Respiratory symptoms, bronchial hyper-responsiveness, and eosinophilic airway inflammation in patients with moderate-to-severe atopic dermatitis.
BACKGROUND
Patients with atopic dermatitis (AD) often have symptoms suggestive of asthma or rhinitis. The prevalence and signs of respiratory disease in AD patients have been studied to a limited extent.


OBJECTIVE
To assess the prevalence and clustering of respiratory symptoms, bronchial hyper-responsiveness (BHR), and eosinophilic airway inflammation in patients with moderate-to-severe AD.


METHODS
Eighty-six consecutive patients with moderate-to-severe AD and 49 randomly selected control subjects without AD were studied by questionnaire, flow volume spirometry, histamine challenge to detect BHR, induced sputum test to detect eosinophilic airway inflammation, and skin prick tests (SPTs) and total serum immunoglobulin (Ig)E measurements to detect atopy.


RESULTS
The patients with AD showed increased risk of physician-diagnosed asthma (36% vs. 2%, odds ratio (OR) 10.1, confidence interval (CI) 1.3-79.7, P=0.03), physician-diagnosed allergic rhinitis (AR) (45% vs. 6%, OR 4.5, CI 1.2-16.7, P=0.02), BHR (51% vs. 10%, OR 5.5, CI 1.5-20.1, P=0.01), and sputum eosinophilia (81% vs. 11%, OR 76.1, CI 9.3-623.5, P<0.0001) compared with the control subjects. In AD patients, elevated s-IgE and positive SPTs were associated with the occurrence of physician-diagnosed asthma and AR, BHR, and the presence of sputum eosinophilia.


CONCLUSIONS
BHR and eosinophilic airway inflammation are more common in patients with AD than in control subjects. The highest prevalences were seen in patients with AD who were SPT positive and had high IgE levels. Longitudinal studies are needed to assess the outcome of patients with signs of airway disease, in order to identify those who need early initiation of asthma treatment.
Kyllönen
H
H
Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland. hannele.kyllonen@fimnet.fi
Malmberg
P
P
Remitz
A
A
Rytilä
P
P
Metso
T
T
Helenius
I
I
Haahtela
T
T
Reitamo
S
S
D000328:Adult; D001249:Asthma / Q000150:complications* / Q000276:immunology; D016535:Bronchial Hyperreactivity; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000150:complications* / Q000276:immunology; D004802:Eosinophilia / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D016015:Logistic Models; D008297:Male; D012129:Respiratory Function Tests; D013183:Sputum / Q000276:immunology*
D007073:Immunoglobulin E