Atopic Comorbidities Research Articles

Molecular mechanisms in atopic eczema: insights gained from genetic studies.

Atopic eczema (synonymous with atopic dermatitis) is a common heterogeneous phenotype with a wide spectrum of severity, from mild transient disease to a severe chronic disorder with atopic and non-atopic comorbidities. Eczema is a complex trait, resulting from the interaction of multiple genetic and environmental factors. The skin, as an organ that can be biopsied easily, provides opportunities for detailed molecular genetic analysis. Strategies applied to the investigation of atopic eczema include candidate gene and genome-wide studies, extreme phenotypes, and comparative analysis of inflammatory skin diseases. Genetic studies have identified a central role for skin barrier impairment in eczema predisposition and perpetuation; this has brought about a paradigm shift in understanding atopic disease, but specific molecular targets to improve skin barrier function remain elusive. The role of Th2-mediated immune dysfunction is also central to atopic inflammation, and has proved to be a powerful target for biological therapy in atopic eczema. Advances in understanding eczema pathogenesis have provided opportunities for patient stratification, primary prevention, and therapy development, but there remain considerable challenges in the application of this knowledge to optimize benefit for patients with atopic eczema in the era of personalized medicine. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder

Atopic dermatitis comorbidities extend well beyond the march to allergic conditions (food allergy, asthma, allergic rhinitis, allergic conjunctivitis, and eosinophilic esophagitis), suggesting both cutaneous and systemic immune activation. In reviewing atopic dermatitis comorbidities, Councilors of the International Eczema Council found a strong pattern of immune activation in peripheral blood and the propensity to both skin and systemic infections. Associations with cardiovascular, neuropsychiatric, and malignant diseases were increasingly reported, but confirmation of their link with atopic dermatitis requires longitudinal studies. Given the possibility of atopic dermatitis-related systemic immune activation, future investigations of new interventions should concurrently examine the impact on these comorbidities.

Anxiety and Atopic Disease: Comorbidity in a Youth Mental Health Setting.

Anxiety frequently co-occurs with atopic diseases (e.g., allergies) in community samples, although data are limited to community and pediatric medical samples. Little work has examined atopy rates among mental health treatment seeking youth or whether youth with comorbid anxiety and atopy present similarly to non-comorbid youth. Using initial intake data from a University-based specialty youth clinic for anxiety and depressive disorders (n=189), rates of atopic comorbidity were benchmarked against lifetime prevalence estimates in epidemiological samples. Anxiety severity and parental stress were compared between youth with and without atopy. Results indicated high rates of atopy in the clinical sample (51.3%) relative to population atopy estimates (34.5%). Anxious youth with atopy exhibited more overall and generalized anxiety symptoms relative to non-atopic youth (ps<.05); parental stress was comparable between atopic and non-atopic anxious youth. This suggests potentially heightened clinical severity for youth with co-occurring anxiety and atopy.

Atopic dermatitis is not independently associated with nonfatal myocardial infarction or stroke among US women.

We aimed to determine the association between atopic dermatitis (AD) and cardiovascular events in the Nurses' Health Study 2, a cohort of US women. We used logistic regression models to calculate age- and multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between history of AD and nonfatal MI and nonfatal stroke. Of the 78 702 participants in our analysis, 7916 (10%) had a history of AD. There were 392 and 391 cases of nonfatal MI and stroke, respectively. AD was not associated with MI in age- or multivariate-adjusted analyses. AD was significantly associated with stroke in the age-adjusted analysis (OR 1.38, 95% CI 1.03-1.85). This was no longer significant in multivariate models that adjusted for hypertension, hypercholesterolemia and diabetes (OR 1.31, 95% CI 0.98-1.76) and atopic comorbidities (OR 1.17, 95% CI 0.86-1.58). AD was not independently associated with nonfatal MI or stroke in this study.

Study of the Atopic March: Development of Atopic Comorbidities.

