Alopecia Areata Is Associated with Atopic Diathesis: Results from a Population-Based Study of 51,561 Patients

Khalaf Kridin; Yael Renert-Yuval; Emma Guttman-Yassky; Arnon D. Cohen

doi:10.1016/j.jaip.2020.01.052

Alopecia Areata Is Associated with Atopic Diathesis: Results from a Population-Based Study of 51,561 Patients

Khalaf Kridin, Yael Renert-Yuval, Emma Guttman-Yassky, Arnon D. Cohen

Research output: Contribution to journal › Article › peer-review

56 Scopus citations

Abstract

Background: Evidence of T_H1/IFN-γ overactivation as a major pathogenic driver somewhat conflicts with data supporting robust allergic background in patients with alopecia areata (AA). Previous investigations of immunological dysregulations show that both T_H1- and T_H2-related markers are overexpressed in AA. Clinical correlations in large populations may shed light on the immune pathways most likely to result in the clinical phenotype of AA. Objective: To investigate the atopic comorbidities among patients with AA in a large population-based study. Methods: This is a cross-sectional retrospective study of patients with AA and a matched comparison group, analyzing the associations between AA and 4 atopic comorbidities: asthma, atopic dermatitis (AD), allergic rhinitis, and allergic conjunctivitis. χ² and t tests were used for univariate analysis, and logistic regression model was used for multivariate analysis. The study was performed using the computerized database of the Clalit Health Services, encompassing more than 4.4 million subjects. Results: The study population included 51,561 patients with AA and 51,410 matched control subjects. The prevalence of asthma (7.8% vs 6.5%; odds ratio [OR], 1.22; 95% CI, 1.17-1.28; P <.001), AD (3.9% vs 2.6%; OR, 1.55; 95% CI, 1.44-1.66; P <.001), allergic rhinitis (16.0% vs 12.8%; OR, 1.29; 95% CI, 1.25-1.34; P <.001), and allergic conjunctivitis (23.5% vs 19.6%; OR, 1.27; 95% CI, 1.23-1.30; P <.001) was significantly higher among patients with AA as compared with matched control subjects. Patients with AA also had a significantly higher probability of having more than 1 atopic comorbidity, with increasing OR as the number of concomitant atopic conditions increased. Conclusions: Our analysis supports the previous literature and provides strong generalizability of significant atopy in patients with AA, suggesting T_H2 pathogenicity in AA, and challenging the traditional view of AA as a single-axis, T_H1-centered disease.

Original language	English
Pages (from-to)	1323-1328.e1
Journal	Journal of Allergy and Clinical Immunology: In Practice
Volume	8
Issue number	4
DOIs	https://doi.org/10.1016/j.jaip.2020.01.052
State	Published - Apr 2020
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2020 American Academy of Allergy, Asthma & Immunology

Funding

Conflicts of interest: E. Guttman-Yassky is an employee of Mount Sinai and has received research funds (grants paid to the institution) from AbbVie, Asana Biosciences, Celgene, Dermavant, DS Biopharma, Galderma, Glenmark, Innovaderm, Janssen Biotech, Leo Pharma, Novan, Novartis, Pfizer, Ralexar, Regeneron, and Union Therapeutics, and is also a consultant for AbbVie, Allergan, Amgen, Asana Biosciences, Celgene, Concert, DBV Technologies, Dermira, DS Biopharma, Lilly, EMD Serono, Escalier, Flx Bio, Galderma, Glenmark, Kyowa Kirin, Leo Pharma, Mitsubishi Tanabe, Novartis, Pfizer, Regeneron, Sanofi, and Union Therapeutics. A. D. Cohen received research grants from Janssen, Novartis, and AbbVie, and served as a consultant, advisor, or speaker to AbbVie, Amgen, Boehringer Ingelheim, Dexcel Pharma, Janssen, Lilly, Neopharm, Novartis, Perrigo, Pfizer, and Rafa. The rest of the authors declare that they have no relevant conflicts of interest.

