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Lapides R, Crespo-Quezada J, Thomas T, Carmona Pires F, Chera G. IgA Vasculitis Followed by IgA Nephropathy Without an Identifiable Trigger: The Same Disease or a Spectrum of Related Conditions? Cureus 2023; 15:e45639. [PMID: 37868543 PMCID: PMC10589066 DOI: 10.7759/cureus.45639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
IgA vasculitis and IgA nephropathy are characterized by IgA deposition in blood vessels and glomerular mesangium, respectively. The former is far more common in the pediatric population, while the latter presents more often in adulthood. A consensus regarding whether these two conditions are manifestations of the same disease that occurs on a spectrum has not yet been reached, and, to our knowledge, no clinical trials to address this question have been conducted. Here, we describe a 27-year-old patient who presented to the emergency department multiple times before being diagnosed with IgA vasculitis with no identifiable trigger and soon after developed IgA nephropathy. This case highlights the importance of ruling out these conditions, especially IgA vasculitis, in adults presenting with a petechial rash, but also the need for studies that investigate whether and how these conditions are related so that patients can be appropriately diagnosed and treated as efficiently as possible.
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Affiliation(s)
- Rebecca Lapides
- Department of Internal Medicine, Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, USA
- Department of Medical Education, Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, USA
| | - Juan Crespo-Quezada
- Department of Internal Medicine, Connecticut Institute for Communities, Danbury, USA
| | - Teena Thomas
- Department of Internal Medicine, Danbury Hospital, Danbury, USA
| | | | - Gagandeep Chera
- Department of Internal Medicine, Connecticut Institute for Communities, Danbury, USA
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Carucci NS, La Barbera G, Peruzzi L, La Mazza A, Silipigni L, Alibrandi A, Santoro D, Chimenz R, Conti G. Time of Onset and Risk Factors of Renal Involvement in Children with Henoch-Schönlein Purpura: Retrospective Study. CHILDREN 2022; 9:children9091394. [PMID: 36138703 PMCID: PMC9497900 DOI: 10.3390/children9091394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
Background: Henoch-Schönlein purpura (HSP) is a common systemic vasculitis in children, involving the skin, musculoskeletal system, gastrointestinal tract and kidneys. Some studies in children have shown possible risk factors linked with the development and severity of HSP Nephritis (HSPN). The aim of this study was to research predicting factors for the development of HSPN. Methods: We retrospectively evaluated 132 pediatric patients with HSP, according to EULAR/PRINTO/PRESS criteria. All patients were screened for HSPN by urinalysis. Finally, we compared demographic, clinical and laboratory data in HSP patients with and without nephritis. Results: The median age at HSP diagnosis [6.2 (2.6–17.5) vs. 5.5 (0.8–15.4) years, p = 0.03] and the incidence of abdominal pain (48 vs. 27%, p = 0.01) were significantly higher in HSPN patients. No differences were evidenced regarding gender, allergic diseases, skin recurrences, gastrointestinal involvement, musculoskeletal involvement, scrotal involvement, and laboratory data (white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, erythrocyte sedimentation rate, and blood concentration of IgA). Conclusions: The age at diagnosis and abdominal pain were independent risk factors for renal involvement in HSP patients. However, due to the retrospective nature of this study, further long-term and prospective studies will be necessary.
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Affiliation(s)
- Nicolina Stefania Carucci
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Giulia La Barbera
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Antonella La Mazza
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Lorena Silipigni
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98125 Messina, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Roberto Chimenz
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU G Martino, University of Messina, 98125 Messina, Italy
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Schonmann Y, Mansfield KE, Mulick A, Roberts A, Smeeth L, Langan SM, Nitsch D. Inflammatory skin diseases and the risk of chronic kidney disease: population-based case-control and cohort analyses. Br J Dermatol 2021; 185:772-780. [PMID: 33730366 DOI: 10.1111/bjd.20067] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging evidence suggests an association between common inflammatory skin diseases and chronic kidney disease (CKD). OBJECTIVES To explore the association between CKD stages 3-5 (CKD3-5) and atopic eczema, psoriasis, rosacea and hidradenitis suppurativa. METHODS We undertook two complementary analyses; a prevalent case-control study and a cohort study using routinely collected primary care data [UK Clinical Practice Research Datalink (CPRD)]. We matched individuals with CKD3-5 in CPRD in March 2018 with up to five individuals without CKD for general practitioner practice, age and sex. We compared the prevalence of CKD3-5 among individuals with and without each inflammatory skin disease. We included individuals in CPRD with diabetes mellitus (2004-2018) in a cohort analysis to compare the incidence of CKD3-5 among people with and without atopic eczema and psoriasis. RESULTS Our study included 56 602 cases with CKD3-5 and 268 305 controls. Cases were more likely than controls to have a history of atopic eczema [odds ratio (OR) 1·14, 99% confidence interval (CI) 1·11-1·17], psoriasis (OR 1·13, 99% CI 1·08-1·19) or hidradenitis suppurativa (OR 1·49, 99% CI 1·19-1·85), but were slightly less likely to have been diagnosed with rosacea (OR 0·92, 99% CI 0·87-0·97), after adjusting for age, sex, practice (matching factors), index of multiple deprivation, diabetes, smoking, harmful alcohol use and obesity. Results remained similar after adjusting for hypertension and cardiovascular disease. In the cohort with diabetes (N = 335 827), there was no evidence that CKD3-5 incidence was associated with atopic eczema or psoriasis. CONCLUSIONS Atopic eczema, psoriasis and hidradenitis suppurativa are weakly associated with CKD3-5. Future research is needed to elucidate potential mechanisms and the clinical significance of our findings.