Atopic dermatitis (AD) is often the first step in the atopic march leading to the development of asthma or allergic rhinitis. The goal of this study was to determine whether early intervention with pimecrolimus limits the atopic march in infants with AD and to evaluate its efficacy and safety. This was a 3-year double-blind study in which patients were randomized to pimecrolimus or vehicle and then open-label pimecrolimus for a planned further 3 years. Rescue topical corticosteroid was permitted if 3 days of study medication led to no improvement; investigators made decisions on rescue medication until week 14 and caregivers thereafter. Efficacy assessments included disease-free days, Eczema Area and Severity Index, and body surface area affected. Infants ages 3 to 18 months with recent-onset AD (≤3 months) were observed for a mean of 2.8 years (N = 1,091). No significant differences between pimecrolimus- and placebo-treated groups were found in the percentage of patients with AD who developed asthma (10.7%) or other allergic conditions (allergic rhinitis, 22.4%; food allergy, 15.9%; allergic conjunctivitis, 14.1%; one or more atopic comorbidities, 37.0%) by study end. Allergic rhinitis, food allergy, and having one or more atopic comorbidities (but not asthma or allergic conjunctivitis alone) developed significantly more often in infants with greater AD severity at baseline. Pimecrolimus was significantly more effective than vehicle for AD treatment at week 14. Adverse event incidences were similar. This longitudinal observation of infants with AD provides evidence of the atopic march. Pimecrolimus was safe and effective in infants with mild to moderate AD.

TSLP, IL-31, IL-33 and sST2 are new biomarkers in endophenotypic profiling of adult and childhood atopic dermatitis.

Recent years have seen growing interest in identifying new biomarkers in atopic dermatitis (AD) that could serve as indicators of disease severity and predictors of treatment response. We compared serum levels of thymic stromal lymphopoietin (TSLP), interleukin(IL)-31, IL-33 and soluble(s)ST2 in AD patients and healthy controls, investigated the possible correlation with disease severity, investigated if other atopic comorbidities could play a role, and assessed their potential as biomarkers in AD. Using standard enzyme-linked immunosorbent assay techniques, we measured target serum levels in 71 adults and 61 children with AD, and 31 adult controls. We characterized our cohort by disease severity, radioallergosorbent test status concerning both dietary and inhalant allergens, and anamnestic reports of food allergy, concomitant allergic asthma and/or allergic rhinitis. Serum levels of TSLP, IL-31 and IL-33, but not sST2, were significantly elevated in AD patients compared with controls. In AD patients, both IL-31 and IL-33 serum levels were higher in children than in adults, while the opposite was the case for sST2. We observed no correlation between disease severity and any of the investigated targets. While serum TSLP levels were unaffected by concomitant allergies and atopic comorbidities, serum levels of IL-31, IL-33 and sST2 were affected to a small extent. We found a positive correlation between TSLP, IL-31 and IL-33, and an inverse relationship between IL-33 and sST2. The studied targets hold little potential as indicators of disease severity. The serum values of our targets show robustness against atopic comorbidities, allergies and changes in disease severity. This robustness strengthens their potential use in biomarker-based stratification and could be instrumental in identifying subgroups and predicting the possible benefit of therapeutic and prevention approaches.

Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database.

Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the United States. We used the IMS Health LifeLink PharMetrics Plus Claims Database, data representative of a US national commercially insured population containing medical and pharmaceutical claims for > 75 million individuals. We restricted our sample to patients ages 0 to 64 with continuous enrollment between July 1, 2009, and June 30, 2011. We identified patients with eosinophilic gastritis, gastroenteritis, and colitis as defined by ≥ 1 instance of the International Classification of Diseases, Ninth Revision codes 535.70, 558.41, and 558.42, respectively. We calculated the prevalence of the codes in the database and then standardized the estimates to the US population by age and sex. The standardized estimated prevalences of eosinophilic gastritis, gastroenteritis, and colitis were 6.3/100,000, 8.4/100,000, and 3.3/100,000, respectively. The prevalence of eosinophilic gastroenteritis was the highest among children age < 5 years, whereas eosinophilic gastritis was more prevalent among older age groups. We observed no age differences for eosinophilic colitis. Among affected patients, there was a high proportion of coexisting allergic conditions, 38.5% for eosinophilic gastritis, 45.6% for gastroenteritis, and 41.8% for colitis. Concomitant allergic disease was most commonly identified in pediatric patients. The prevalence of non-EoE EGIDs remains rare in the United States, with < 50,000 total patients affected. There appears to be a female predominance and a high co-occurrence of atopic comorbidities.

