Risk for Atopic Dermatitis and Asthma Increased Among Patients With Hidradenitis Suppurativa

Patients with hidradenitis suppurativa were found to be at increased risk for atopic dermatitis and asthma, according to the results of a study published in Dermatology.

The systematic review and meta-analysis assessed the risk of allergic diseases such as atopic dermatitis, asthma, allergic rhinitis, and conjunctivitis among patients with hidradenitis suppurativa. According to the study authors, “Due to the complicated interaction between allergic diseases and the communication of atopic march, it’s critical to provide integrated real-world evidence regarding the association between [hidradenitis suppurativa] and allergic status.”

Researchers conducted a search in the PubMed, Embase, and Web of Science databases on September 29, 2022, for relevant cohort, case-control, and cross-sectional studies. Inclusion criteria included clinical, observational studies that evaluated an association between hidradenitis suppurativa and atopic diseases, and included an appropriate comparative control group without hidradenitis suppurativa.

A total of 12 studies (9 cross-sectional, 2 case-control, and 1 retrospective cohort) were included in the analysis, with 8 studies conducted in the United States, 2 in Europe, and 2 in Asia.

Results from 4 cross-sectional studies with more than 196,757 participants were pooled to determine the odds ratio of patients with hidradenitis suppurativa who also had asthma. The prevalence of asthma was 1.50-fold higher (95% CI, 1.24-1.81) in patients with hidradenitis suppurativa compared with individuals in the control group without hidradenitis suppurativa, according to integrated results with similar adjustment models. Heterogeneity in the analysis was I²=81%. The significance of the trend was still evident in sensitivity analysis that pooled an additional study that reported asthma odds ratios (ORs) in patients with (95% CI, 1.24-1.81) based on cohort design.

The risk for atopic dermatitis was significantly increased among patients with hidradenitis suppurativa, with a pooled OR of 4.10 (95% CI, 2.06-8.18), according to adjusted models of cross-sectional studies. Moderate heterogeneity was observed within the studies (I²=56%). Compared with individuals without hidradenitis suppurativa, the risk for atopic dermatitis among those with hidradenitis suppurativa was 3.07 (95% CI, 1.45-6.52), after combining results of cross-sectional studies in unadjusted models.

A sensitivity analysis that pooled observational studies that assessed the association between hidradenitis suppurativa and atopic dermatitis revealed the significance to persist (OR, 3.34; 95% CI, 1.83-6.10). The risk of developing allergic rhinitis or allergic conjunctivitis in patients with hidradenitis suppurativa was insignificant based on the available data.

Among several limitations, subgroup analysis according to age, ethnicity, or sex was not available owing to limited data. Also, whether severity of hidradenitis suppurativa would affect the observed association is not known, and adjustment models in the analysis of hidradenitis suppurativa and atopic dermatitis were of high heterogeneity. Furthermore, confounding bias caused by medical use is possible, as increased use of medical resources could lead to patients with hidradenitis suppurativa and atopic spectrum diseases being over-represented in the databases compared with patients with hidradenitis suppurativa and without other comorbidities.

“In this meta-analysis, current evidence supported that risk of having atopic dermatitis and asthma were both higher in people with [hidradenitis suppurativa],” stated the researchers. “Physicians should be aware of the reported association while caring [for] “people with [hidradenitis suppurativa], and related screening of allergic status should be recommended to patients.”