Diagnosing atopic dermatitis in infancy: Questionnaire reports vs criteria-based assessment

Paediatr Perinat Epidemiol. 2018 Nov;32(6):556-567. doi: 10.1111/ppe.12525. Epub 2018 Nov 21.


Background: Persisting atopic dermatitis (AD) is known to be associated with more serious allergic diseases at later ages; however, making an accurate diagnosis during infancy is challenging. We assessed the diagnostic performance of questionnaire-based AD measures with criteria-based in-person clinical assessments at age 1 year and evaluated the ability of these diagnostic methods to predict asthma, allergic rhinitis and food allergies at age 5 years.

Methods: Data relate to 3014 children participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study who were directly observed in a clinical assessment by an experienced healthcare professional using the UK Working Party criteria. The majority (2221; 73.7%) of these children also provided multiple other methods of AD ascertainment: a parent reporting a characteristic rash on a questionnaire, a parent reporting the diagnosis provided by an external physician and a combination of these two reports.

Results: Relative to the direct clinical assessment, the area under the Receiver Operating Characteristic curve for a parental report of a characteristic rash, reported physician diagnosis and a combination of both were, respectively, 0.60, 0.69 and 0.70. The strongest predictor of asthma at 5 years was AD determined by criteria-based in-person clinical assessment followed by the combination of parental and physician report.

Conclusions: These findings suggest that questionnaire data cannot accurately substitute for assessment by experienced healthcare professionals using validated criteria for diagnosis of atopic dermatitis. Combining the parental report with diagnosis by a family physician might sometimes be appropriate (eg to avoid costs of a clinical assessment).

Keywords: accuracy; atopic dermatitis; diagnosis; eczema; epidemiology; questionnaire reports.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Canada / epidemiology
  • Child, Preschool
  • Dermatitis, Atopic / diagnosis*
  • Dermatitis, Atopic / therapy
  • Female
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Prevalence
  • ROC Curve
  • Risk Assessment / methods*
  • Risk Factors
  • Surveys and Questionnaires