Atopic Diseases and Subsequent Ischemic Stroke Among Patients With Schizophrenia: A Nationwide Longitudinal Study.

Chronic inflammation plays an important role in schizophrenia and atopic diseases, and studies have suggested that chronic inflammation is associated with an increased risk of stroke. The role of atopic diseases in the development of stroke among patients with schizophrenia is still unknown. A total of 63,913 patients with schizophrenia without a stroke history between 2002 and 2008 and 63,913 age- and sex-matched controls were included and followed up to the end of 2011. Patients with schizophrenia and the reference group were divided into subgroups based on the presence or absence of atopic diseases. Individuals who developed stroke during follow-up were identified. Patients with schizophrenia had an increased risk of developing ischemic stroke (no atopic disease: hazard ratio [HR] = 2.18, 95% confidence interval [CI] = 1.88-2.53; with atopic disease: HR = 3.11, 95% CI = 2.63-3.69) compared with the reference group without atopic diseases. Among patients with schizophrenia, the presence of atopic diseases increased the risk of developing ischemic stroke (HR = 1.44, 95% CI = 1.24-1.66), with a cumulative relationship between greater numbers of atopic comorbidities and a greater risk of ischemic stroke (one atopic disease: HR = 1.39, 95% CI = 1.19-1.63; two atopic comorbidities: HR = 1.48, 95% CI = 1.10-2.00; at least 3 atopic comorbidities: HR = 2.81, 95% CI = 1.55-5.12). The combined presence of schizophrenia and atopic diseases is associated with an increased risk of ischemic stroke in later life compared with individuals without these conditions.

Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: A nationwide longitudinal study

BackgroundPrevious cross-sectional studies have suggested a comorbid association between atopic dermatitis (AD) and depressive disorder as well as anxiety disorders, but the temporal relationship was not determined. MethodsUsing the Taiwan National Health Insurance Research Database, 8208 AD patients aged 12 and older without psychiatric history and age-/sex-matched (1:1) controls between 1998 and 2008 were enrolled in our study and followed to the end of 2011. Subjects who developed major depression, any depressive disorder, and anxiety disorders during the follow-up were identified. ResultsThe Cox regression analysis after adjusting for demographic data and atopic comorbidities demonstrated that patients with AD had an elevated risk of developing major depression (hazard ratio [HR]: 6.56, 95% confidence interval [CI]: 3.64–11.84), any depressive disorder (HR: 5.44, 95% CI: 3.99–7.44), and anxiety disorders (HR: 3.57, 95% CI: 2.55–4.98). Stratified by age group, both adolescents and adults with AD were prone to developing major depression (HR: 4.26, 95% CI: 1.39–13.13; HR: 7.56, 95% CI: 3.75–15.23), any depressive disorder (HR: 4.38, 95% CI: 2.09–9.18; HR: 5.66, 95% CI: 4.01–7.99), and anxiety disorders (HR: 5.40, 95% CI: 2.02–14.39; HR: 3.36, 95% CI: 2.38–4.80). ConclusionsAD in both adolescence and adulthood increased the risk of developing major depression, any depressive disorder, and anxiety disorders in later life. Further studies would be required to clarify the possible underlying mechanism between AD and depression as well as anxiety disorders.

Rhinitis in the first 18 months of life: exploring the role of respiratory viruses.

