In one tertiary dermatology clinic in Fujian, China, house dust mite was the most common reported trigger among 47 children and adolescents with atopic dermatitis. Twenty-seven patients, or 57.4%, had house dust mite recorded in their history. Seafood or crustaceans came next, reported for 19 patients (40.4%), followed by a damp environment, reported for 10 patients (21.3%). Most patients listed more than one trigger. These were reported associations in clinical records, not proof that any exposure caused eczema.
The records were reviewed retrospectively rather than collected through a planned testing program. Triggers came from clinician-, parent- or patient-reported histories, which one investigator coded into 11 categories. No specific IgE testing or skin-prick testing was performed, and the coding dictionary was not registered in advance. The house-dust-mite figure therefore describes what was recorded at the clinic, not the share of patients objectively sensitized to mites.
Allergic histories were common, but not rechecked
Allergic rhinitis was recorded in 33 of 47 patients (70.2%), and a family history of allergic disease in 45 (95.7%). Conjunctivitis appeared in 6 of 44 records (13.6%), while asthma appeared in just 1 of 44 (2.3%). In total, 36 of 47 patients (76.6%) had at least one recorded respiratory or ocular comorbidity. The pattern was therefore dominated by rhinitis and family history, not by recorded asthma.
Patients with recorded rhinitis were older than those without it, with median ages of 11.2 and 6.0 years, respectively. The reported comparison had a p-value of 0.013. These figures were not verified diagnoses or prevalence estimates. Rhinitis was partly built into the study's enrollment criteria, and the family-history definition was broad and unverified, so the rates should not be read as a picture of the wider community.
The two batches told different severity stories
The analysis combined records from two source batches, but it did not treat them as interchangeable. Forty-nine records were initially identified. Two were removed because they contained duplicate laboratory data blocks, leaving 47 analyzed patients: 16 in batch 1 and 31 in batch 2.
Batch 1 had a median recorded severity score of 44.5 and median BSA, the percentage of body surface affected, of 10.5%. It included 13 moderate and three severe cases. Batch 2 had a lower median severity score of 34.0 but a higher median BSA of 17.0%, with four mild and 27 moderate cases. The between-batch comparisons for both measures were reported at p < 0.001. Most patients in each batch fell in the moderate band, but the distributions were different.
The severity score was a retrospective global clinical impression, not a total calculated from the SCORAD formula. It was assigned by one assessor, without reliability data, and the batch-specific scoring pattern limited the value of one pooled severity estimate. The safest reading is that moderate disease was common within these two clinic batches, while the exact comparison between them needs standardized prospective scoring.
The decision to pool or separate the batches changed the apparent relationship between how much skin was affected and the severity score. Within batch 1 and batch 2, the correlations were 0.71 and 0.58. When all records were pooled without accounting for batch, the correlation was 0.03, with p = 0.835. A stratified analysis produced 0.62, while a precision-weighted estimate was 0.63, with a 95% confidence interval from 0.41 to 0.78. In plain terms, the pooled result made the relationship look almost absent, whereas analyses that respected the source batches found a moderate positive association.
The patient-reported eczema measure, POEM, showed a more stable link with BSA. Its within-batch correlations were 0.75 and 0.56, and the pooled correlation was 0.57. That finding is still an association within this small retrospective series, not evidence that greater skin involvement causes worse symptoms or the reverse.
A clinic signal, not a population estimate
The study was designed as a descriptive snapshot of routine records from a single tertiary referral clinic, with no external control group or community sample. Patients were under 20 and had to meet the study's clinical eligibility rules, including recorded BSA and severity scores; recent systemic therapy was an exclusion. Those choices make the series useful for showing what clinicians and families recorded, but they limit generalization beyond this service.
Several data problems add to the uncertainty. Trigger, comorbidity and family-history entries were not prospectively defined or confirmed. The quality-of-life score also depended on a retrospective clinician account rather than original documents. The reported Children's Dermatology Life Quality Index median was 8 on the standard 0 to 30 scale, with the middle half of scores from 6 to 11 and a range of 1 to 27, but that conversion could not be independently checked.
Taken together, the findings point to questions for larger studies rather than a basis for avoidance diets or causal clinical decisions. Future work would need to compare reported triggers with confirmed sensitization testing in the same patients, use standardized severity scoring and comorbidity definitions, and test whether the batch-related pattern persists across multiple centres.
Paper data and sources
Original title: Clinical profile, reported triggers, and comorbidity pattern in children and adolescents with atopic dermatitis: a cross-sectional study from Fujian, China
Authors: Ma W, Liu J, Li R, Zhang Z
Journal/Repository: Frontiers in pediatrics
Status: Peer-reviewed
First online: 2026-10-08
DOI: Not available
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