THE DERMO-RESPIRATORY SYNDROME - CLINICAL -DEVELOPMENTAL FEATURES

The prognosis of the child with Atopic Dermatitis (AD) is not only con ditioned by dermatosis evolution, but also and above all by the possib le following development of asthma. This occurs in 20-85% of cases, mo stly in scolar age, when cutaneous lesions are regressed or localized. In 1987 Carron first described a serious clinical picture of AD assoc iated to asthma - he called it <<Dermo-respiratory Syndrome>> (DRS) - caracterized by severe AD associated to early (near 2 years of age) an d often evolutive asthma. We wanted to define, in a group of children affected by AD, the prevalence of DRS and identify its clinical-develo pmental features, in comparison with Carron observation. Our study inc ludes 24 children affected by AD (16 males - 8 females) aged 1 to 46 m onths, followed until 60-84 months of life. Considering the age of the onset of asthma, we identified three groups of patients: Group 1 (<24 months), 7 cases (29.1 %); Group 2 (>24 months), 4 cases (16 7%); Gro up 3 (absence of asthma), 13 cases (54.2%). We defined affected by DRS patients of Group 1: thus the prevalence of DRS is 29.1 %. In Group 1 asthma developes as frequent, chronic or severe-chronic in 85.7% of c ases, unlike late form (Group 2), always episodic. In addition, patien ts of Group 1 significantly differ from the other two groups for most of the clinical and laboratory features: the AD has a early onset (ave rage 1.9 months) and is serius in two third of cases at the first obse rvation, need frequent hospitalization and is very easly infected, in addition it implies a serious form of atopy (iper-IgE in 2/3 of cases, serum level of specific IgE for inhalant allergens in 37.5% of cases and food allergens in 50% of cases, food allergy in 100% of cases with food polysensitization, particularly to wheat). Persistence and sever ity of AD at the end of follow-up do not significantly differ in the t hree groups. Our results agree with Carron conclusions, except for dat a regarding food allergy. It might be hypothesize that the pathogenesi s of DRS is based on a particularly severe allergic immuno-phlogosis c ondition, that cause on one hand a severe and early DA and on the othe r a precocoius and severe asthma.