by using data from a cross-sectional study on 1511 children aged 6 years from East and West Germany. We tested three questions in relation to a point prevalence of atopic eczema as recorded by a dermatologist: (i) has a physician ever diagnosed eczema in your child? (ii) Has your child ever had an itchy rash which came and went for at least 6 months? (iii) Has your child ever had ‘neurodermatitis’ (atopic eczema, endogenous eczema)? The point prevalence of atopic eczema on the day of investigation was 11.1% (134 of 1217). According to the questionnaire, 15.7% of the children had had physician-diagnosed eczema, 14.1% had had neurodermatitis and 11.3% had had an itchy rash for > 6 months. Fifty-one per cent of parents who had a child with atopic eczema on the day of investigation said that their child had had an itchy rash which came and went for at least 6 months. This sensitivity value is less than that found in another community survey conducted in the U.K., suggesting that the German wording of the question seems to mean something more severe to the parents than the English one. The education of the parents had an influence on the validity of the three questions: parents with < 10 years of schooling often answered symptom and diagnosis questions less positively. Parents with academic degrees, contrary to expectation, did not answer most precisely, this being especially true for the symptom questions. The association between symptom questions and clinical diagnosis was higher in West than in East Germany. We compared lifetime eczema symptoms and diagnosis with a point prevalence clinical diagnosis. In the absence of knowledge of how extraneous factors measured in this paper can affect diseases chronicity, it is difficult to say with certainty that such factors affect the validity of symptom and diagnosis questions on atopic eczema. Our study suggests that more studies are needed to examine the influence of social class, education and location on the validity of symptom questionnaires for atopic eczema. Until then, we recommend that information about such variables should be gathered routinely.