Association of atopic dermatitis with allergic, autoimmune, and cardiovascular comorbidities in US adults

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Abstract

Background

Atopic dermatitis (AD) has been associated with multiple comorbid extracutaneous and systemic disorders. The relation between AD severity and disease comorbidities is complex and not fully understood.

Objective

To determine the complex relation between AD severity and comorbidities.

Methods

A cross-sectional US population-based study of 8,217 adults who were participants in a nationally representative internet health panel was performed using a structured questionnaire. A diagnosis of AD was determined using modified United Kingdom Working Party Criteria for AD (n = 602). AD severity was assessed using Patient-Oriented Scoring AD, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and self-reported global AD severity. Logistic regression and structural equation models were used to explore associations of AD with self-reported allergic, cardiometabolic, anxiety and depression, and autoimmune disease.

Results

In multivariable regression models controlling for sociodemographics, AD was associated with higher odds of asthma (adjusted odds ratio [OR] 2.09, 95% confidence interval [CI] 1.71–2.55), hay fever (OR 4.31, 95% CI 3.27–5.69), food allergy (OR 2.07, 95% CI 1.54–2.77), anxiety and depression (OR 2.34, 95% CI 1.91–2.87), autoimmune disease (OR 3.05, 95% CI 2.31–4.03), obesity (OR 1.37, 95% CI 1.13–1.67), diabetes (OR 1.52, 95% CI 1.16–1.99), high blood pressure (OR 1.46, 95% CI 1.18–1.80), and heart disease (OR 1.94, 95% CI 1.40–2.70) compared with controls (P < .01 for all). All these associations were significant in mild and/or moderate disease, with even stronger effects in severe AD. Results of structural equation models showed direct effects of moderate to severe AD on food allergy, anxiety and depression, and diabetes, direct and indirect effects on obesity, and indirect effects on high blood pressure and heart disease.

Conclusion

There is a strong relation of AD severity to allergic, autoimmune, and cardiovascular comorbidities.

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Disclosures: Dr Silverberg served as a consultant and/or advisory board member for and received honoraria from Abbvie, Asana, Eli Lilly, Galderma, GlaxoSmithKline, Glenmark, Kiniksa, Leo, Menlo, Pfizer, Regeneron-Sanofi, Realm, and Roivant; was a speaker for Regeneron-Sanofi; received research grants from GlaxoSmithKline and Regeneron-Sanofi; and is supported by the Dermatology Foundation. Dr Gelfand served as a consultant for and received honoraria from BMS, Boehringer Ingelheim, GSK, Janssen Biologics, Menlo Therapeutics, Novartis Corp, Regeneron, Dr Reddy's Labs, UCB (DSMB), Sanofi, and Pfizer Inc; receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis Corp, Sanofi, Celgene, Ortho Dermatologics, and Pfizer Inc; received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Ortho Dermatologics; is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma; is a Deputy Editor for the Journal of Investigative Dermatology and receives honoraria from the Society for Investigative Dermatology; and is supported by NIH/NIAMS K24-AR064310. Dr Chiesa Fuxench has served as a consultant for and received honoraria from the National Eczema Association and the Asthma and Allergy Foundation; receives or has received research grants (to the Trustees of the University of Pennsylvania) from Regeneron, Sanofi, Tioga, Vanda, and Realm Therapeutics for work in atopic dermatitis; and has received payment for continuing medical education work related to atopic dermatitis that was supported indirectly by Regeneron and/or Sanofi. Dr Margolis is the chair of the data monitoring committee for all Sunovion clinical trials of dupilamab and has received independent research funding to his institution from the National Institute of Health and Valeant. Dr Boguniewicz has received research funding from Anacor and Regeneron and consulted for Regeneron, Sanofi-Genzyme, and Pfizer. Dr Fonacier has served as a consultant for and received honoraria from Regeneron; is speaker for Regeneron; and received research and educational grants from Genentech, Baxter, and Pfizer. Dr Grayson is a board member of the AAFA and chair of the AAFA Medical Scientific Council. Dr Simpson has served as a consultant and/or advisory board member for Regeneron-Sanofi.

Funding Sources: The Atopic Dermatitis in America Study is an independent research project of the Asthma and Allergy Foundation of America in partnership with the National Eczema Association and is sponsored by Sanofi, Genzyme, and Regeneron.