Seasonality in the severity of atopic dermatitis and birth season

Seasonality in the severity of atopic dermatitis and birth season | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Seasonality in the severity of atopic dermatitis and birth season Yu-ting Zhang, Hong-min Li, Cheng Tan, Bo Xie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4382810/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Some patients with atopic dermatitis (AD) get worse in the summer and others in the winter. Birth season was suggested to be associated with the prevalence of AD in previous studies. This study aimed to explore the relationship between birth season and alterations in the severity of AD. Methods This is a pilot prospective study of 50 patients from the outpatient unit of the department of dermatology at the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine in China with one year follow-up. The scoring atopic dermatitis (SCORAD) was employed to evaluate the severity of AD. The SCORAD score and itch score were recorded at each visit. Seasonal fluctuations in AD severity were analyzed classified by birth season, as well as other potential risk factors. Results Summer was the most severe season for AD patients with summer births (with a SCORAD of 63.54 ± 9.13), compared to spring, autumn, or winter (SCORAD was 51.30 ± 17.19, 43.72 ± 13.44 and 47.04 ± 16.44, respectively) (P < 0.01). Among individuals with summer birth, the itching score was highest in the summer (P = 0.01), too. Besides, in newly onset AD, the severity of SCORAD worsened in the spring (P = 0.04). Conclusions Patients with summer birth experienced the most severe AD in summer. Interventions on exacerbations at the earliest time of onset should be implemented in this population. atopic dermatitis birth season seasonality severity Figures Figure 1 Introduction Atopic dermatitis (AD) is a chronic relapsing skin disease. Patients with severe AD suffer an average of twelve relapses per year, severely affecting their quality of life 1 . However, the reasons for its intermittent exacerbation are still inconclusive. The seasonality in aggravation of AD has been stated in previous studies 2 – 6 . Based on whether skin symptoms worsen in the summer or winter, AD was classified into two types: the summer type and the winter type 4 . However, it is unclear which group of AD patients becomes worse in the winter and which gets worse in the summer. A fall or winter birth has been suggested to be associated with an increased risk of AD 7 , 8 . However, there is no research on whether the seasonal exacerbation of AD is relevant to the birth season or not. Given this background, the goal of this study was to explore seasonal variations in the severity of AD in people born in different seasons, as well as to identify unique populations of winter-type and summer-type AD patients. Interventions on exacerbations at the earliest time of onset should be implemented in this population. Methods Study design This is a prospective study conducted at the outpatient unit of the department of dermatology at the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine in China. Individuals were recruited between March 2020 and March 2021, and followed up every three months for at least one year. Potential risk factors for exacerbation of AD were collected through a structured questionnaire at each visit from participants or their parents. The severity of AD and itch were evaluated by a trained investigator (Yu-ting Zhang) at baseline and at each follow-up.The research followed the TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis Or Diagnosis) guidelines. AD participants The diagnosis of AD of all participants was established by two senior dermatologists (Cheng Tan and Hong-min Li) according to the criteria of Hannifin and Rajka at the first visit. The patients were not aware of the study hypothesis. Finally, fifty patients with AD were recruited within the time frame. Definition of season Spring was defined as March 1st to May 31st, summer was June 1st to August 31st, fall was September 1st to November 30th, and winter was December 1st to February 28th/29th, according to the meteorological distribution of the seasons. Nanjing is located in the northern subtropical monsoon climate zone, with a warm, humid and rainy climate as well as distinctive seasons. Its mean temperature is 15.4°C, and its annual average precipitation is 1106 mm. In Nanjing, the temperature difference between winter and summer is enormous. Assessment of the severity of AD The severity of AD was measured by scoring atopic dermatitis (SCORAD), and the itch was evaluated by the visual analogue scale (VAS) scale at each visit. The data collected from patients during each of the four seasons was analyzed to see if there were any seasonal differences in severity. Risk factors for the potential flare of AD A standardized questionnaire was used to document potential risk factors for the aggravation of AD. Demographic information was collected, including sex, age, and birth season. At the begin of the study, potential risk factors for AD flares were gathered, including duration, delivery mode, gestational age during childbirth, feeding types throughout infancy, time spent outdoor per day, family history of allergic disease, and allergic complications. Statistical analysis All statistical analyses were carried out using SPSS Statistics 23.0 (IBM, Armonk, NY, USA). Continuous measurements were summarized as mean and standard deviation (for normally distributed data), and categorical variables were expressed as counts and percentages. For categorical variables, χ2 tests or Fisher’s exact tests were used to determine whether statistical differences exist. For continuous measurements, multivariate analyses of variance (MANOVA) (F statistic)with repeated measures were used to evaluate the differences, and the Kruskal-Wallis H test was used if the variances were heterogeneous. Moreover, post hoc pairwise comparisons were performed using t-tests when significant seasonal differences were detected. All comparisons were two-tailed, and results were considered statistically significant if the P-value was less than 0.05 for all analyses. Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research including all experimental methods was approved by the ethics committee of Affiliated Hospital of Nanjing University of Chinese Medicine (2017NL-056-02). Informed consent Informed consent was obtained from all individual participants included in the study. Results Characteristics of participants Baseline characteristics of the population recruited in the study (n=50) are presented in Table 1. The average age was 14.09±10.36 years, with a mean duration of 43.70±58.76 months. Symptoms of AD started at a mean age of 11.21±9.91 years. Ten (20%) participants were born in the spring, 12 (24%) in the summer, 17 (34%) in the autumn, and 11 (22%) in the winter. Thirty-one (62%) were born via vaginal delivery, while the remaining 19 (38%) were delivered via cesarean section. Forty-six (92%) were term births, three (6%) were preterm births, and one (2%) were overdue in terms of the gestational age. Thirty-two (64%) were breastfed, six (12%) were fed infant formula, and twelve (24%) were mixed fed in infancy. Thirty-seven (74%) spent less than two hours per day outdoors, whereas thirteen (26%) spent more. Twenty-nine patients (58%) had a family history of any allergic disease, and three (6%) had a family history of AD. Thirty-eight patients (76.0%) had a diagnosis of AD with complications. Nineteen were with asthma, 29 with allergic rhinitis, and 11 with urticaria. The baseline SCORAD was 53.01±14.26 and the itching score was 5.70±2.02 for all participants. The characteristics were consistent across all seasons of birth in Table 1. The second visit was completed by all 50 participants, with the loss to follow-up gradually increasing throughout the study (8%, and 34% were lost to follow-up at the third and fourth visit, respectively). The socio-demographic and clinical features were similar between those who completed the fourth visit and those who were lost to follow-up in Table 2. Seasonal alterations in the severity of AD There were 31 visits in spring, 46 visits in summer, 76 visits in autumn, and 51 visits in winter during the baseline and follow-up periods. The seasonal variations in the severity of AD are shown in Table 2, Table 3, Table 4 and Fig. 1. Seasonal differences in the severity of newly-onset AD (duration less than one year) were shown to be significant (F=3.00, P=0.04). The severity of AD was the most severe in spring, with a SCORAD of 55.23±15.38, followed by summer, with a SCORAD of 52.46±18.50. The severity was most alleviated in autumn, with a SCORAD of 40.05±13.03. In patients with a clinical course of more than one year, there was no significant difference in seasonal fluctuations. The severity of AD in patients born in the summer varied significantly (F=4.90, P<0.01). The severity was the most severe in summer, with a SCORAD of 63.54±9.13, which was significantly higher than that in spring (51.30±17.19, t =2.04, P=0.06), autumn (43.72±13.44, t=4.35, P<0.001) or winter (47.04±16.44, t=2.91, P<0.01). There were no significant seasonal differences in the severity of patients born in the spring, autumn, or