Multidisciplinary Approach Identifies Allergic, Immunology Burden in Severe AD

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

A multidisciplinary evaluative approach between allergy, immunology, and dermatology specialists was shown to identify additional comorbid conditions among patients with severe atopic dermatitis (AD). Findings were reported at the 2022 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting 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 relapsing inflammatory skin disease that is commonly associated with other atopic manifestations such as food allergy, allergic rhinitis, and asthma.

Prior research has also shown increased risk of autoimmune, systemic, and psychiatric conditions among those with AD, in which even those with mild disease have been found to have at least 1 inflammatory or atopic comorbidity.

In considering AD as a potential harbinger of severe allergic or immunologic disease, researchers sought to further characterize the comorbidity burden of patients. They examined the effectiveness of a shared evaluative approach between allergy, immunology, and dermatology specialists of their center’s Multidisciplinary Integrated Clinic (MDIC), with a focus on the most severely affected patient population.

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

“Variables of particular interest included demographics, presence of other atopy, infections and immunologic evaluation for primary immunodeficiency (PID),” they added.

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

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

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

“The MCID model of evaluating AD patients has successfully identified patients with additional contact dermatitis, atopy, or immune dysfunction contributing to severe AD,” concluded the study authors. “Awareness of these other conditions can lead to improved 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 evaluate patients with severe atopic dermatitis. J Allergy Clin Immunol. Published online February 1, 2022. doi:10.1016/j.jaci.2021.12.070