Children, adults with atopic dermatitis at greater risk for inflammatory bowel diseases
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Key takeaways:
- Children and adults with atopic dermatitis are 44% and 35% more likely, respectively, to experience inflammatory bowel disease.
- Risk increased with worsening disease severity.
Children and adults with atopic dermatitis are at an increased risk for inflammatory bowel disease, ulcerative colitis and Crohn’s disease, according to a study.
“These findings are important towards better understanding the health trajectories of people with atopic dermatitis, which is a very common and potentially disabling condition,” Joel M. Gelfand, MD, MSCE, professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine, told Healio. “Treatments for AD are improving dramatically but we will need to determine if these treatments reduce or increase risk of other immune-mediated diseases over time.”
Gastrointestinal diseases in particular are commonly linked to atopic dermatitis, according to Gelfand and colleagues.
In their population-based cohort study, the researchers examined the risk for new-onset inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) in children (age range, 1-10 years) and adults (age range, 30-68 years).
The study included 409,431 children with AD compared with 1,809,029 healthy pediatric controls, as well as 625,083 adults with AD compared with 2,678,888 healthy adult controls.
Results showed that children with AD experience a 44% increased risk for IBD (adjusted HR = 1.44; 95% CI, 1.31-1.58) compared with healthy controls. Children with vs. without AD were also at a 74% increased risk for CD (aHR = 1.74; 95% CI, 1.54-1.97), which was also associated with heightened AD severity.
On the other hand, children with mild to moderate AD did not experience an increased risk for UC (aHR = 1.09; 95% CI, 0.94-1.27) compared with healthy controls, although those with severe AD (aHR = 1.65; 95%, CI, 1.02-2.67) did.
The risk for certain inflammatory diseases among adults with AD was lower than that of children, but still significantly higher than healthy controls. Adults with vs. without AD had a 34% increased risk for IBD (aHR = 1.34; 95% CI, 1.27-1.4), a 36% increased risk for CB (aHR = 1.36; 95% CI, 1.26-1.47) and a 32% increased risk for UC (aHR = 1.32; 95% CI, 1.24-1.41). The risk for all diseases increased with worsening AD.
The study authors concluded that, compared with healthy controls, children and adults with AD are more at risk for IBD and CD, whereas children with severe AD and all adults with AD are at increased risk for UC.
According to Gelfand, these findings should encourage dermatologists to “be aware of immune modulating treatments that help both AD and IBD, because some patients will have both conditions,” he said.
One example of such a medication is upadacitinib, Gelfand explained, which is approved for moderate to severe refractory atopic dermatitis, moderate to severe CD and UC.
“The induction dose is much higher for CD and UC and therefore it is important to work with our [gastrointestinal] colleagues when patients need a [Janus kinase] inhibitor for both their skin and their gut,” he concluded.