winter. When the subjects were subgrouped by factors such as sex, age, delivery mode, gestational age, feeding types during infancy, the time span of outdoor activities per day, family history of allergic disease, or self-allergic complications, there was no significant seasonal variation in AD severity. Seasonal alterations of itch in AD AD patients born in summer experienced significant seasonal changes in pruritus (F=3.99, P=0.01). The itching was the worst in summer, with a score of 7.09±1.38, significantly higher than that in spring (5.33±2.06, t=2.28, P=0.04), autumn (4.85±1.60, t=3.91 P=0.001) or winter (5.09±2.21, t=2.55, P=0.02) (Table 3 and Table 5). There were no statistically significant variations in pruritus across subgroups divided by other factors. Discussion AD can be divided into two types, that is winter type and summer type, according to the season of exacerbation 3-5 . Only a few research have looked into which patients are worsened in the winter and which are worsened in the summer 4 , 9 . Seasonal variation in SCORAD was discovered in this study in individuals with a clinical history of less than one year. In this newly-onset subgroup, the severity of AD deteriorated in the spring and summer and improved in the autumn and winter. In patients with a duration longer than one year, the seasonal difference was not significant. Furthermore, AD patients born in the summer were the most severe in the summer, whereas AD patients born in other seasons exhibited no seasonality. The aggravation of AD in summer can be attributed to high temperatures 10 ,11 , low humidity 11 ,12 , sweating 13 , grass-pollen exposure 14 , and ultraviolet radiation 15 ,16 . In our study, patients with summer birth were the most aggravated in the summer, which may be related to high summer temperature and sweat stimulation. The exacerbation of AD in the winter might be related to low temperatures 10 ,17 and the deterioration of the skin barrier. During the winter, there was a decrease in epidermal lipids, skin hydration, and skin NMF components 18 . In this study, individuals who were born in the winter got worse in the winter, although there was no statistical difference in severity across the seasons. More research is needed to determine which patients will be worsened in the winter. In this study, patients born in the summer demonstrated seasonal variation in itch severity. The itch score was greatest in summer, which is the hottest season of the year. Previous studies have suggested that pruritus severity is associated with high temperatures 19 , and scratching scores are related to hot weather and sweating 11 , which is consistent with our findings. There was no difference in the age and sex distribution of children with summer-type and winter-type AD in the study by Krämer et al 4 . The rate of positive sensitization did not differ statistically between the two groups. Similar to the findings above, in this study, factors such as sex, age, family history of allergic disease, and allergic complications of the participants had no effect on seasonal fluctuations in AD severity. Besides, delivery mode, gestation age, feeding types during infancy, and the amount of time spent outside per day showed no relation to the seasonal variations in AD severity according to our findings. The season of birth may have an impact on the progression of AD. Children born in the autumn or winter showed a higher prevalence of AD than those born in the spring or summer, according to studies in Japan 20 , Norway 21 , Madagascar 22 , the United States 23 , and a meta-analysis in the northern hemisphere 7 . Although numerous risk factors for AD flares have been proposed 10-16 , it is unknown if the season of birth influences the seasonal variation in AD severity. We focused on the birth season and seasonal changes in AD in this study to determine which groups are more likely to exacerbate in the winter and which are more likely to aggravate in the summer. Our data suggest that AD patients born in the summer experienced the most severe symptoms in the summer, but AD patients born in other seasons showed no seasonality. In addition, patients born in the summer also experienced seasonal fluctuations in pruritus, which were most severe in the summer. It is crucial to figure out the specific type of variation in AD severity in each individual so that preventive measures can be taken before exacerbations arise. There are many strengths of this study. First, this is a prospective study in which individuals with AD were followed for one year, avoiding the effect of recall bias in the study. Second, our results are more credible since we used Hannifin and Rajka criteria for diagnosis by doctors rather than questionnaires or electronic registries, as in some previous research 10 ,12 ,17 ,24 . Third, the SCORAD adopted in this study enhanced our findings, since daily use of topical anti-inflammatory medications, or clinic/hospital visits were employed as indicators of AD flares in many previous studies 5 ,17 ,24 ,25 . The limitations of this study are as follows. First, the samples were recruited from a single location, limiting the generalizability of the results to the general population. Multiple sites or communities should be sampled in future studies to improve sample representativeness. Second, during the one-year interview, 34% of individuals were lost to follow-up. However, the demographic and clinical characteristics of patients who were lost to follow-up were not statistically different from the general population, reducing the bias associated with loss to follow-up. Finally, follow-ups over multiple years are need in the future to determine whether these seasonal variations can be repeated. Conclusion In conclusion, AD patients with summer birth experienced the greatest severity in the summer, and their itch symptoms were also the worst in the summer. It is essential to understand the patterns of seasonal variation in symptom severity in specific populations, as well as to take preventive measures before flare-ups in these populations. Declarations Availability of data and materials The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. Competing interests The authors declare no competing interests. Funding This work was supported by Medical Science and Technology Project of Zhejiang Province [2023KY189], Jiangsu Province Hospital of Chinese Medicine Foundation [Grant No. y2021rc25 and Grant No. y2021rc32]. Author contributions All authors contributed to the conception and design of the study. Data were collected by Yu-ting Zhang, Hong-min Li. Bo Xie and Cheng Tan performed the data analysis and figure visualization. Yu-ting zhang wrote the first draft of the manuscript, and all authors commented on the previous version of the manuscript. All authors have read and approved the final manuscript. References A. Egeberg, C.E.M. Griffiths, H.C. Williams, Y.M.F. Andersen, J.P. Thyssen. Clinical characteristics, symptoms and burden of psoriasis and atopic dermatitis in adults. The British journal of dermatology 2020; 183: 128-138. S. Stander. Atopic Dermatitis. N Engl J Med 2021; 384: 1136-1143. M. Kim, Y.M. Kim, J.Y. Lee, H.K. Yang, H. Kim, J. Cho. 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US health care utilization and costs in adult patients with atopic dermatitis by disease severity. J Manag Care Spec Pharm 2022; 28: 69-77. Tables Table 1. Baseline characteristics of participants in the study Characteristics Mean±SD N (%) Age, years 14.09±10.36 Male 30 (60%) Age of onset of AD, years 11.21±9.91 Duration, months 43.70±58.76 Season of birth Spring 10 (20%) Summer 12 (24%) Autumn 17 (34%) Winter 11 (22%) Delivery mode Virginal delivery 31 (62%) Cesarean section delivery 19 (38%) Gestational age Term birth (37-42 weeks) 46 (92%) Preterm birth (42 weeks) 1 (2%) Feeding types during infancy Breastfeeding 32 (64%) Formula feeding 6 (12%) Mixed feeding 12 (24%) Outdoor activities per day Less than 2 hours 37 (74%) More than 2 hours 13 (26%) Family history Family history of allergic disease 29 (58%) Family history of AD 3 (6%) Allergic complications Asthma 19 (38%) Rhinitis 29 (58%) Urticaria 11 (22%) SCORAD 53.01±14.26 Itch 5.70±2.02 AD: atopic dermatitis; SCORAD: scoring atopic dermatitis. Table 2. Seasonal changes in the severity of AD patients evaluated by SCORAD N (visits) Spring Summer Autumn Winter F P Overall 204 51.58±15.64 49.88±17.12 48.71±16.24 49.86±17.43 0.23 0.88 Sex Male 125 53.14±13.83 49.67±16.70 46.30±16.69 47.93±17.78 0.80 0.50 Female 79 49.42±18.21 50.25±18.34 52.41±15.04 53.10±16.79 0.19 0.91 Age <18 years 142 51.68±14.78 50.97±16.68 46.23±14.33 49.80±15.52 1.01 0.39 18 years or older 62 51.38±18.17 46.78±18.72 54.10±18.98 49.99±21.60 0.40 0.75 Duration of AD <12 months 55 55.23±15.38 52.46±18.50 40.05±13.03 49.29±15.46 3.00 0.04* 12 months or longer 149 49.85±15.83 48.75±16.66 52.02±16.22 50.00±18.05 0.29 0.83 Delivery mode Virginal delivery 128 52.89±16.12 51.25±18.30 46.46±15.53 47.44±16.90 0.97 0.41 Cesarean section delivery 76 49.21±15.17 47.75±15.36 51.80±16.92 55.67±17.88 0.70 0.56 Gestation age: term birth 188 50.98±14.98 50.05±16.43 48.78±16.26 50.16±18.39 0.15 0.93 Feeding types during infancy Breastfeeding 122 48.50±13.68 48.65±17.34 49.13±17.35 50.52±18.54 0.08 0.97 Formula feeding 27 54.15±8.37 