BackgroundRhinitis is common in early childhood, but allergic rhinitis is considered a later manifestation of the atopic march. This study aimed to evaluate rhinitis (allergic and non‐allergic) in the first 18 months of life, its link with other atopic manifestations and the role of respiratory viruses.MethodsSubjects (n = 1237) of the Singapore GUSTO birth cohort were followed up quarterly until 18 months of age with questionnaires to screen for rhinitis symptoms lasting at least 2 wk and with monthly calls to positive subjects to detect prolonged/recurrent rhinitis symptoms (total duration ≥4 wk). Anterior nasal swabbing for molecular‐based virus detection was conducted during these visits and near (within a month) rhinitis episodes. Skin prick testing to common environmental and food allergens was conducted at the 18 month visit.ResultsProlonged/recurrent rhinitis was significantly associated with history of parental atopy (mother: aOR = 2.17; father: aOR = 1.82) and atopic comorbidities of eczema (aOR = 2.53) and wheeze (aOR = 4.63) (p < 0.05), though not with allergen sensitization. Although the frequency of nasal respiratory virus detection during scheduled quarterly visits did not differ between prolonged/recurrent rhinitis and matched controls (p > 0.05), virus detection was higher in swabs obtained within a month following rhinitis episodes in prolonged/recurrent rhinitis subjects compared with scheduled visits (adjusted p = 0.04).ConclusionsBased on the duration of rhinitis symptoms, this study defined a subset of early childhood rhinitis which was associated with atopic predisposition and comorbidities. Persistent respiratory viral shedding may contribute to the symptomatology. Whether this entity is a precursor of subsequent childhood allergic rhinitis will require longer follow‐up.

Impact of comorbidities on the treatment of atopic dermatitis in clinical practice.

Atopic dermatitis is often associated with atopic comorbidities such as allergic rhinitis, allergic asthma and food allergy. The aim of the present study was to analyze treatment data pertaining to atopic dermatitis patients in Germany with regard to the presence of other atopic comorbidities in the primary care and to investigate whether the presence of atopic codiagnoses has an impact on the treatment of atopic dermatitis (AD) patients. We used data from the Disease Analyzer database (IMS HEALTH, Germany) including 1,631 physicians (general practitioners, dermatologists and pediatricians) and 3.3 million patients. 39,642 (7.5%) of these patients were treated by dermatologists, 17,124 (5.2%) by pediatricians and 15,774 (0.9%) by general practitioners and had a documented diagnosis of atopic dermatitis. 46.4% of AD patients treated by general practitioners, 42.5% by dermatologists and 32.0% by pediatricians were codiagnosed with one defined atopic diseases (allergic asthma, urticaria, allergic rhinitis and food allergy). In patients without AD, the proportion of atopic diseases was significantly smaller (41.4% for those treated by general practitioners, 38.4% for those treated by dermatologists, 26.4% for those treated by pediatricians). AD patients with another atopic comorbidity received topical corticosteroids (CS) (42.5%) more frequently than those without comorbidity (46.4% vs. 41.4% for patients treated by general practitioners, 42.5% vs. 38.4% for patients treated by dermatologists, 32.0% vs. 26.4% for patients treated by pediatricians). The general practitioners and pediatricians prescribed systemic corticosteroids to 13.2% and 7.8% of AD patients with additional atopic diseases, while the rate was only 5.1% and 3.0% in patients without comorbidities. In AD patients, the share of patients diagnosed with atopic diseases is significantly higher than in patients without AD. AD outpatients with concomitant atopic comorbidities receive topical, but also systemic corticosteroid prescriptions more frequently.

A predisposition for allergies predicts subsequent hypertension, dyslipidemia, and diabetes mellitus among patients with schizophrenia or bipolar disorder: A nationwide longitudinal study

