We used the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 core symptom questionnaire to assess the prevalence and severity of AD since it is the most widely used epidemiologic measure of AD and contains a severity measure. ISAAC has been validated in 6–7 and 13–14 year-old children and has been used but not validated in children as young as 2 years [17]. Our methods of ISAAC administration and comparability to the U.K. Criteria [1820], an assessment tool that has been validated in infants [21,22] and young children [20], were reported previously [15]. AD was defined as an itchy rash at any time coming and going for at least 6 months, that had at any time affected the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears or eyes in the past 12 months. Severe AD was defined as being kept awake one or more nights per week on average by this itchy rash in the past 12 months. While previous surveys with ISAAC have not included infants, if the child was under the age of 6 months we considered any presence of rash as affirmative and determined a positive screen by an affirmative response to the question regarding the anatomical location of the rash.

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