53.77±14.79 51.31±16.11 51.20±10.44 0.09 0.97 Mixed feeding 55 56.21±22.74 50.38±18.86 46.69±14.35 47.71±16.92 0.64 0.59 Outdoor activities per day Less than 2 hours 153 51.26±16.83 48.99±17.67 48.61±16.98 51.51±18.33 0.29 0.83 More than 2 hours 51 52.92±10.29 52.15±16.10 49.03±14.18 45.03±13.99 0.69 0.56 Season of birth Born in spring 35 55.18±11.62 45.22±14.09 37.74±14.59 43.70±17.02 1.64 0.20 Born in summer 51 51.30±17.19 63.54±9.13 43.72±13.44 47.04±16.44 4.90 <0.01* Born in autumn 69 55.99±17.55 47.34±16.59 56.85±17.22 53.56±18.09 0.92 0.42 Born in winter 49 44.70±13.89 43.70±20.53 49.57±13.78 50.74±17.96 0.51 0.68 Family history Any allergic disease 118 53.14±15.78 54.18±16.12 47.13±15.75 50.34±17.00 1.27 0.29 Complications Asthma 81 56.68±14.59 50.70±17.12 54.85±16.40 53.44±19.09 0.37 0.77 Allergic rhinitis 120 50.68±16.13 51.04±17.32 46.49±15.99 47.65±17.20 0.56 0.64 Urticaria 45 41.79±17.46 40.55±16.36 40.02±13.68 42.50±16.85 0.06 0.98 AD: atopic dermatitis; SCORAD: scoring atopic dermatitis; *the difference is statistically significant. Table 3. Seasonal changes in itch severity of AD patients N (visits) Spring Summer Autumn Winter F P Overall 204 4.94±1.98 5.30±2.22 5.00±1.75 4.92±2.13 0.37 0.78 Sex Male 125 5.00±1.85 5.28±2.10 4.78±1.78 4.66±2.22 0.58 0.63 Female 79 4.85±2.23 5.35±2.47 5.33±1.69 5.37±1.95 0.22 0.88 Age <18 yeears 142 5.00±1.95 5.56±2.19 4.87±1.69 4.80±1.89 1.17 0.32 18 years or older 62 4.80±2.15 4.58±2.23 5.29±1.88 5.19±2.64 0.34 0.80 Duration of AD <12 months 55 5.00±2.00 5.79±2.15 4.48±1.75 4.50±2.17 1.40 0.25 12 months or longer 149 4.90±2.02 5.09±2.25 5.20±1.73 5.02±2.14 0.13 0.94 Delivery mode Virginal delivery 128 4.80±2.28 5.25±2.35 4.75±1.81 4.53±2.02 0.66 0.58 Cesarean section delivery 76 5.18±1.33 5.39±2.06 5.34±1.64 5.87±2.17 0.38 0.77 Gestation age: term birth 188 4.93±1.89 5.35±2.19 5.03±1.76 4.91±2.24 0.43 0.74 Feeding types during infancy Breastfeeding 122 4.76±1.99 5.33±2.30 5.32±1.83 4.97±2.18 0.45 0.72 Formula feeding 27 5.50±1.76 5.29±2.06 4.50±1.27 5.25±2.22 0.52 0.67 Mixed feeding 55 4.88±2.30 5.25±2.30 4.59±1.71 4.69±2.14 0.29 0.83 Outdoor activities per day Less than 2 hours 153 4.84±2.01 5.00±2.25 5.02±1.91 5.03±2.24 0.05 0.99 More than 2 hours 51 5.33±1.97 6.08±2.02 4.95±1.18 4.62±1.85 1.84 0.15 Season of birth Born in spring 35 4.60±1.67 4.70±1.64 4.00±1.48 4.33±2.18 0.31 0.82 Born in summer 51 5.33±2.06 7.09±1.38 4.85±1.60 5.09±2.21 3.99 0.01* Born in autumn 69 5.33±1.50 4.93±2.09 5.88±2.09 4.90±2.19 1.09 0.36 Born in winter 49 4.25±2.60 4.55±2.73 4.60±1.14 5.30±2.11 0.45 0.72 Family history Any allergic disease 118 5.29±2.11 5.85±2.14 5.11±1.89 5.03±1.95 0.99 0.40 Complications Asthma 81 5.73±1.91 5.18±2.56 5.40±1.87 5.58±2.19 0.21 0.89 Allergic rhinitis 120 5.00±2.31 5.67±2.35 4.89±1.85 4.77±2.31 1.00 0.40 Urticaria 45 3.50±1.85 3.90±2.08 4.07±1.44 4.42±1.83 0.45 0.72 AD: atopic dermatitis; *the difference is statistically significant. Table 4. Multiple comparisons of seasonal severity of AD in patients born in summer Comparison (season A v.s. season B) Severity by SCORAD Season A Severity by SCORAD Season B t P Spring v.s. summer 51.30±17.19 63.54±9.13 -2.04 0.06 Spring v.s. autumn 51.30±17.19 43.72±13.44 1.29 0.21 Spring v.s. winter 51.30±17.19 47.04±16.44 0.57 0.58 Summer v.s. autumn 63.54±9.13 43.72±13.44 4.35 <0.001* Summer v.s. winter 63.54±9.13 47.04±16.44 2.91 <0.01* Autumn v.s. winter 43.72±13.44 47.04±16.44 -0.61 0.55 AD: atopic dermatitis; SCORAD: scoring atopic dermatitis; *the difference is statistically significant. Table 5. Multiple comparisons of seasonal itch of AD in patients born in summer Comparison (season A v.s. season B) Severity by itch Season A Severity by itch Season B t P Spring v.s. summer 5.33±2.06 7.09±1.38 -2.28 0.04* Spring v.s. autumn 5.33±2.06 4.85±1.60 0.69 0.50 Spring v.s. winter 5.33±2.06 5.09±2.21 0.25 0.80 Summer v.s. autumn 7.09±1.38 4.85±1.60 3.91 0.001* Summer v.s. winter 7.09±1.38 5.09±2.21 2.55 0.02* Autumn v.s. winter 4.85±1.60 5.09±2.21 -0.35 0.73 AD: atopic dermatitis; *the difference is statistically significant. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4382810","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":304506935,"identity":"093fa8f6-3fd9-433f-b95d-d61a73653f1c","order_by":0,"name":"Yu-ting Zhang","email":"","orcid":"","institution":"Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu-ting","middleName":"","lastName":"Zhang","suffix":""},{"id":304506936,"identity":"82d31fcb-1107-4756-bb15-faa07153e1f8","order_by":1,"name":"Hong-min Li","email":"","orcid":"","institution":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hong-min","middleName":"","lastName":"Li","suffix":""},{"id":304506937,"identity":"bc9196b0-fcfd-423a-97d3-e2a193d351cd","order_by":2,"name":"Cheng Tan","email":"","orcid":"","institution":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Tan","suffix":""},{"id":304506938,"identity":"b86fa95c-2f7b-4e62-b4b3-52f4b35992e6","order_by":3,"name":"Bo Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie3NMUvDQBjG8TcE2uWk64V+iQTBMX4VXwJxiV06iVVbAjdps14R+hns5iB4RyBZTrp2vFLonC61QylGZ0+aTeT+07P8eABstr+aMwSg4IqvfXEckd+khcOmhATHEb9UwWrzEva8TH3oahD2Ot1Sw+b11kxUcupLFfW79Go24kXU98aJ7/B1aSRnIo6pZC5O6cksJS2Bz4qAS0RhJvP15U6ye5x21DLdHwS+qbb+nSyiAiTL8QkSJ3VY/ULAr8nASM4Xq5y+sxInPA4mj+MIuSK+5EIYiZfhqLpmN8jnua522xCzh/ZSV+LOSH6uvsgbkrqmLzabzfaP+wRez2RZhLrXmwAAAABJRU5ErkJggg==","orcid":"","institution":"Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University","correspondingAuthor":true,"prefix":"","firstName":"Bo","middleName":"","lastName":"Xie","suffix":""}],"badges":[],"createdAt":"2024-05-07 11:52:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4382810/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4382810/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57306149,"identity":"fc42c079-3c1e-4773-a5f0-0e1193db72d1","added_by":"auto","created_at":"2024-05-29 01:56:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36228,"visible":true,"origin":"","legend":"\u003cp\u003eSeason of birth and seasonal variations in the severity of AD\u003c/p\u003e\n\u003cp\u003eAD: atopic dermatitis;\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4382810/v1/2d0ff721aacc9391ada7ac51.png"},{"id":59465796,"identity":"2b211756-d9ac-43d4-b369-31c86490a031","added_by":"auto","created_at":"2024-07-02 06:32:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":770686,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4382810/v1/4f791519-a9a7-4a9a-9464-d5ddb7a75e4f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Seasonality in the severity of atopic dermatitis and birth season","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtopic dermatitis (AD) is a chronic relapsing skin disease. Patients with severe AD suffer an average of twelve relapses per year, severely affecting their quality of life\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. However, the reasons for its intermittent exacerbation are still inconclusive. The seasonality in aggravation of AD has been stated in previous studies\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Based on whether skin symptoms worsen in the summer or winter, AD was classified into two types: the summer type and the winter type\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. However, it is unclear which group of AD patients becomes worse in the winter and which gets worse in the summer. A fall or winter birth has been suggested to be associated with an increased risk of AD\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. However, there is no research on whether the seasonal exacerbation of AD is relevant to the birth season or not.\u003c/p\u003e \u003cp\u003eGiven this background, the goal of this study was to explore seasonal variations in the severity of AD in people born in different seasons, as well as to identify unique populations of winter-type and summer-type AD patients. Interventions on exacerbations at the earliest time of onset should be implemented in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis is a prospective study conducted at the outpatient unit of the department of dermatology at the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine in China. Individuals were recruited between March 2020 and March 2021, and followed up every three months for at least one year. Potential risk factors for exacerbation of AD were collected through a structured questionnaire at each visit from participants or their parents. The severity of AD and itch were evaluated by a trained investigator (Yu-ting Zhang) at baseline and at each follow-up.The research followed the TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis Or Diagnosis) guidelines.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAD participants\u003c/h2\u003e \u003cp\u003eThe diagnosis of AD of all participants was established by two senior dermatologists (Cheng Tan and Hong-min Li) according to the criteria of Hannifin and Rajka at the first visit. The patients were not aware of the study hypothesis. Finally, fifty patients with AD were recruited within the time frame.