EARLY respiratory infection burden was associated with greater childhood atopic dermatitis risk across two independent birth cohorts.
Infection Burden and Childhood Atopic Dermatitis
Researchers investigated whether infections occurring during the first 3 years of life were associated with childhood atopic dermatitis through age 10 years. The cohort study included 663 children from a Danish birth cohort, with findings assessed for replication among 707 children from a separate U.S. birth cohort.
In the Danish cohort, parents recorded daily episodes of colds, acute otitis media, tonsillitis, pneumonia, gastroenteritis, and fever until their children reached 3 years of age. Researchers subsequently monitored atopic dermatitis diagnoses, disease severity, systemic antibiotic use, and filaggrin gene variant status.
Children in the highest tertile for the number of infection episodes had a 61% greater adjusted likelihood of yearly atopic dermatitis prevalence between birth and 10 years compared with those in the lowest tertile. Those with the greatest number of days affected by infection had a 69% greater adjusted likelihood.
Each additional infection episode was also associated with increased childhood atopic dermatitis risk. This relationship remained after researchers accounted for systemic antibiotic treatment and filaggrin gene variants, suggesting that neither factor fully explained the association.
Respiratory Infections Drive the Association
Further analysis indicated that respiratory infections were primarily responsible for the observed relationship. Other infection types did not appear to contribute to the association to the same extent.
The findings were replicated in the U.S. cohort, where respiratory infection and fever episodes were recorded until age 3 years and physician diagnosed atopic dermatitis was reported through age 6 years.
Children in the highest infection burden tertile had 76% greater odds of atopic dermatitis compared with those in the lowest tertile. The odds of atopic dermatitis also increased by 3% with each additional infection episode.
Long Term Relationship Requires Further Study
The consistent dose dependent association across two independent populations supports a possible long term relationship between early respiratory infections and childhood atopic dermatitis. However, the observational design does not establish that respiratory infections directly cause the skin condition.
The findings may help clarify previously inconsistent evidence surrounding infections and atopic dermatitis development. Further investigation is needed to identify the biological mechanisms connecting respiratory infection burden during early life with later skin inflammation.
Reference
Brustad N et al. Early respiratory infection burden and atopic dermatitis in childhood. JAMA Dermatol. 2026;DOI:10.1001/jamadermatol.2026.2626.
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