Have the prevalence of eczema symptoms increased in the Mexican pediatric population? Prevalence and associated factors according to Global Asthma Network Phase I

Open AccessPublished:October 16, 2022DOI:



      In children, atopic dermatitis or eczema is the most common inflammatory disease of the skin. According to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase IIIB in Mexico, 5.8% of children and 4.9% of adolescents had eczema symptoms. In 2012, Global Asthma Network (GAN) was established to update the prevalence of eczema and estimate potential factors contributing to its development.


      To estimate the prevalence and associated factors for atopic eczema symptoms and diagnosis in children and adolescents according to GAN Phase I and compare the results with ISAAC Phase IIIB in Mexico.


      A cross-sectional, multicenter survey was conducted in 15 Mexican centers during the period of 2015–2017 using the GAN Phase I questionnaires in children (6–7-year-olds) and adolescents (13–14-year-olds). The prevalences obtained from the GAN Phase I study, were compared with ISAAC Phase IIIB results; a Spearman's correlation analysis was conducted between temperature, relative humidity, and altitude and eczema symptoms, and a logistic regression was performed to predict current eczema symptoms by age group.


      A total of 35 777 children and 41 399 adolescents were included. Since ISAAC Phase IIIB, the prevalence of itchy rash in the past 12 months significantly increased in the children's group [6.6% (95% CI 5.7–7.4) vs 7.8 (95% CI 7.5–8.1), p = 0.000] and adolescents' group [5.8% (95% CI 5.0–6.7) vs 6.7% (95% CI 6.5–7.0), p = 0.000].
      In the adolescents' group, the prevalence of nocturnal awakenings caused by rash symptoms on more than one night per week had a negative correlation between altitude (Spearman's Rho = −0.558, p value = 0.031), and a positive correlation with the average annual temperature (Spearman's Rho = 0.604, p value = 0.017) and annual relative humidity (Spearman's Rho = 0.742, p value = 0.002). The most significant associations in children were the presence of sneezing or runny or blocked nose in the past 12 months [(OR 3.13, 95% CI 2.60–3.77), p = 0.000], the use of paracetamol in the first year of life ([OR 1.52, 95% CI 1.15–2.01), p = 0.003] and the use of antibiotics in the first year of life [(OR 1.30, 95% CI 1.08–1.55) p = 0.004]. Moreover, altitude at 100–1000 m above sea level was associated with current eczema symptoms in adolescents (p = 0.001).


      There has been a significant increase in eczema symptoms in both age groups since ISAAC Phase IIIB study. Additionally, eczema symptoms were associated with temperature, relative humidity, asthma, hay fever symptoms, the use of paracetamol and antibiotics.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to World Allergy Organization Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Saini S.
        • Pansare M.
        New insights and treatments in atopic dermatitis.
        Pediatr Clin. 2019; 66: 1021-1033
        • Odhiambo J.A.
        • Williams H.C.
        • Clayton T.O.
        • Robertson C.F.
        • Asher M.I.
        • ISAAC Phase Three Study Group
        Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three.
        J Allergy Clin Immunol. 2009; 124: 1251-1258.e23
        • Weidinger S.
        • Beck L.A.
        • Bieber T.
        • Kabashima K.
        • Irvine A.D.
        Atopic dermatitis.
        Nat Rev Dis Prim. 2018; 4: 1
        • Halkjær L.B.
        • Loland L.
        • Buchvald F.F.
        • et al.
        Development of atopic dermatitis during the first 3 Years of life.
        Arch Dermatol. 2006; 142
        • Kim J.P.
        • Chao L.X.
        • Simpson E.L.
        • Silverberg J.I.
        Persistence of atopic dermatitis (AD): a systematic review and meta-analysis.
        J Am Acad Dermatol. 2016 Oct; 75 (Epub 2016 Aug 17. PMID: 27544489; PMCID: PMC5216177): 681-687.e11
        • Spergel J.M.
        • Paller A.S.
        Atopic dermatitis and the atopic march.
        J Allergy Clin Immunol. 2003; 112: S118-S127
        • Tokura Y.
        • Hayano S.
        Subtypes of atopic dermatitis: from phenotype to endotype.
        Allergol Int Off J Jpn Soc Allergol. 2022; 71: 14-24
        • Paternoster L.
        • Standl M.
        • Waage J.