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDefinition of season\u003c/h2\u003e \u003cp\u003eSpring was defined as March 1st to May 31st, summer was June 1st to August 31st, fall was September 1st to November 30th, and winter was December 1st to February 28th/29th, according to the meteorological distribution of the seasons. Nanjing is located in the northern subtropical monsoon climate zone, with a warm, humid and rainy climate as well as distinctive seasons. Its mean temperature is 15.4\u0026deg;C, and its annual average precipitation is 1106 mm. In Nanjing, the temperature difference between winter and summer is enormous.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of the severity of AD\u003c/h2\u003e \u003cp\u003eThe severity of AD was measured by scoring atopic dermatitis (SCORAD), and the itch was evaluated by the visual analogue scale (VAS) scale at each visit. The data collected from patients during each of the four seasons was analyzed to see if there were any seasonal differences in severity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for the potential flare of AD\u003c/h2\u003e \u003cp\u003eA standardized questionnaire was used to document potential risk factors for the aggravation of AD. Demographic information was collected, including sex, age, and birth season. At the begin of the study, potential risk factors for AD flares were gathered, including duration, delivery mode, gestational age during childbirth, feeding types throughout infancy, time spent outdoor per day, family history of allergic disease, and allergic complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were carried out using SPSS Statistics 23.0 (IBM, Armonk, NY, USA). Continuous measurements were summarized as mean and standard deviation (for normally distributed data), and categorical variables were expressed as counts and percentages. For categorical variables, χ2 tests or Fisher\u0026rsquo;s exact tests were used to determine whether statistical differences exist. For continuous measurements, multivariate analyses of variance (MANOVA) (F statistic)with repeated measures were used to evaluate the differences, and the Kruskal-Wallis H test was used if the variances were heterogeneous. Moreover, post hoc pairwise comparisons were performed using t-tests when significant seasonal differences were detected. All comparisons were two-tailed, and results were considered statistically significant if the P-value was less than 0.05 for all analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This research including all experimental methods was approved by the ethics committee of Affiliated Hospital of Nanjing University of Chinese Medicine (2017NL-056-02).\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline characteristics of the population recruited in the study (n=50) are presented in Table 1. The average age was 14.09\u0026plusmn;10.36 years, with a mean duration of 43.70\u0026plusmn;58.76 months. Symptoms of AD started at a mean age of 11.21\u0026plusmn;9.91 years. Ten (20%) participants were born in the spring, 12 (24%) in the summer, 17 (34%) in the autumn, and 11 (22%) in the winter. Thirty-one (62%) were born via vaginal delivery, while the remaining 19 (38%) were delivered via cesarean section. Forty-six (92%) were term births, three (6%) were preterm births, and one (2%) were overdue in terms of the gestational age. Thirty-two (64%) were breastfed, six (12%) were fed infant formula, and twelve (24%) were mixed fed in infancy. Thirty-seven (74%) spent less than two hours per day outdoors, whereas thirteen (26%) spent more. Twenty-nine patients (58%) had a family history of any allergic disease, and three (6%) had a family history of AD. Thirty-eight patients (76.0%) had a diagnosis of AD with complications. Nineteen were with asthma, 29 with allergic rhinitis, and 11 with urticaria. The baseline SCORAD was 53.01\u0026plusmn;14.26 and the itching score was 5.70\u0026plusmn;2.02 for all participants. The characteristics were consistent across all seasons of birth\u0026nbsp;in\u0026nbsp;Table 1.\u003c/p\u003e\n\u003cp\u003eThe second visit was completed by all 50 participants, with the loss to follow-up gradually increasing throughout the study (8%, and 34% were lost to follow-up at the third and fourth visit, respectively). The socio-demographic and clinical features were similar between those who completed the fourth visit and those who were lost to follow-up\u0026nbsp;in\u0026nbsp;Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeasonal alterations in the severity of AD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 31 visits in spring, 46 visits in summer, 76 visits in autumn, and 51 visits in winter during the baseline and follow-up periods. The seasonal variations in the severity of AD are shown in Table 2, Table 3, Table 4 and Fig. 1. Seasonal differences in the severity of\u0026nbsp;newly-onset AD (duration less than one year) were shown to be significant (F=3.00, P=0.04). The severity of AD was the most severe in spring, with a SCORAD of 55.23\u0026plusmn;15.38, followed by summer, with a SCORAD of 52.46\u0026plusmn;18.50. The severity was most alleviated in autumn, with a SCORAD of 40.05\u0026plusmn;13.03. In patients with a clinical course of more than one year, there was no significant difference in seasonal fluctuations.\u003c/p\u003e\n\u003cp\u003eThe severity of AD in patients born in the summer varied significantly (F=4.90, P\u0026lt;0.01). The severity was the most severe in summer, with a SCORAD of 63.54\u0026plusmn;9.13, which was significantly higher than that in spring (51.30\u0026plusmn;17.19, t =2.04, P=0.06), autumn (43.72\u0026plusmn;13.44, t=4.35, P\u0026lt;0.001) or winter (47.04\u0026plusmn;16.44, t=2.91, P\u0026lt;0.01). There were no significant seasonal differences in the severity of patients born in the spring, autumn, or winter. When the subjects were subgrouped by factors such as sex, age, delivery mode, gestational age, feeding types during infancy, the time span of outdoor activities per day, family history of allergic disease, or self-allergic complications, there was no significant seasonal variation in AD severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeasonal alterations of itch in AD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAD patients born in summer experienced significant seasonal changes in pruritus (F=3.99, P=0.01). The itching was the worst in summer, with a score of 7.09\u0026plusmn;1.38, significantly higher than that in spring (5.33\u0026plusmn;2.06, t=2.28, P=0.04), autumn (4.85\u0026plusmn;1.60, t=3.91 P=0.001) or winter (5.09\u0026plusmn;2.21, t=2.55, P=0.02) (Table 3 and Table 5). There were no statistically significant variations in pruritus across subgroups divided by other factors.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAD can be divided into two types, that is winter type and summer type, according to the season of exacerbation\u003csup\u003e3-5\u003c/sup\u003e. Only a few research have looked into which patients are worsened in the winter and which are worsened in the summer\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e. Seasonal variation in SCORAD was discovered in this study in individuals with a clinical history of less than one year. In this newly-onset subgroup, the severity of AD deteriorated in the spring and summer and improved in the autumn and winter. In patients with a duration longer than one year, the seasonal difference was not significant. Furthermore, AD patients born in the summer were the most severe in the summer, whereas AD patients born in other seasons exhibited no seasonality.\u003c/p\u003e\n\u003cp\u003eThe aggravation of AD in summer can be attributed to high temperatures\u003csup\u003e10\u003c/sup\u003e\u003csup\u003e,11\u003c/sup\u003e, low humidity\u003csup\u003e11\u003c/sup\u003e\u003csup\u003e,12\u003c/sup\u003e, sweating\u003csup\u003e13\u003c/sup\u003e, grass-pollen exposure\u003csup\u003e14\u003c/sup\u003e, and ultraviolet radiation\u003csup\u003e15\u003c/sup\u003e\u003csup\u003e,16\u003c/sup\u003e. In our study, patients with summer birth were the most aggravated in the summer, which may be related to high summer temperature and sweat stimulation. The exacerbation of AD in the winter might be related to low temperatures\u003csup\u003e10\u003c/sup\u003e\u003csup\u003e,17\u003c/sup\u003e and the deterioration of the skin barrier. During the winter, there was a decrease in epidermal lipids, skin hydration, and skin NMF components\u003csup\u003e18\u003c/sup\u003e. In this study, individuals who were born in the winter got worse in the winter, although there was no statistical difference in severity across the seasons. More research is needed to determine which patients will be worsened in the winter.\u003c/p\u003e\n\u003cp\u003eIn this study, patients born in the summer demonstrated seasonal variation in itch severity. The itch score was greatest in summer, which is the hottest season of the year. Previous studies have suggested that pruritus severity is associated with high temperatures\u003csup\u003e19\u003c/sup\u003e, and scratching scores are related to hot weather and sweating\u003csup\u003e11\u003c/sup\u003e, which is consistent with our findings.