Despite clinical experience and some data suggesting a link between atopic dermatitis (AD) and other atopic morbidities, few studies have investigated the full spectrum of type 2 inflammatory diseases in a large population of pediatric patients. For a study published in the Journal of the American Academy of Dermatology, Elaine C. Siegfried, MD, and colleagues assessed the overall prevalence and incidence of type 2 inflammatory diseases in a large sample of commercially insured pediatric patients with AD from a national claims database (IBM MarketScan 2013-2017). Patients were stratified by treatment proxy for AD severity. The prevalence of type 2 inflammatory diseases was assessed 12-months after an index date, defined as the date of the first AD diagnosis. Nearly 245,000 patients with AD and matched patients without AD were included.

“There is limited real-world evidence on the prevalence of type 2 diseases in children with AD, and how the severity of AD impacts the risk of extracutaneous atopic morbidities,” Dr. Siegfried says. She also emphasizes that this population did not include Medicaid-insured children. “This is an important distinction, because about 50% of children are insured by Medicaid.”

Children With AD Have a Two-Fold Higher Prevalence of Extracutaneous Atopic Morbidities

“When compared with patients who did not have AD, our study showed that patients with AD were more than twice as likely to be diagnosed with any type 2 inflammatory disease during the first year after the index date,” says Dr. Siegfried. Overall, the prevalence more than doubled for asthma (odds ratio [OR], 2.29), eosinophilic esophagitis (OR, 2.46), urticaria (OR, 2.42), and rhinitis (OR, 2.80) and increased with AD severity. The prevalence rates for chronic rhinosinusitis and nasal polyps (OR, 1.10) and conjunctivitis (OR, 1.47) were also significantly higher for patients with AD Figure.

“Our study also showed that the prevalence of each type 2 inflammatory disease increased with AD treatment severity level,” Dr. Siegfried adds. Patients with treatment severity Level 3 were more than four times as likely to be diagnosed with asthma (OR, 4.43) and more than twice as likely to be diagnosed with chronic rhinosinusitis and nasal polyps (OR, 2.46), eosinophilic esophagitis (OR, 3.22), or rhinitis (OR, 2.33) when compared with patients who had treatment severity that was Levels 1 or 2. The prevalence of urticaria and conjunctivitis was 1.70 times and 1.46 times higher in patients with AD with treatment severity Level 3, respectively.

Among children younger than 2, the risk of developing subsequent type 2 inflammatory diseases was significantly higher in those with AD when compared to those without it (HR, 1.47). A greater cumulative probability of developing any type 2 inflammatory disease at 24 months was seen among patients with AD compared with those without it.

Real-World Evidence Demonstrates AD Burden in Children

“Collectively, our real-world data further support what has been documented by other studies,” says Dr. Siegfried. “Commercially insured pediatric patients with more severe AD appear to be at higher risk for other type 2 inflammatory diseases. It’s clear that the burden of these diseases in children with AD is substantial and more than skin deep. Ultimately, these data may be used to help identify appropriate candidates for systemic therapy.”

According to Dr. Siegfried, it has become increasingly important for dermatologists to be aware of the spectrum of type 2 inflammatory diseases that affect their patients with AD. “Clinicians should be vigilant about tracking atopic morbidities and all the medications patients are using to treat these conditions,” she notes. “Improved patient access to specialty and subspecialty care is also critical. Availability of telemedicine was significantly enhanced by the COVID-19 pandemic, allowing more efficient and readily available evaluations for patients in need of dermatologic care. When possible, a multidisciplinary approach can optimize care for children with AD and associated atopic morbidities. In a related publication, we examined the healthcare disparities among Medicaid-insured children with AD, who have much more limited access to specialty care.”