Age 3-7

The eczema which began in infancy sometimes disappears between 2 and 4 years of age, but often it recurs as the more chronic childhood stage of eczema. Dry skin is a constant feature, especially on the hands, worsening during the winter months. Flexural involvement becomes more marked. The face is less involved, except for the skin around the mouth and ears. Previously recognized allergens and new allergens can cause acute exacerbations. Factors such as tiredness, infection and heat or cold combine to lower the allergic threshold.

Atopic eczema, contact dermatitis and urticaria have different immunological mechanisms. Contact dermatitis and chronic urticaria are usually not IgE-mediated. They are caused by cold, heat or physical contact with irritants. Acute urticaria is most often due to infections, but sometimes IgE-mediated and then usually caused by foods or insect stings. The concomitant angioedema can be life-threatening if it occurs as laryngeal edema. Patients allergic to certain foods should avoid them totally. Those reacting strongly to insect stings should be considered for immunotherapy.

Age 7-15

If the atopic eczema has not healed earlier in childhood, numerous cases heal in puberty. However, some patients with atopic eczema do not develop their first lesions until late childhood, adolescence, or even adulthood.

At this age both acute and chronic urticaria may occur, but IgE-mediated reactions are uncommon.