\u003c/p\u003e\n\u003cp\u003eThere was no difference in the age and sex distribution of children with summer-type and winter-type AD in the study by Kr\u0026auml;mer et al\u003csup\u003e4\u003c/sup\u003e. The rate of positive sensitization did not differ statistically between the two groups. Similar to the findings above, in this study, factors such as sex, age, family history of allergic disease, and allergic complications of the participants had no effect on seasonal fluctuations in AD severity. Besides, delivery mode, gestation age, feeding types during infancy, and the amount of time spent outside per day showed no relation to the seasonal variations in AD severity according to our findings.\u003c/p\u003e\n\u003cp\u003eThe season of birth may have an impact on the progression of AD. Children born in the autumn or winter showed a higher prevalence of AD than those born in the spring or summer, according to studies in Japan\u003csup\u003e20\u003c/sup\u003e, Norway\u003csup\u003e21\u003c/sup\u003e, Madagascar\u003csup\u003e22\u003c/sup\u003e, the United States\u003csup\u003e23\u003c/sup\u003e, and a meta-analysis in the northern hemisphere\u003csup\u003e7\u003c/sup\u003e. Although numerous risk factors for AD flares have been proposed\u003csup\u003e10-16\u003c/sup\u003e, it is unknown if the season of birth influences the seasonal variation in AD severity. We focused on the birth season and seasonal changes in AD in this study to determine which groups are more likely to exacerbate in the winter and which are more likely to aggravate in the summer. Our data suggest that AD patients born in the summer experienced the most severe symptoms in the summer, but AD patients born in other seasons showed no seasonality. In addition, patients born in the summer also experienced seasonal fluctuations in pruritus, which were most severe in the summer. It is crucial to figure out the specific type of variation in AD severity in each individual so that preventive measures can be taken before exacerbations arise.\u003c/p\u003e\n\u003cp\u003eThere are many strengths of this study. First, this is a prospective study in which individuals with AD were followed for one year, avoiding the effect of recall bias in the study. Second, our results are more credible since we used Hannifin and Rajka criteria for diagnosis by doctors rather than questionnaires or electronic registries, as in some previous research\u003csup\u003e10\u003c/sup\u003e\u003csup\u003e,12\u003c/sup\u003e\u003csup\u003e,17\u003c/sup\u003e\u003csup\u003e,24\u003c/sup\u003e. Third, the SCORAD adopted in this study enhanced our findings, since daily use of topical anti-inflammatory medications, or clinic/hospital visits were employed as indicators of AD flares in many previous studies\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e,17\u003c/sup\u003e\u003csup\u003e,24\u003c/sup\u003e\u003csup\u003e,25\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe limitations of this study are as follows. First, the samples were recruited from a single location, limiting the generalizability of the results to the general population. Multiple sites or communities should be sampled in future studies to improve sample representativeness. Second, during the one-year interview, 34% of individuals were lost to follow-up. However, the demographic and clinical characteristics of patients who were lost to follow-up were not statistically different from the general population, reducing the bias associated with loss to follow-up. Finally, follow-ups over multiple years are need in the future to determine whether these seasonal variations can be repeated.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, AD patients with summer birth experienced the greatest severity in the summer, and their itch symptoms were also the worst in the summer. It is essential to understand the patterns of seasonal variation in symptom severity in specific populations, as well as to take preventive measures before flare-ups in these populations.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Medical Science and Technology Project of Zhejiang Province [2023KY189], Jiangsu Province Hospital of Chinese Medicine Foundation [Grant No. y2021rc25 and Grant No. y2021rc32].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study. Data were collected by\u0026nbsp;Yu-ting Zhang, Hong-min Li.\u0026nbsp;Bo Xie\u0026nbsp;and\u0026nbsp;Cheng Tan\u0026nbsp;performed the data analysis and figure visualization.\u0026nbsp;Yu-ting zhang\u0026nbsp;wrote the first draft of the manuscript, and all authors commented on the previous version of the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eA. Egeberg, C.E.M. Griffiths, H.C. Williams, Y.M.F. Andersen, J.P. Thyssen. Clinical characteristics, symptoms and burden of psoriasis and atopic dermatitis in adults. The British journal of dermatology 2020; 183: 128-138.\u003c/li\u003e\n\u003cli\u003eS. Stander. Atopic Dermatitis. N Engl J Med 2021; 384: 1136-1143.\u003c/li\u003e\n\u003cli\u003eM. Kim, Y.M. Kim, J.Y. Lee, H.K. Yang, H. Kim, J. Cho. Seasonal variation and monthly patterns of skin symptoms in Korean children with atopic eczema/dermatitis syndrome. Allergy Asthma Proc 2017; 38: 294-299.\u003c/li\u003e\n\u003cli\u003eU. Kramer, S. Weidinger, U. Darsow, M. Mohrenschlager, J. Ring, H. Behrendt. Seasonality in symptom severity influenced by temperature or grass pollen: results of a panel study in children with eczema. J Invest Dermatol 2005; 124: 514-523.\u003c/li\u003e\n\u003cli\u003eC.R. Hamann, Y.M.F. Andersen, K.A. Engebretsen, L. Skov, J.I. Silverberg, A. Egeberg, et al. The effects of season and weather on healthcare utilization among patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2018; 32: 1745-1753.\u003c/li\u003e\n\u003cli\u003eP. Silcocks, H.C. Williams. A scientific look at seasonality of symptom severity in atopic dermatitis. J Invest Dermatol 2005; 124: xviii-xix.\u003c/li\u003e\n\u003cli\u003eM. Calov, F. Alinaghi, C.R. Hamann, J. Silverberg, A. Egeberg, J.P. Thyssen. The Association Between Season of Birth and Atopic Dermatitis in the Northern Hemisphere: A Systematic Review and Meta-Analysis. The journal of allergy and clinical immunology. In practice 2020; 8: 674-680 e675.\u003c/li\u003e\n\u003cli\u003eK. Kuzume, M. Kusu. Before-birth climatologic data may play a role in the development of allergies in infants. Pediatr Allergy Immunol 2007; 18: 281-287.\u003c/li\u003e\n\u003cli\u003eK.A. Engebretsen, J.D. Johansen, S. Kezic, A. Linneberg, J.P. Thyssen. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol 2016; 30: 223-249.\u003c/li\u003e\n\u003cli\u003eF. Wang, C. Shi, J. Dong, H. Nie. Association between ambient temperature and atopic dermatitis in Lanzhou, China: a time series analysis. Environmental science and pollution research international 2021; 28: 67487-67495.\u003c/li\u003e\n\u003cli\u003eS.M. Langan, J.F. Bourke, P. Silcocks, H.C. Williams. An exploratory prospective observational study of environmental factors exacerbating atopic eczema in children. The British journal of dermatology 2006; 154: 979-980.\u003c/li\u003e\n\u003cli\u003eH. Yokomichi, M. Mochizuki, A. Tsuchida, R. Kojima, S. Horiuchi, T. Ooka, et al. Association of the incidence of atopic dermatitis until 3 years old with birth month and with sunshine duration and humidity in the first 6 months of life: Japan Environment and Children\u0026apos;s Study. BMJ open 2021; 11: e047226.\u003c/li\u003e\n\u003cli\u003eH. Murota, Y. Koike, H. Morisaki, M. Matsumoto, M. Takenaka. Exacerbating factors and disease burden in patients with atopic dermatitis. Allergology international : official journal of the Japanese Society of Allergology 2022; 71: 25-30.\u003c/li\u003e\n\u003cli\u003eT. Werfel, A. Heratizadeh, M. Niebuhr, A. Kapp, L.M. Roesner, A. Karch, et al. Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber. The Journal of allergy and clinical immunology 2015; 136: 96-103 e109.\u003c/li\u003e\n\u003cli\u003eS.M. Langan, A.D. Irvine. Childhood eczema and the importance of the physical environment. J Invest Dermatol 2013; 133: 1706-1709.\u003c/li\u003e\n\u003cli\u003eA.H. Lossius, O. Sundnes, A.C. Ingham, S.M. Edslev, J.V. Bjornholt, B. Lilje, et al. Shifts in the Skin Microbiota after UVB Treatment in Adult Atopic Dermatitis. Dermatology 2022; 238: 109-120.\u003c/li\u003e\n\u003cli\u003eC. Ye, H. Gu, M. Li, R. Chen, X. Xiao, Y. Zou. Air Pollution and Weather Conditions Are Associated with Daily Outpatient Visits of Atopic Dermatitis in Shanghai, China. Dermatology 2022; 1-11.\u003c/li\u003e\n\u003cli\u003eC. Devillers, G.E. Pierard, P. Quatresooz, S. Pierard. Environmental dew point and skin and lip weathering. J Eur Acad Dermatol Venereol 2010; 24: 513-517.\u003c/li\u003e\n\u003cli\u003eR. Grandhi, A. He, Y.R. Semenov, S.G. Kwatra. Seasonal variation of itch: A study using real-time data from 2004 to 2016. J Am Acad Dermatol 2017; 76: 563-564.\u003c/li\u003e\n\u003cli\u003eY. Kuwabara, R. Nii, K. Tanaka, E. Ishii, M. Nagao, T. Fujisawa. Season of birth is associated with increased risk of atopic dermatitis in Japanese infants: a retrospective cohort study. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology 2020; 16: 44.\u003c/li\u003e\n\u003cli\u003eE.M. Rehbinder, K.M. Advocaat Endre, K.C. Lodrup Carlsen, A. Asarnoj, K.E. Stensby Bains, T.L. Berents, et al. Predicting Skin Barrier Dysfunction and Atopic Dermatitis in Early Infancy. The journal of allergy and clinical immunology. In practice 2020; 8: 664-673 e665.\u003c/li\u003e\n\u003cli\u003eF.A. Sendrasoa, V.T. Ratovonjanahary, N.H. Razanakoto, M.F. Rakotoarisaona, O. Raharolahy, M. Andrianarison, et al. Birth Month and Prevalence of Atopic Dermatitis in Children Under 3 Years in Antananarivo, Madagascar. Journal of asthma and allergy 2020; 13: 265-268.