        • et al.
        Multi-ancestry genome-wide association study of 21,000 cases and 95,000 controls identifies new risk loci for atopic dermatitis.
        Nat Genet. 2015; 47: 1449-1456
        • Stefanovic N.
        • Irvine A.D.
        • Flohr C.
        The role of the environment and exposome in atopic dermatitis.
        Curr Treat Opt Allergy. 2021; 8: 222-241
        • Belgrave D.C.M.
        • Simpson A.
        • Buchan I.E.
        • Custovic A.
        Atopic dermatitis and respiratory Allergy: what is the link.
        Curr Dermatol Rep. 2015; 4: 221-227
        • Roduit C.
        • Frei R.
        • Depner M.
        • et al.
        Phenotypes of atopic dermatitis depending on the timing of onset and progression in childhood.
        JAMA Pediatr. 2017; 171: 655-662
        • Na C.H.
        • Chung J.
        • Simpson E.L.
        Quality of life and disease impact of atopic dermatitis and psoriasis on children and their families.
        Children. 2019; 6: 133
        • Chang Y.S.
        • Chiang B.L.
        Sleep disorders and atopic dermatitis: a 2-way street?.
        J Allergy Clin Immunol. 2018; 142: 1033-1040
        • Alexander H.
        • Paller A.S.
        • Traidl-Hoffmann C.
        • et al.
        The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group.
        Br J Dermatol. 2020; 182: 1331-1342
        • Muzzolon M.
        • Muzzolon S.
        • Lima M.
        • Canato M.
        • Carvalho V.O.
        Mental disorders and atopic dermatitis in children and adolescents.
        Postępy Dermatologii i Alergologii. 2021; 38: 1099-1104
        • Hebert A.A.
        • Stingl G.
        • Ho L.K.
        • et al.
        Patient impact and economic burden of mild-to-moderate atopic dermatitis.
        Curr Med Res Opin. 2018; 34: 2177-2185
        • Asher M.I.
        • Montefort S.
        • Björkstén B.
        • et al.
        Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys.
        Lancet (London, England). 2006; 368: 733-743
        • Williams H.
        • Stewart A.
        • von Mutius E.
        • Cookson W.
        • Anderson H.R.
        Is eczema really on the increase worldwide?.
        J Allergy Clin Immunol. 2008; 121: 947-954.e15
        • Mallol J.
        • Crane J.
        • von Mutius E.
        • Odhiambo J.
        • Keil U.
        • Stewart A.
        The international study of asthma and allergies in childhood (ISAAC) phase three: a global synthesis.
        Allergol Immunopathol. 2013; 41: 73-85
        • Solé D.
        • Mallol J.
        • Wandalsen G.F.
        • Aguirre V.
        Prevalence of symptoms of eczema in Latin america: results of the international study of asthma and allergies in childhood (ISAAC) phase 3.
        J Invest Allergol Clin Immunol. 2010; 20: 311-323
        • Ellwood P.
        • Asher M.I.
        • Billo N.E.
        • et al.
        The Global Asthma Network rationale and methods for Phase I global surveillance: prevalence, severity, management and risk factors.
        Eur Respir J. 2017; 491601605
        • Ellwood P.
        • Williams H.
        • Aït-Khaled N.
        • Björkstén B.
        • Robertson C.
        Translation of questions: the international study of asthma and allergies in childhood (ISAAC) experience.
        Int J Tubercul Lung Dis Off J Int Union Against Tubercul Lung Dis. 2009; 13: 1174-1182
        • García-Marcos L.
        • Innes Asher M.
        • Pearce N.
        • et al.
        The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study.
        Eur Respir J. 2022; (2102866. Advance online publication)
        • Ellwood P.
        • Ellwood E.
        • Rutter C.
        • et al.
        Global asthma Network phase I surveillance: geographical coverage and response rates.
        J Clin Med. 2020; 9: 3688
        • Bieber T.
        Atopic dermatitis.
        N Engl J Med. 2008; 358: 1483-1494
        • Ramirez F.D.
        • Chen S.
        • Langan S.M.
        • et al.
        Association of atopic dermatitis with sleep quality in children.
        JAMA Pediatr. 2019; 173e190025
        • Hon K.L.
        • Leung T.F.
        • Wong K.Y.
        • Chow C.M.
        • Chuh A.
        • Ng P.C.
