title: Association of atopic dermatitis with smoking: A systematic review and meta-analysis.
abstract: BACKGROUND
  Tobacco exposure might be a modifiable risk factor for atopic dermatitis (AD).
  
  
  OBJECTIVE
  We examine the association between AD and exposure to tobacco smoke.
  
  
  METHODS
  We performed a systematic review and meta-analysis of observational studies (n = 86) in MEDLINE, EMBASE, Scopus, and Cochrane Library (1823-2015). Quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS). A meta-analysis was performed using random-effects models to estimate pooled odds ratios (OR). Subset analyses were performed for different ages (children, adult), regions, study designs (cross-sectional, longitudinal), study sizes (<5000, ≥5000), study quality (NOS score <6, ≥6), and amount of smoking (mild, extensive).
  
  
  RESULTS
  A diagnosis of AD was associated with higher odds of active smoking (OR 1.87, 95% confidence interval 1.32-2.63) and exposure to passive smoke (OR 1.18, 95% confidence interval 1.01-1.38), but not maternal smoking during pregnancy (OR 1.06, 95% confidence interval 0.80-1.40). The association between active smoking and AD remained significant in children and adults, all continents studied, and study sizes, but all were cross-sectional designs and had NOS score 6 or greater. Passive smoke was associated with AD in children and adults, cross-sectional studies, South/Central American and African studies, study size less than 5000, and NOS score less than 6.
  
  
  CONCLUSIONS
  AD severity and distribution were not assessed.
  
  
  CONCLUSIONS
  Active and passive exposure to smoke are associated with increased AD prevalence.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Robert
authors.initials: R
authors.lastname: Kantor
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ashley
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Dermatology, and Allergology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Thyssen
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois. Electronic address: JonathanISilverberg@gmail.com.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
mesh_terms: D000349:Africa / Q000453:epidemiology; D000367:Age Factors; D001208:Asia / Q000453:epidemiology; D002489:Central America / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D009656:North America / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013020:South America / Q000453:epidemiology; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution
keywords: active smoking; atopic dermatitis; eczema; meta-analysis; passive smoking; prenatal smoking; prevalence; systematic review