Two independent birth cohorts (COPSAC2010, Denmark, n=663; VDAART, US, n=707) examined whether early-life infection burden — tracked daily until age 3 — was associated with atopic dermatitis (AD) risk from ages 0–10 years, adjusting for filaggrin (FLG) variants and systemic antibiotic use.
Children in the highest vs. lowest tertile of infection episodes had 61% higher odds of AD in COPSAC2010 (AOR 1.61; 95% CI 1.05–2.47) and 76% higher odds in VDAART (OR 1.76; 95% CI 1.16–2.70); each additional infection episode raised AD risk by ~3% (OR 1.03) in VDAART. Associations were driven primarily by **respiratory infections** and were independent of antibiotic use and FLG status.
Full text was not available (embargoed until 2027), so details on confounding control, infection ascertainment validity, and atopic comorbidities could not be fully assessed. Both cohorts are birth cohorts with potential selection bias toward higher-risk or health-engaged families. Causal direction cannot be confirmed from observational data.
Clinicians counseling families of young children with frequent respiratory infections should be aware of a dose-dependent association with AD development — independent of antibiotic exposure and genetic risk. This does not yet warrant changes in infection management but supports early AD surveillance in high-infection-burden children.
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