        Does age or gender influence quality of life in children with atopic dermatitis?.
        Clin Exp Dermatol. 2008; 33: 705-709
        • Jaakkola J.J.
        • Hwang B.F.
        • Jaakkola M.S.
        Home dampness and molds as determinants of allergic rhinitis in childhood: a 6-year, population-based cohort study.
        Am J Epidemiol. 2010; 172: 451-459
        • Sargen M.R.
        • Hoffstad O.
        • Margolis D.J.
        Warm, humid, and high sun exposure climates are associated with poorly controlled eczema: PEER (Pediatric Eczema Elective Registry) cohort, 2004-2012.
        J Invest Dermatol. 2014; 134: 51-57
        • Suárez-Varela M.M.
        • García-Marcos Alvarez L.
        • Kogan M.D.
        • et al.
        Climate and prevalence of atopic eczema in 6- to 7-year-old school children in Spain. ISAAC phase III.
        Int J Biometeorol. 2008; 52: 833-840
        • Sato J.
        • Katagiri C.
        • Nomura J.
        • Denda M.
        Drastic decrease in environmental humidity decreases water-holding capacity and free amino acid content of the stratum corneum.
        Arch Dermatol Res. 2001; 293: 477-480
        • Ashida Y.
        • Ogo M.
        • Denda M.
        Epidermal interleukin-1 alpha generation is amplified at low humidity: implications for the pathogenesis of inflammatory dermatoses.
        Br J Dermatol. 2001; 144: 238-243
        • Ashida Y.
        • Denda M.
        Dry environment increases mast cell number and histamine content in dermis in hairless mice.
        Br J Dermatol. 2003; 149: 240-247
        • Walters T.J.
        • Ryan K.L.
        • Constable S.H.
        Thermoregulation by rhesus monkeys at different absolute humidities.
        J Comp Physiol B Biochem Syst Environ Physiol. 2004; 174: 481-487
        • Uter W.
        • Gefeller O.
        • Schwanitz H.J.
        An epidemiological study of the influence of season (cold and dry air) on the occurrence of irritant skin changes of the hands.
        Br J Dermatol. 1998; 138: 266-272
        • Ma Y.L.
        • Li S.
        • Liu J.T.
        • et al.
        Impact of absolute humidity and temperature on eczema.
        Biomed Environ Sci BES (Biomed Environ Sci). 2021; 34: 61-65
        • Camfferman D.
        • Short M.A.
        • Kennedy J.D.
        • Gold M.
        • Kohler M.
        • Lushington K.
        Thermoregulation, scratch, itch and sleep deficits in children with eczema.
        Sleep Med. 2016; 25: 145-150
        • Fieten K.B.
        • Weststrate A.C.
        • van Zuuren E.J.
        • Bruijnzeel-Koomen C.A.
        • Pasmans S.G.
        Alpine climate treatment of atopic dermatitis: a systematic review.
        Allergy. 2015; 70: 12-25
        • Porta B.
        • Barandun J.
        • Wüthrich B.
        Neurodermitis atopica--Therapie im Hochgebirgsklima [Atopic neurodermatitis--therapy in high altitude climate].
        Praxis. 2000; 89: 1147-1153
        • Eberlein B.
        • Gulyas A.
        • Schultz K.
        • et al.
        Benefits of alpine mountain climate of Bavaria in patients with allergic diseases and chronic obstructive pulmonary disease: results from the AURA∗ study.
        J Invest Allergol Clin Immunol. 2009; 19: 159-161
        • Petermann F.
        • Gulyas A.F.
        • Niebank K.
        • Warschburger P.
        Effects of allergen avoidance at high altitude on children with asthma or atopic dermatitis.
        Pediatr Asthma Allergy Immunol. 2004; 17: 15-24
        • Fieten K.B.
        • Weststrate A.C.
        • van Zuuren E.J.
        • Bruijnzeel-Koomen C.A.
        • Pasmans S.G.
        Alpine climate treatment of atopic dermatitis: a systematic review.
        Allergy. 2015; 70: 12-25
        • Weiland S.K.
        • Hüsing A.
        • Strachan D.P.
        • Rzehak P.
        • Pearce N.
        • ISAAC Phase One Study Group
        Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children.
        Occup Environ Med. 2004; 61: 609-615
        • Solé D.
        • Wandalsen G.F.
        • Camelo-Nunes I.C.