Funders	Funder number
Union Therapeutics
Amgen
Novartis
AbbVie
Allergan
Janssen Pharmaceuticals
Asana Biosciences

Keywords

Allergic conjunctivitis
Allergic rhinitis
Alopecia areata
Asthma
Atopic dermatitis
Atopy
Big data
Comorbidities
Population-based

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10.1016/j.jaip.2020.01.052

Cite this

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title = "Alopecia Areata Is Associated with Atopic Diathesis: Results from a Population-Based Study of 51,561 Patients",

abstract = "Background: Evidence of TH1/IFN-γ overactivation as a major pathogenic driver somewhat conflicts with data supporting robust allergic background in patients with alopecia areata (AA). Previous investigations of immunological dysregulations show that both TH1- and TH2-related markers are overexpressed in AA. Clinical correlations in large populations may shed light on the immune pathways most likely to result in the clinical phenotype of AA. Objective: To investigate the atopic comorbidities among patients with AA in a large population-based study. Methods: This is a cross-sectional retrospective study of patients with AA and a matched comparison group, analyzing the associations between AA and 4 atopic comorbidities: asthma, atopic dermatitis (AD), allergic rhinitis, and allergic conjunctivitis. χ2 and t tests were used for univariate analysis, and logistic regression model was used for multivariate analysis. The study was performed using the computerized database of the Clalit Health Services, encompassing more than 4.4 million subjects. Results: The study population included 51,561 patients with AA and 51,410 matched control subjects. The prevalence of asthma (7.8% vs 6.5%; odds ratio [OR], 1.22; 95% CI, 1.17-1.28; P <.001), AD (3.9% vs 2.6%; OR, 1.55; 95% CI, 1.44-1.66; P <.001), allergic rhinitis (16.0% vs 12.8%; OR, 1.29; 95% CI, 1.25-1.34; P <.001), and allergic conjunctivitis (23.5% vs 19.6%; OR, 1.27; 95% CI, 1.23-1.30; P <.001) was significantly higher among patients with AA as compared with matched control subjects. Patients with AA also had a significantly higher probability of having more than 1 atopic comorbidity, with increasing OR as the number of concomitant atopic conditions increased. Conclusions: Our analysis supports the previous literature and provides strong generalizability of significant atopy in patients with AA, suggesting TH2 pathogenicity in AA, and challenging the traditional view of AA as a single-axis, TH1-centered disease.",

keywords = "Allergic conjunctivitis, Allergic rhinitis, Alopecia areata, Asthma, Atopic dermatitis, Atopy, Big data, Comorbidities, Population-based",

author = "Khalaf Kridin and Yael Renert-Yuval and Emma Guttman-Yassky and Cohen, {Arnon D.}",

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AU - Cohen, Arnon D.

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N2 - Background: Evidence of TH1/IFN-γ overactivation as a major pathogenic driver somewhat conflicts with data supporting robust allergic background in patients with alopecia areata (AA). Previous investigations of immunological dysregulations show that both TH1- and TH2-related markers are overexpressed in AA. Clinical correlations in large populations may shed light on the immune pathways most likely to result in the clinical phenotype of AA. Objective: To investigate the atopic comorbidities among patients with AA in a large population-based study. Methods: This is a cross-sectional retrospective study of patients with AA and a matched comparison group, analyzing the associations between AA and 4 atopic comorbidities: asthma, atopic dermatitis (AD), allergic rhinitis, and allergic conjunctivitis. χ2 and t tests were used for univariate analysis, and logistic regression model was used for multivariate analysis. The study was performed using the computerized database of the Clalit Health Services, encompassing more than 4.4 million subjects. Results: The study population included 51,561 patients with AA and 51,410 matched control subjects. The prevalence of asthma (7.8% vs 6.5%; odds ratio [OR], 1.22; 95% CI, 1.17-1.28; P <.001), AD (3.9% vs 2.6%; OR, 1.55; 95% CI, 1.44-1.66; P <.001), allergic rhinitis (16.0% vs 12.8%; OR, 1.29; 95% CI, 1.25-1.34; P <.001), and allergic conjunctivitis (23.5% vs 19.6%; OR, 1.27; 95% CI, 1.23-1.30; P <.001) was significantly higher among patients with AA as compared with matched control subjects. Patients with AA also had a significantly higher probability of having more than 1 atopic comorbidity, with increasing OR as the number of concomitant atopic conditions increased. Conclusions: Our analysis supports the previous literature and provides strong generalizability of significant atopy in patients with AA, suggesting TH2 pathogenicity in AA, and challenging the traditional view of AA as a single-axis, TH1-centered disease.

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Alopecia Areata Is Associated with Atopic Diathesis: Results from a Population-Based Study of 51,561 Patients

Abstract

Bibliographical note

Funding

Keywords

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