Greater Risk of COVID-19 Infection Found in Patients With Atopic Dermatitis

Incidence of atopic dermatitis (AD) may increase the risk of COVID-19 infection, according to study findings published recently in the JAAD International.

Characterized by a complex and multifactorial pathophysiology, AD has been known to involve immune dysregulation and activity of T-helper-2 (Th2) cytokines, including interleukin (IL)-4 and IL-13. Moreover, researchers note that current systemic treatments for AD such as dupilumab, an anti–IL-4 receptor monoclonal antibody, have immunomodulatory properties with indeterminate effects on the risk of COVID-19 infection.

“There is an incomplete understanding of the relationship between AD and the risk of COVID-19 infection,” they added. “For example, inconsistent data in the literature concerning COVID-19 infection rates in AD patients, with some studies finding an increased incidence of infection and others showing no significant difference.”

Aiming to further evaluate the association between AD and COVID-19 infection, the researchers conducted a nested, matched, case-control study of adults 18 years and older in the All of Us research program, a National Institutes of Health database with health data from over 250,000 Americans.

They focused on recruiting populations historically underrepresented in biomedical research, in which participant data from 2018 onward included survey responses, physical measurements, electronic health record (EHR) data, and genomic information. Comorbidities and risk factors were also compared between those with AD and controls using multivariable analyses.

From the total All of Us cohort, 11,752 patients with AD (mean [SD] age, 59 [16] years; 68% female) and 47,008 controls matched by age, sex, and race/ethnicity were recruited.

Compared with matched controls, patients with AD were more likely to have a COVID-19 diagnosis (4.2% vs 2.8%, P < .001) and significantly more likely to have higher rates of the following comorbid conditions (all P < .001):

• Body mass index: 30.3 vs 29.9
• Hypertension: 59.4% vs 48.9%
• Hyperlipidemia: 63.5% vs 47.3%
• Type 2 diabetes: 27.7% vs 20.2%
• Sleep apnea: 9.6% vs 6.8%
• Cardiovascular disease: 15.6% vs 10.5%
• Malignancy: 22.0% vs 15.6%
• Autoimmune disease: 15.0% vs 7.9%

After adjusting for demographic factors and comorbidities in the multivariable analysis, patients with AD remained significantly more likely to receive a diagnosis of COVID-19 (odds ratio, 1.29; P < .001).

Addressing limitations of the study findings, the researchers mentioned the ascertainment of AD and COVID-19 cases using EHRs and lack of clinical data on AD severity or therapy and COVID-19 outcomes.

“Further studies are needed to determine the immunopathologic links between AD and COVID-19 infection and whether certain AD comorbidities or treatments modify the risk of COVID-19 infection,” they concluded.

Reference

Fan R, Leasure AC, Damsky W, Cohen JM. Association between atopic dermatitis and COVID-19 infection: A case-control study in the All of Us research program. JAAD Int. Published online December 27, 2021. doi:10.1016/j.jdin.2021.12.007