        • Naspitz C.K.
        • ISAAC - Brazilian Group
        Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC) - phase 3.
        J Pediatr. 2006; 82: 341-346
        • Kurt E.
        • Metintas S.
        • Basyigit I.
        • et al.
        Prevalence and risk factors of allergies in Turkey: results of a multicentric cross-sectional study in children.
        Pediatr Allergy Immunol. 2007; 18 (official publication of the European Society of Pediatric Allergy and Immunology): 566-574
        • Beasley R.
        • Clayton T.
        • Crane J.
        • et al.
        Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme.
        Lancet (London, England). 2008; 372: 1039-1048
        • Lipiec A.
        • Wawrzyniak Z.M.
        • Sybilski A.J.
        • et al.
        The association between paracetamol use and the risk of asthma, rhinitis and eczema in the Polish population.
        Ann Agric Environ Med AAEM. 2018; 25: 428-432
        • Eneli I.
        • Sadri K.
        • Camargo Jr., C.
        • Barr R.G.
        Acetaminophen and the risk of asthma: the epidemiologic and pathophysiologic evidence.
        Chest. 2005; 127: 604-612
        • Yamaura K.
        • Akiyama S.
        • Oda M.
        • Suwa E.
        • Ueno K.
        Acetaminophen enhances pruritus in a mouse model of contact dermatitis induced by suboptimal concentration of hapten.
        J Toxicol Sci. 2011; 36: 669-674
        • Farquhar H.
        • Stewart A.
        • Mitchell E.
        • et al.
        The role of paracetamol in the pathogenesis of asthma.
        Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2010; 40: 32-41
        • Allmers H.
        Frequent acetaminophen use and allergic diseases: is the association clear?.
        J Allergy Clin Immunol. 2005; 116: 859-862
        • Strzępa A.
        • Majewska-Szczepanik M.
        • Kowalczyk P.
        • Woźniak D.
        • Motyl S.
        • Szczepanik M.
        Oral treatment with enrofloxacin early in life promotes Th2-mediated immune response in mice.
        Pharmacol Rep PR. 2016; 68: 44-50
        • Song H.
        • Yoo Y.
        • Hwang J.
        • Na Y.C.
        • Kim H.S.
        Faecalibacterium prausnitzii subspecies-level dysbiosis in the human gut microbiome underlying atopic dermatitis.
        J Allergy Clin Immunol. 2016; 137: 852-860
        • Slob E.
        • Brew B.K.
        • Vijverberg S.
        • et al.
        Early-life antibiotic use and risk of asthma and eczema: results of a discordant twin study.
        Eur Respir J. 2020; 551902021
        • Shamssain M.
        Trends in the prevalence and severity of asthma, rhinitis and atopic eczema in 6- to 7- and 13- to 14-yr-old children from the north-east of England.
        Pediatr Allergy Immunol Off Publ Eur Soc Pediat Allergy Immunol. 2007; 18: 149-153
        • Yang Y.C.
        • Cheng Y.W.
        • Lai C.S.
        • Chen W.
        Prevalence of childhood acne, ephelides, warts, atopic dermatitis, psoriasis, alopecia areata and keloid in Kaohsiung County, Taiwan: a community-based clinical survey.
        J Eur Acad Dermatol Venereol JEADV. 2007; 21: 643-649
        • Govaere E.
        • Van Gysel D.
        • Massa G.
        • Verhamme K.M.
        • Doli E.
        • De Baets F.
        The influence of age and gender on sensitization to aero-allergens.
        Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol. 2007; 18: 671-678
        • Osman M.
        • Hansell A.L.
        • Simpson C.R.
        • Hollowell J.
        • Helms P.J.
        Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care.
        Prim Care Respir J. 2007; 16: 28-35
        • Ziyab A.H.
        Prevalence and risk factors of asthma, rhinitis, and eczema and their multimorbidity among young adults in Kuwait: a cross-sectional study.
        BioMed Res Int. 2017; 20172184193
        • Hanifin J.M.
        • Reed M.L.
        • Eczema Prevalence and Impact Working Group
        A population-based survey of eczema prevalence in the United States.
        Dermatitis. 2007; 18: 82-91
        • Yang G.
        • Han Y.Y.
        • Forno E.
        • et al.
        Under-diagnosis of atopic dermatitis in Puerto Rican children.
        World Allergy Org J. 2019; 12100003