\u003c/li\u003e\n\u003cli\u003eJ.H. Dunlop, J.P. Keller, R.D. Peng, C.A. Keet. The effect of season of birth on atopic dermatitis and food allergy. Annals of allergy, asthma \u0026amp; immunology : official publication of the American College of Allergy, Asthma, \u0026amp; Immunology 2020; 125: 221-223 e222.\u003c/li\u003e\n\u003cli\u003eA.B. Fleischer, Jr. Atopic dermatitis: the relationship to temperature and seasonality in the United States. International journal of dermatology 2019; 58: 465-471.\u003c/li\u003e\n\u003cli\u003eX. Wang, N.N. Boytsov, M. Gorritz, W.N. Malatestinic, O.M. Goldblum, R.L. Wade. US health care utilization and costs in adult patients with atopic dermatitis by disease severity. J Manag Care Spec Pharm 2022; 28: 69-77.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable\u0026nbsp;1.\u0026nbsp;Baseline characteristics of participants in the study\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"92%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e14.09\u0026plusmn;10.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e30 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eAge of onset of AD, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e11.21\u0026plusmn;9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eDuration, months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e43.70\u0026plusmn;58.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eSeason of birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eSpring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e10 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eSummer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e12 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eAutumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e17 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eWinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e11 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eDelivery mode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eVirginal\u0026nbsp;delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e31 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eCesarean section delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e19 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eGestational age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eTerm birth (37-42 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e46 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003ePreterm birth (\u0026lt;37 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003ePost-term birth (\u0026gt;42 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eFeeding types during infancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eBreastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e32 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eFormula feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e6 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eMixed feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e12 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eOutdoor activities per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e37 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eMore than 2 hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e13 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history of allergic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e29 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history of AD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eAllergic complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e19 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eRhinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e29 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eUrticaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e11 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eSCORAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e53.01\u0026plusmn;14.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.10204081632653%\" valign=\"top\"\u003e\n \u003cp\u003eItch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e5.70\u0026plusmn;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAD: atopic dermatitis; SCORAD: scoring atopic dermatitis.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2.\u0026nbsp;Seasonal changes in the severity of AD patients evaluated by\u0026nbsp;SCORAD\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e(visits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpring\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSummer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAutumn\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWinter\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.58\u0026plusmn;15.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.88\u0026plusmn;17.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.71\u0026plusmn;16.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.86\u0026plusmn;17.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.14\u0026plusmn;13.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.67\u0026plusmn;16.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.30\u0026plusmn;16.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.93\u0026plusmn;17.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.42\u0026plusmn;18.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.25\u0026plusmn;18.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.41\u0026plusmn;15.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.10\u0026plusmn;16.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.68\u0026plusmn;14.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.97\u0026plusmn;16.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.23\u0026plusmn;14.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.80\u0026plusmn;15.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 years or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.38\u0026plusmn;18.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.78\u0026plusmn;18.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.10\u0026plusmn;18.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.99\u0026plusmn;21.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of AD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.23\u0026plusmn;15.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.46\u0026plusmn;18.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.05\u0026plusmn;13.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.29\u0026plusmn;15.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 months or longer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.85\u0026plusmn;15.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.75\u0026plusmn;16.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.02\u0026plusmn;16.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.00\u0026plusmn;18.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDelivery mode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVirginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.89\u0026plusmn;16.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.25\u0026plusmn;18.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.46\u0026plusmn;15.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.44\u0026plusmn;16.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCesarean section delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.21\u0026plusmn;15.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.75\u0026plusmn;15.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.80\u0026plusmn;16.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.67\u0026plusmn;17.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGestation age: term birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.98\u0026plusmn;14.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.05\u0026plusmn;16.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.78\u0026plusmn;16.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.16\u0026plusmn;18.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFeeding types during infancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBreastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.50\u0026plusmn;13.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.65\u0026plusmn;17.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.13\u0026plusmn;17.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.52\u0026plusmn;18.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFormula feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.15\u0026plusmn;8.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.77\u0026plusmn;14.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.31\u0026plusmn;16.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.20\u0026plusmn;10.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMixed feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.21\u0026plusmn;22.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.38\u0026plusmn;18.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.69\u0026plusmn;14.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.71\u0026plusmn;16.