BackgroundPrevious studies have shown that both severe mental disorders (schizophrenia and bipolar disorder) and atopic diseases were associated with an increased risk of metabolic syndrome. However, the role of atopy/the predisposition for allergies in the development of metabolic syndrome is still unknown among those with severe mental disorders. MethodsUsing the Taiwan National Health Insurance Research Database, 5826 patients with schizophrenia or bipolar disorder (1908 with a predisposition for allergies and 3918 without) were enrolled between 1998 and 2008. Those who developed hypertension, dyslipidemia, and/or diabetes mellitus were identified during the follow-up to the end of 2011. ResultsA predisposition for allergies increased the risk of developing hypertension (HR: 1.67), dyslipidemia (HR: 1.82), and diabetes mellitus (HR: 1.37) in later life among those with severe mental disorders. A dose-dependent relationship was noted between having more atopic comorbidities and a greater likelihood of hypertension (1 atopic disease: HR: 1.60; ≧2 atopic comorbidities: HR: 1.87), dyslipidemia (HR: 1.73; HR: 2.12), and diabetes mellitus (HR: 1.26; HR: 1.69). ConclusionA predisposition for allergies was an independent risk factor for hypertension, dyslipidemia, and diabetes mellitus among patients with schizophrenia or bipolar disorder. Further studies would be required to elucidate the underlying pathophysiology among atopy, schizophrenia, bipolar disorder, and metabolic syndrome.

Extraintestinal Manifestations in Children With Gastrointestinal Food Allergy

The presence of extraintestinal manifestations (EIM) in children with gastrointestinal (GI) food allergy (GIFA) is greatly debated. In the present study we assessed the prevalence of EIM in children with GIFA and investigated whether their presence is helpful in the allergy-focused history-taking process. The medical records of all children with a proven diagnosis of GIFA were reviewed along with those of children diagnosed as having inflammatory bowel disease (IBD) as controls. Data regarding age at onset, age at diagnosis, atopic family history, atopic comorbidities, GI symptoms, and EIM were recorded. Data from 436 children with GIFA and 74 children with IBD were included in the analysis. EIM were documented in 368 children with GIFA, including fatigue (53.0%), allergic shiners (49.1%), mouth ulcers (39.0%), joint pain/hypermobility (35.8%), poor sleep (34.4%), night sweats (34.4%), headache (22.7%), and bed-wetting (17.7%). The proportion of patients with EIM was higher in the GIFA group compared with that in the IBD group (368/436 [84.4%] vs 40/74 [54.1%]; P < 0.001). Segregating the GIFA group into children with and without atopic comorbidities, both atopic (276/30; 89.9%) and nonatopic (93/130; 71.5%) children showed higher proportion of EIM than children with IBD ([40/74; 54.1%], P < 0.01 and <0.05, respectively). GIFA are commonly associated with a wide range of EIM, which appear to represent important and specific clinical features of this group of conditions. Their recognition in taking an allergy-focused history may play an important role for both diagnosis and management.

2014 update on atopic dermatitis in children.

The prevalence of pediatric atopic dermatitis (AD) has increased throughout the world, now ranging from 10 to 20% in developed countries. Pediatric patients with AD make up a substantial proportion of patients seen by general pediatricians, allergists, dermatologists, and other specialists. As such, there is a need to optimize understanding and management of AD. The traditional atopic comorbidities of AD have now expanded to include associations with nonatopic conditions such as attention deficit hyperactivity disorder. Furthermore, with insights from basic, translational, and clinical research, experts have a more comprehensive knowledge of the genetic, immunological, and environmental factors influencing the development of AD. With this new perception, innovative approaches to the management of AD have developed with an emphasis on preventive rather than reactive care. The role of biological agents in the treatment of this common, yet chronic, disease of the skin has not been clearly elucidated. There have been several recent breakthroughs in the diagnosis, pathophysiology, and management of AD. Despite these advances, much work is still needed in order to ensure optimal care for AD sufferers.

