TY - JOUR
T1 - Phenotypic and Endotypic Determinants of Atopic Dermatitis Severity From the Atopic Dermatitis Research Network (ADRN) Registry
AU - Simpson, Eric L.
AU - De Benedetto, Anna
AU - Boguniewicz, Mark
AU - Ong, Peck Y.
AU - Lussier, Stephanie
AU - Villarreal, Miguel
AU - Schneider, Lynda C.
AU - Paller, Amy S.
AU - Guttman-Yassky, Emma
AU - Hanifin, Jon M.
AU - Spergel, Jonathan M.
AU - Barnes, Kathleen C.
AU - David, Gloria
AU - Austin, Briahnna
AU - Leung, Donald Y.M.
AU - Beck, Lisa A.
N1 - Publisher Copyright:
© 2023 American Academy of Allergy, Asthma & Immunology
PY - 2023/8
Y1 - 2023/8
N2 - Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition with a highly variable clinical phenotype. Objective: This study aimed to identify historical and clinical features and biomarkers associated with AD severity. Methods: A US registry of extensively phenotyped AD participants (aged 0.73-80 years) were enrolled at 9 academic centers. Information on family and personal medical history, examination, skin swabs (culture), and serum biomarkers was collected to evaluate their association with AD severity. Results: Participants with AD (N = 2862) whose disease was categorized as mild (11.6%), moderate (58.0%), or severe (30.4%) based on Rajka-Langeland scoring were enrolled. The trend test, when adjusting for gender, race, and age, demonstrated that severity was strongly (P ≤ .04) associated with a personal/family history of allergic disorders, history of alopecia, exposure to passive smoke, ocular herpes infection, skin bacterial and viral infections, and history of arrhythmia. Features observed more frequently (P ≤ .002), as a function of severity, included skin infections (impetigo, human papillomavirus, and molluscum contagiosum virus), Staphylococcus aureus colonization, excoriations, hyperlinear palms, ichthyosis, blepharitis, conjunctivitis, ectropion, and wheezing. Serum IgE, allergen and food (≤6 years) Phadiatop, and eosinophilia were strongly linked to severity (P < .001). Conclusions: In a diverse US AD population, severity was associated with a history of atopic disorders, skin and extracutaneous bacterial and viral infections (by history and physical examination), higher IgE, eosinophilia and allergen sensitization, atopic skin manifestations (ie, excoriation, hyperlinear palms, and ichthyosis), and atopic ocular features (ie, blepharitis, conjunctivitis, and ectropion) as well as asthma findings (ie, wheezing). Data from our prospective registry significantly advance our understanding of AD phenotypes and endotypes, which is critical to achieve optimal management.
AB - Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition with a highly variable clinical phenotype. Objective: This study aimed to identify historical and clinical features and biomarkers associated with AD severity. Methods: A US registry of extensively phenotyped AD participants (aged 0.73-80 years) were enrolled at 9 academic centers. Information on family and personal medical history, examination, skin swabs (culture), and serum biomarkers was collected to evaluate their association with AD severity. Results: Participants with AD (N = 2862) whose disease was categorized as mild (11.6%), moderate (58.0%), or severe (30.4%) based on Rajka-Langeland scoring were enrolled. The trend test, when adjusting for gender, race, and age, demonstrated that severity was strongly (P ≤ .04) associated with a personal/family history of allergic disorders, history of alopecia, exposure to passive smoke, ocular herpes infection, skin bacterial and viral infections, and history of arrhythmia. Features observed more frequently (P ≤ .002), as a function of severity, included skin infections (impetigo, human papillomavirus, and molluscum contagiosum virus), Staphylococcus aureus colonization, excoriations, hyperlinear palms, ichthyosis, blepharitis, conjunctivitis, ectropion, and wheezing. Serum IgE, allergen and food (≤6 years) Phadiatop, and eosinophilia were strongly linked to severity (P < .001). Conclusions: In a diverse US AD population, severity was associated with a history of atopic disorders, skin and extracutaneous bacterial and viral infections (by history and physical examination), higher IgE, eosinophilia and allergen sensitization, atopic skin manifestations (ie, excoriation, hyperlinear palms, and ichthyosis), and atopic ocular features (ie, blepharitis, conjunctivitis, and ectropion) as well as asthma findings (ie, wheezing). Data from our prospective registry significantly advance our understanding of AD phenotypes and endotypes, which is critical to achieve optimal management.
KW - Allergen sensitization
KW - Atopic dermatitis
KW - Biomarkers
KW - Comorbidity
KW - Disease severity
KW - Endotype
KW - Infection
KW - Rajka-Langeland score
KW - Registry
KW - Staphylococcus aureus
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U2 - 10.1016/j.jaip.2023.04.052
DO - 10.1016/j.jaip.2023.04.052
M3 - Article
C2 - 37182563
AN - SCOPUS:85163701804
SN - 2213-2198
VL - 11
SP - 2504
EP - 2515
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 8
ER -