A multidisciplinary approach identifies the allergic and immunological burden in severe AD

Patients with severe atopic dermatitis showed significant associations with concurrent contact dermatitis and immune dysfunction after undergoing multidisciplinary evaluation between allergy, immunology, and dermatology specialists.

A multidisciplinary evaluative approach between allergy, immunology and dermatology specialists has identified additional comorbid conditions in patients with severe atopic dermatitis (AD). The findings were reported at the 2022 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) and are published in The Journal of Allergy and Clinical Immunology.

As the most common skin condition in children, affecting 10% to 20% of pediatric populations, AD has been characterized as a multifaceted chronic recurrent inflammatory skin disease that is commonly associated with other atopic manifestations such as food allergies, allergic rhinitis and asthma. .

Previous research has also shown an increased risk of autoimmune, systemic, and psychiatric diseases in people with Alzheimer’s disease, in which even people with mild disease have at least one inflammatory or atopic comorbidity.

By considering Alzheimer’s disease as a potential harbinger of a severe allergic or immunological disease, researchers sought to better characterize the comorbidity burden of patients. They examined the effectiveness of a shared evaluative approach between allergy, immunology and dermatology specialists in their center’s multidisciplinary integrated clinic (MDIC), with a focus on the patient population most seriously affected.

For the study, the electronic medical records of 198 patients assessed between June 2015 and December 2020 in the MDIC were retrospectively assessed. A consistent immunologic assessment was initiated in August 2019, in which patients were characterized as severe if treated with systemic therapies (methotrexate, dupilumab, or cyclosporine), medium to high potency steroids, or chronic topical calcineurin.

“Variables of particular interest included demographics, presence of other atopies, infections, and immunological assessment of primary immunodeficiency (PID),” they added.

Of the study cohort, 52 (26%) had severe AD. The median age of onset for this population was 1 year, and the majority were male (n=28) and Caucasian (n=19).

Regarding the comorbidity burden in patients with severe disease, the MDIC identified concurrent contact dermatitis in 90% of patients; food allergies (n = 46) were more common than environmental allergies (n = 23).

In addition, 65% required systemic treatment and 34 patients underwent primary immunodeficiency evaluation, including lymphocyte phenotyping and humoral function assessment, which led to genetic evaluation for PID in one patient.

“The MCID model for assessing patients with AD successfully identified patients with additional contact dermatitis, atopy, or immune dysfunction contributing to severe AD,” the study authors concluded. “Awareness of these other conditions can lead to better personalization of therapy.”

Reference

Rowe S, Alfaro MK, Brown-Whitehorn T, Spergel J, Treat J, Heimall J. A multidisciplinary approach between allergy, immunology and dermatology to assess patients with severe atopic dermatitis. J Allergy Clin Immunol. Published online February 1, 2022. doi:10.1016/j.jaci.2021.12.070

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