Childhood atopic eczema

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Abstract
Introduction Atopic eczema is a common condition that affects more than one in ten children in developed countries, and the incidence is increasing. There are probably several reasons for this, including higher exposure to air pollution, smaller families with less exposure to infections, more pets, higher maternal age, and a wider range of foods. There is clearly also an important hereditary component to atopic eczema. This is complex because not all affected children are atopic, though the genes implicated in atopy are likely to be involved, together with others as yet unknown. Atopic eczema usually presents during the first year of life, and when it is severe it is extremely disabling. It may also cause major psychological problems. Most affected children are also allergic to house dust mite, and this is probably a major cause of exacerbation of the condition. Probably less than 10% overall have IgE mediated food allergy, but some have late phase reactions with positive results on patch tests to foods. Summary points Atopic eczema in children is a complex condition Four in five children with atopic eczema have IgE mediated allergy to inhalants or foods House dust mite exacerbates atopic eczema Food allergy exacerbates eczema in less than one in ten children To reduce the need for admission to hospital children with severe eczema can be treated with topical or oral immunosuppression