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOutdoor activities per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.26\u0026plusmn;16.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.99\u0026plusmn;17.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.61\u0026plusmn;16.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.51\u0026plusmn;18.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMore than 2 hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.92\u0026plusmn;10.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.15\u0026plusmn;16.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.03\u0026plusmn;14.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.03\u0026plusmn;13.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeason of birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in spring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.18\u0026plusmn;11.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.22\u0026plusmn;14.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.74\u0026plusmn;14.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.70\u0026plusmn;17.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in summer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.30\u0026plusmn;17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.54\u0026plusmn;9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.72\u0026plusmn;13.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.04\u0026plusmn;16.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in autumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.99\u0026plusmn;17.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.34\u0026plusmn;16.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.85\u0026plusmn;17.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.56\u0026plusmn;18.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in winter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44.70\u0026plusmn;13.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.70\u0026plusmn;20.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.57\u0026plusmn;13.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.74\u0026plusmn;17.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAny allergic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.14\u0026plusmn;15.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.18\u0026plusmn;16.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.13\u0026plusmn;15.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.34\u0026plusmn;17.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.68\u0026plusmn;14.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.70\u0026plusmn;17.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.85\u0026plusmn;16.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.44\u0026plusmn;19.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAllergic rhinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.68\u0026plusmn;16.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.04\u0026plusmn;17.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.49\u0026plusmn;15.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.65\u0026plusmn;17.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrticaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.79\u0026plusmn;17.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.55\u0026plusmn;16.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.02\u0026plusmn;13.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.50\u0026plusmn;16.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAD: atopic dermatitis; SCORAD: scoring atopic dermatitis; *the difference is statistically significant.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3. Seasonal changes in itch severity of AD patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN (visits)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpring\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSummer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAutumn\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWinter\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.94\u0026plusmn;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.30\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.00\u0026plusmn;1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.92\u0026plusmn;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.00\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.28\u0026plusmn;2.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.78\u0026plusmn;1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.66\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.85\u0026plusmn;2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.35\u0026plusmn;2.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.37\u0026plusmn;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;18 yeears\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.00\u0026plusmn;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.56\u0026plusmn;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.87\u0026plusmn;1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.80\u0026plusmn;1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 years or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.80\u0026plusmn;2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.58\u0026plusmn;2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.29\u0026plusmn;1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.19\u0026plusmn;2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of AD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.00\u0026plusmn;2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.79\u0026plusmn;2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.48\u0026plusmn;1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.50\u0026plusmn;2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 months or longer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.90\u0026plusmn;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.09\u0026plusmn;2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.20\u0026plusmn;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.02\u0026plusmn;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDelivery mode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVirginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.80\u0026plusmn;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.25\u0026plusmn;2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.75\u0026plusmn;1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.53\u0026plusmn;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCesarean section delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.18\u0026plusmn;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.39\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.34\u0026plusmn;1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.87\u0026plusmn;2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGestation age: term birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.93\u0026plusmn;1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.35\u0026plusmn;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.03\u0026plusmn;1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.91\u0026plusmn;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFeeding types during infancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBreastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.76\u0026plusmn;1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.32\u0026plusmn;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.97\u0026plusmn;2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFormula feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.50\u0026plusmn;1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.29\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.50\u0026plusmn;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.25\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMixed feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.88\u0026plusmn;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.25\u0026plusmn;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.59\u0026plusmn;1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.69\u0026plusmn;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOutdoor activities per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.84\u0026plusmn;2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.00\u0026plusmn;2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.02\u0026plusmn;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.03\u0026plusmn;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMore than 2 hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.08\u0026plusmn;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.95\u0026plusmn;1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.62\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeason of birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in spring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.60\u0026plusmn;1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.70\u0026plusmn;1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.00\u0026plusmn;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.33\u0026plusmn;2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in