Is atopy in early childhood a risk factor for ADHD and ASD? A longitudinal study

ObjectivePrevious studies have found a temporal concordance in the increased prevalence of atopic diathesis/atopic diseases, attention-deficit hyperactivity disorder (ADHD), and autistic spectrum disorder (ASD) worldwide. But, the temporal association among these 3 distinct diseases is unknown. Method14,812 atopic subjects diagnosed with any atopic disease (asthma, atopic dermatitis, allergic rhinitis, or allergic conjunctivitis) before the age of 3 (atopic cohort) and 6944 non-atopic subjects with no lifetime atopic disease (non-atopic cohort), born between 1997 and 2000, were enrolled and followed to December 31, 2010 to identify the development of ADHD and ASD. ResultsThe presence of any atopic disease in early childhood increased the risk of developing ADHD (hazard ratio [HR]: 1.97) and ASD (HR: 3.40) in later life. Greater numbers of atopic comorbidities (4 comorbidities: ADHD: HR: 2.53; ASD: HR: 4.29) were significantly related to a greater risk of developing ADHD and ASD. DiscussionAtopic diathesis in early childhood elevated the risk of developing ADHD and ASD in later life, with the dose-dependent relationship of more atopic comorbidities with a greater likelihood of ADHD and ASD.

Lymphocytic Esophagitis Presenting as Severe Dysphagia

Purpose: A 35-year-old African-American male with a history of childhood asthma, eczema, and food, drug and seasonal allergies presented with dysphagia. His symptoms began at age 7 years when he presented with regurgitation and dysphagia. There was no toxic ingestion. He was treated with antacids and H2 blockers. Symptoms were troublesome for years but resolved by age 10 years. He presented again at age 27 years with inability to tolerate solid foods. Upper endoscopy (EGD) at his local hospital was reportedly normal. He underwent manometry and was reportedly diagnosed with achalasia. A surgical myotomy was performed with only minimal improvement in symptoms. The patient presented to our institution with progressive severe solid dysphagia and weight loss. He denied odynophagia, fever, or night sweats. Physical exam: thin male, no oral lesions or lymphadenopathy. Labs: normal hemoglobin, electrolytes, and serum albumin. HIV negative. Barium esophagram: dilated esophagus with severe esophageal dysmotility. Repeat EGD: severely fibrotic and nodular mucosa. Biopsies caused linear tears and bleeding, requiring endoscopic clipping. Pathology showed active esophagitis and an inflammatory infiltrate composed of lymphocytes with admixed neutrophils and eosinophils. Based on the patient's history and pathologic findings, a clinical diagnosis of severe longstanding lymphocytic esophagitis (LE) or eosinophilic esophagitis (EoE) was made. A trial of high-dose PPI and topical budesonide was unsuccessful. Given the severity of the endoscopic findings and lack of response to medical therapy, the patient underwent an esophagectomy. Post-operatively he is able to tolerate a solid diet without recurrent dysphagia. Lymphocytic esophagitis is a poorly-understood entity. The primary symptom is dysphagia, though symptoms can include chest pain, abdominal pain, and heartburn. A wide range of ages at diagnosis has been reported. Patients often have GERD and atopic comorbidities. Endoscopic findings include rings, esophagitis, strictures, furrows, and nodularity. Biopsies are required for diagnosis and show a high number of intraepithelial lymphocytes but no more than rare neutrophils and eosinophils. Appropriate treatment for LE has not yet been defined, though prognosis appears to be good. This patient's pathology does not meet strict histologic criteria for LE. This may reflect a diagnosis of EoE, an overlap syndrome, or LE with post-surgical changes. LE should be considered in the differential diagnosis of dysphagia and more research is needed on the diagnosis, management, and natural history of this disorder.

