Dermatology disorders

Jacob P. Thyssen, MD, PhD, DmSci, on the Prevalence of Asthma in Patients With Atopic Dermatitis

It is well known that patients with atopic dermatitis (AD) have an increased risk of developing asthma, but the exact prevalence has not been studied. However, a recent systematic review and meta-analysis found that, on average, asthma presents in 25.7% of patients with AD.

“Since IL-4 receptor antagonistic drugs such as dupilumab and future IL-5 inhibitors seem to work in both AD and asthma, there is a need to explore the overlap of the 2 conditions and their severities to ultimately establish whether these medications should be used rather than medications with narrower effects,” said senior author of the review, Jacob P. Thyssen, MD PhD, DmSci, who is a doctor of Dermatology and Venereology at Bispebjerg Hospital in Copenhagen.

This association between AD and asthma can be due to similar genetic risk variants and environmental factors as well as a strong overlap in pathophysiology. An impaired skin barrier with filaggrin deficiency can allow the patients with AD to become sensitive to allergens through the skin, and then upon later airway exposure to allergens, asthma symptoms appear.

“The 2 conditions very commonly overlap and, maybe to a high degree, belong to the same disease spectrum of type 2 inflammatory diseases,” Dr Thyssen said.

The systematic review and meta-analysis included data from studies on the prevalence or association of asthma in patients with AD. Data from 218 studies were used in the qualitative analysis and data from 213 studies were used in the quantitative analysis. There were no limitations on age, study type, or year of publication in the studies included in the analysis.

“All sensitivity analyses we made showed that the prevalence of asthma was essentially similar. However, we do know from the SOLO 1 and 2 trials with dupilumab in AD that up to 50% of patients with AD and very severe disease may have asthma,” Dr Thyssen said.

According to the analysis in this review, the association between asthma and AD is 3, which is very strong.

“As clinicians, we should look for AD and asthma (as well as rhinitis and nasal polyps) in our patients,” Dr Thyssen said. Now we need to establish whether asthma is mild, moderate, or severe in patients with AD and which groups may have moderate to severe disease. This may inform us on who to treat for AD with, for example, dupilumab compared with other biologics or Janus-kinase inhibitors.”

—Jessica Bard

Reference:

Ravnborg N, Ambikaibalan D, Agnihotri G, et al. Prevalence of asthma in patients with atopic dermatitis: a systematic review and meta-analysis. J Am Acad Dermatol. 2021;84(2):471-478. https://doi.org/10.1016/j.jaad.2020.02.055