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Pediatricians should consider family history of atopic dermatitis (AD) in both parents to help frame the risk for their offspring.
Maternal and paternal genetics, immune function, and socioeconomic factors influence atopic dermatitis (AD) risk in offspring, and whereas studies looking at how parents impact their children’s risk for the common skin disease tend to demonstrate a greater maternal influence, more studies are needed to examine how paternal genetics, lifestyle, and more might increase or decrease AD risk in their children, according to a review published in 2017 in Dermatitis.1
“There appears to be a larger maternal factor than paternal in many of the studies reviewed. For example, maternal smoking doubles the risk of AD development, but apparently not paternal. To a certain extent, fathers are ‘off the hook,’ but it is probably not that simple. Practical aspects such as recall bias in filling out the surveys could mean that paternal risk factors were overlooked, and some studies found evidence that if either parent has AD, the risk is increased in offspring,” says study author Peter A. Lio, MD, clinical assistant professor of Dermatology and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago. Illinois.
No slam dunk
There is a body of research that suggests fathers and mothers with histories of AD have similar chances of passing the disease to their offspring. One example: A US study of more than 1000 mothers’ infants found that of children who developed AD in the first 6 months of life, 26% had fathers with a history of AD versus 32% with mothers who had a history of the disease-a difference that was not statistically signficant.2
Other researchers studying 285 families, each with 1 parent who had AD, found 58% of children developed AD if they had a father who had the disease versus 57% of children who developed it who had mothers with a history of AD.3 Authors of still another study of 4089 children followed from birth to 4 years found one-third of children were diagnosed with AD. Nearly 38% of those had at least 1 parent-with equal likelihood of it being a mother or father-who had a history of AD.4
When they reviewed epigenetic research, Lio and colleagues found AD’s heritability involves multiple alleles on separate chromosomes. Mothers’ and fathers’ genetic makeups likely both exert influence on offspring’s development of AD, but studies to date support a mother’s genes have a stronger impact, the review authors report.1
Socioeconomics, occupation, maternal/paternal lifestyle
Lio says there were 2 things that surprised him when doing research for the review.
“The first was that having a higher socioeconomic status is associated with a higher AD risk. This is interesting because many conditions seem to affect lower socioeconomic groups more, presumably for a number of health and lifestyle-related reasons,” Lio says. “The second was that higher education level in mothers was associated with a higher risk of AD. I have long felt that our AD patients seemed to be a particularly intelligent group, and this is a fascinating association.”
Maternal influence seems to outweigh paternal impact when it comes to educational differences. Data suggesting that parents with higher education levels were more likely than parents with low education levels to have kids with AD was statistically significant only for more educated mothers.1
Although research is lacking about whether fathers’ occupations impact their offspring’s AD risk, there is data suggesting that working pregnant women are more at risk of having children who develop AD than nonworking pregnant women.5
Maternal smoking, prenatally and postnatally, and maternal alcohol consumption during pregnancy both have been shown to increase AD risk in offspring. However, whether paternal smoking or alcohol consumption impact AD risk isn’t clear. One study showed that paternal alcohol consumption had no influence on AD risk in children.6
Greater clarity on the way?
The dream of “precision medicine” is finally starting to come into fruition, according to Lio.
“With new therapies such as targeted biologic medications for AD, we are beginning to more deeply understand the complex pathogenesis of the disease. Along with this, I am hopeful that we will be better able to tease out maternal and paternal factors and, perhaps most importantly, explain why they have the effects that they do on the children,” Lio says. “To some extent, this research is useful as it can also help guide mechanistic understanding of the disease, as well as allow for better counseling. Knowing that certain lifestyle issues like smoking and alcohol use can increase the risk of development of AD-a disease with significant morbidity and sometimes shocking associated costs-should help guide public policy programs to minimize such risks.”
Pediatricians should consider asking about family history of AD in both parents to help frame some of the risk, according to Lio.
“Reviewing the behaviors that are associated with increased risk such as alcohol use and smoking is probably important,” Lio says. “We also have some evidence that taking probiotics during pregnancy may decrease the risk of developing AD, and evidence that moisturizing daily starting in the newborn period may also decrease the risk of AD. Together, these may help identify higher-risk families and promote potentially helpful approaches to minimize disease.”
1. Vaughn AR, Sivamani RK, Lio PA, Shi VY. Paternal vs maternal factors in childhood atopic dermatitis. Dermatitis. 2017;28(4):241-245. Available at: https://insights.ovid.com/pubmed?pmid=28614111. Accessed August 6, 2019.
2. Moore MM, Rifas-Shiman SL, Rich-Edwards JW, et al. Perinatal predictors of atopic dermatitis occurring in the first six months of life. Pediatrics. 2004;113(3 pt 1):468-474.
3. Uehara M, Sugiura H, Omoto M. Paternal and maternal atopic dermatitis have the same influence on development of the disease in children. Acta Derm Venereol. 1999;79(3):235.
4. BÃµhme M, Wickman M, Lennart Nordvall S, Svartengren M, Wahlgren CF. Family history and risk of atopic dermatitis in children up to 4 years. Clin Exp Allergy. 2003;33(9):1226-1231.
5. Wang IJ, Wen HJ, Chiang TL, Lin SJ, Chen PC, Guo YL. Maternal employment and atopic dermatitis in children: a prospective cohort study. Br J Dermatol. 2013;168(4):794-801.
6. Wada K, Konishi K, Tamura T, Shiraki M, Iwasa S, Nagata C. Alcohol intake during pregnancy and offspring’s atopic eczema risk. Alcohol Clin Exp Res. 2016;40(5):1037-1043.