Etoricoxib: a safe alternative for NSAID intolerance in Asian patients

NSAID intolerance is not uncommon. Etoricoxib, a cox-2 inhibitor NSAID, has been shown to be a safe alternative in these patients. This study aims to determine the rate of NSAID intolerant patients who are able to tolerate etoricoxib without adverse reactions. This study analyzed charts and electronic databases of all patients referred to the allergy clinics of the National University Hospital and Gleneagles Hospital in Singapore from 2006-2011 for oral provocation tests to etoricoxib (cumulative dose of 120 mg), on the background of NSAID intolerance. Demographics, atopic comorbidities, history of chronic urticaria, inciting NSAID, onset and type of reaction, and provocation test outcomes were obtained. A total of 74 patients (mean age 37; range: 16-72 years) underwent provocation tests to etoricoxib. Of these, 59% were female. Majority were Chinese (69%), followed by Malay (12%), Caucasian (8%), Indian (5%) and various other races (6%). Forty-six percent of the study population had atopic comorbidities, and 4% had concomitant chronic urticaria. Eighty percent of patients had a history of intolerance to 1 NSAID, while the rest (20%) had intolerance to multiple NSAIDS. Forty-one percent of patients had concomitant acetaminophen intolerance. Some of the patients had multiple symptoms on presentation, the most common of which were periorbital and facial edema (90%), breathing difficulties (26%) and urticaria (25%), with the onset of reaction occurring mostly within 30 minutes to 1 hour. Etoricoxib was tolerated in 95% of the patients. Subjects who reacted to the challenge all had mild reactions which resolved with antihistamines. Etoricoxib is a safe alternative in NSAID intolerant patients. Nevertheless, it is advised that patients should undergo provocation tests to confirm tolerance.

Evaluation of the adult patient with atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a large impact on quality of life of the patients and their families. In most cases, the diagnosis of AD can easily be made based on (family) history and clinical examination. If necessary, a practical set of diagnostic criteria such as the UK diagnostic criteria can be used. During the diagnostic phase, it is important to pay attention to atopic comorbidity, such as allergic airway disease (allergic asthma and/or rhinitis), allergic eye disease (atopic (kerato) conjunctivitis) and immediate-type food allergy. This will not have direct consequences for the treatment of AD, but may be important for the overall well-being of the patient. Psychological factors, such as family circumstances, work/school performance and lifestyle factors should also be explored. Severity scoring using properly validated scoring lists may not be necessary for the diagnosis, however, is recommended for monitoring therapy. Simple scoring systems, such as TIS and IGA are easy to perform in daily practice. Several flare factors in AD, such as exposure to irritants or UV light, can be identified by history and clinical examination: in individual cases, additional diagnostic tests may sometimes be useful to confirm clinical suspicion. There is only limited evidence that allergen exposure to aeroallergens and/or food allergens influences AD severity. Therefore, routine allergen testing is not necessary for diagnosis and treatment of AD. The decision to perform allergen tests mainly depends on atopic comorbidity.

Self-reported Lifetime Prevalence of Atopic Dermatitis and Co-morbidity with Asthma and Eczema in Adulthood: A Population-based Cross-sectional Survey

Atopic dermatitis and its co-morbidity with asthma and allergy is well described in younger age groups. However, population-based studies on adults with atopic dermatitis in childhood are sparse. The aims of this study were to determine: (i) the prevalence of self-reported childhood atopic dermatitis in the population; and (ii) its association with present self-reported hand eczema, eczema, allergy, urticaria and asthma. A questionnaire was sent to a cross-sectional random sample of the Swedish population (n=7,985), age range 18-84 years (response rate 61.1%). The questionnaire included the question "Have you had childhood eczema?" and questions on 5 other medical problems (hand eczema, other eczema, asthma, urticaria and allergy). Persons reporting eczema in childhood reported increased odds ratios (OR) for hand eczema (4.01), other eczema (3.88), urticaria (2.50), allergy (2.98), and asthma (2.06) as adults. The combination of eczema, allergy and asthma had an OR of 14.10 (95% confidence interval 8.44-23.54). Adults in the age range 18-84 years reporting childhood atopic dermatitis still have high co-morbidity with eczema, asthma, urticaria and allergy.

Current Issues in Atopic Comorbidities and Preventing the Atopic March

The individual, family, and public health burden of atopic dermatitis (AD) is considerable. The prevalence of AD is high, the signs and symptoms of the disease adversely affect quality of life for patients and their families, and the comorbid conditions associated with AD can increase considerably the negative impact of the disease. These comorbid conditions patients with AD are susceptible to include skin infectious, IgE-mediated diseases, and mental health disorders. New research identifies the skin barrier as not only an important initiator of atopic dermatitis but may even be a site for allergic sensitization to protein antigens. The skin barrier represents a potential new target for novel atopic prevention strategies.