summer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.09\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.85\u0026plusmn;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.09\u0026plusmn;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in autumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.93\u0026plusmn;2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.88\u0026plusmn;2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.90\u0026plusmn;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBorn in winter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.25\u0026plusmn;2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.55\u0026plusmn;2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.60\u0026plusmn;1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.30\u0026plusmn;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAny allergic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.29\u0026plusmn;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.85\u0026plusmn;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.11\u0026plusmn;1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.03\u0026plusmn;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.73\u0026plusmn;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.18\u0026plusmn;2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.40\u0026plusmn;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.58\u0026plusmn;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAllergic rhinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.00\u0026plusmn;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.67\u0026plusmn;2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.89\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.77\u0026plusmn;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrticaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.50\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.90\u0026plusmn;2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.07\u0026plusmn;1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.42\u0026plusmn;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAD: atopic dermatitis; *the difference is statistically significant.\u003c/p\u003e\n\u003cp\u003eTable 4.\u0026nbsp;Multiple comparisons of seasonal severity of AD in patients born in summer\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eComparison\u003c/p\u003e\n \u003cp\u003e(season A \u003cem\u003ev.s.\u003c/em\u003e season\u0026nbsp;B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eSeverity by SCORAD\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSeason A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eSeverity by SCORAD\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSeason B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSpring \u003cem\u003ev.s.\u003c/em\u003e summer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e51.30\u0026plusmn;17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e63.54\u0026plusmn;9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e-2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSpring \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003eautumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e51.30\u0026plusmn;17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e43.72\u0026plusmn;13.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSpring \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003ewinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e51.30\u0026plusmn;17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e47.04\u0026plusmn;16.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSummer \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003eautumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e63.54\u0026plusmn;9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e43.72\u0026plusmn;13.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSummer\u003cem\u003e\u0026nbsp;v.s.\u0026nbsp;\u003c/em\u003ewinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e63.54\u0026plusmn;9.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e47.04\u0026plusmn;16.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eAutumn \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003ewinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e43.72\u0026plusmn;13.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e47.04\u0026plusmn;16.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e-0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAD: atopic dermatitis; SCORAD: scoring atopic dermatitis; *the difference is statistically significant.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5.\u0026nbsp;Multiple comparisons of seasonal itch of AD in patients born in summer\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eComparison\u003c/p\u003e\n \u003cp\u003e(season A \u003cem\u003ev.s.\u003c/em\u003e season B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003eSeverity by itch\u003c/p\u003e\n \u003cp\u003eSeason A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003eSeverity by itch\u003c/p\u003e\n \u003cp\u003eSeason B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSpring \u003cem\u003ev.s.\u003c/em\u003e summer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e7.09\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e-2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSpring \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003eautumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e4.85\u0026plusmn;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSpring \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003ewinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e5.33\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e5.09\u0026plusmn;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSummer \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003eautumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e7.09\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e4.85\u0026plusmn;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e3.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eSummer\u003cem\u003e\u0026nbsp;v.s.\u0026nbsp;\u003c/em\u003ewinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e7.09\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e5.09\u0026plusmn;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"top\"\u003e\n \u003cp\u003eAutumn \u003cem\u003ev.s.\u0026nbsp;\u003c/em\u003ewinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.556701030927837%\" valign=\"top\"\u003e\n \u003cp\u003e4.85\u0026plusmn;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e5.09\u0026plusmn;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e-0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAD: atopic dermatitis; *the difference is statistically significant.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"atopic dermatitis, birth season, seasonality, severity","lastPublishedDoi":"10.21203/rs.3.rs-4382810/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4382810/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSome patients with atopic dermatitis (AD) get worse in the summer and others in the winter. Birth season was suggested to be associated with the prevalence of AD in previous studies. This study aimed to explore the relationship between birth season and alterations in the severity of AD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a pilot prospective study of 50 patients from the outpatient unit of the department of dermatology at the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine in China with one year follow-up. The scoring atopic dermatitis (SCORAD) was employed to evaluate the severity of AD. The SCORAD score and itch score were recorded at each visit. Seasonal fluctuations in AD severity were analyzed classified by birth season, as well as other potential risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSummer was the most severe season for AD patients with summer births (with a SCORAD of 63.54\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13), compared to spring, autumn, or winter (SCORAD was 51.30\u0026thinsp;\u0026plusmn;\u0026thinsp;17.19, 43.72\u0026thinsp;\u0026plusmn;\u0026thinsp;13.44 and 47.04\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44, respectively) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Among individuals with summer birth, the itching score was highest in the summer (P\u0026thinsp;=\u0026thinsp;0.01), too. Besides, in newly onset AD, the severity of SCORAD worsened in the spring (P\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePatients with summer birth experienced the most severe AD in summer. Interventions on exacerbations at the earliest time of onset should be implemented in this population.\u003c/p\u003e","manuscriptTitle":"Seasonality in the severity of atopic dermatitis and birth season","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-29 01:56:32","doi":"10.21203/rs.3.rs-4382810/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"448bd764-f09f-4d0a-9f06-b71e055a338b","owner":[],"postedDate":"May 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-02T06:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-29 01:56:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4382810","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4382810","identity":"rs-4382810","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}