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Affiliation(s)
- Y Schonmann
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - K E Mansfield
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Mulick
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - L Smeeth
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - S M Langan
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,St John's Institute of Dermatology, Guy's & St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.,Health Data Research, London, UK
| | - D Nitsch
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Renal Department, Royal Free London NHS Foundation Trust, London, UK.,UK Renal Registry, Bristol, UK
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4
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Silverwood RJ, Mansfield KE, Mulick A, Wong AYS, Schmidt SAJ, Roberts A, Smeeth L, Abuabara K, Langan SM. Atopic eczema in adulthood and mortality: UK population-based cohort study, 1998-2016. J Allergy Clin Immunol 2021; 147:1753-1763. [PMID: 33516523 PMCID: PMC8098860 DOI: 10.1016/j.jaci.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
Background Atopic eczema affects up to 10% of adults and is becoming more common globally. Few studies have assessed whether atopic eczema increases the risk of death. Objective We aimed to determine whether adults with atopic eczema were at increased risk of death overall and by specific causes and to assess whether the risk varied by atopic eczema severity and activity. Methods The study was a population-based matched cohort study using UK primary care electronic health care records from the Clinical Practice Research Datalink with linked hospitalization data from Hospital Episode Statistics and mortality data from the Office for National Statistics from 1998 to 2016. Results A total of 526,736 patients with atopic eczema were matched to 2,567,872 individuals without atopic eczema. The median age at entry was 41.8 years, and the median follow-up time was 4.5 years. There was limited evidence of increased hazard for all-cause mortality in those with atopic eczema (hazard ratio = 1.04; 99% CI = 1.03-1.06), but there were somewhat stronger associations (8%-14% increased hazard) for deaths due to infectious, digestive, and genitourinary causes. Differences on the absolute scale were modest owing to low overall mortality rates. Mortality risk increased markedly with eczema severity and activity. For example, patients with severe atopic eczema had a 62% increased hazard (hazard ratio = 1.62; 99% CI = 1.54-1.71) for mortality compared with those without eczema, with the strongest associations for infectious, respiratory, and genitourinary causes. Conclusion The increased hazards for all-cause and cause-specific mortality were largely restricted to those with the most severe or predominantly active atopic eczema. Understanding the reasons for these increased hazards for mortality is an urgent priority.
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Affiliation(s)
- Richard J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Longitudinal Studies, University College London Social Research Institute, University College London, London, United Kingdom
| | - Kathryn E Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amy Mulick
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Y S Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sigrún A J Schmidt
- Department of Clinical Epidemiology and Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, United Kingdom
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, Calif
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Health Data Research UK, London, United Kingdom.
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5
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Wilkinson A. Early recognition and treatment of Henoch-Schönlein purpura in children. Nurs Child Young People 2019; 31:36-40. [PMID: 31486599 DOI: 10.7748/ncyp.2019.e1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 06/10/2023]
Abstract
Henoch-Schönlein purpura (HSP) is characterised by a non-blanching rash, which commonly affects the lower limbs of children aged 3-15 years. It is the most common vasculitis in children. HSP often develops after an upper respiratory tract infection and is more likely to present in autumn, winter and spring. The majority of cases resolve with symptomatic treatment although some cases may progress to serious complications, including renal involvement. A case study is presented and differential diagnoses are explored. The pathophysiology of HSP is discussed. Nurses are often the first to assess patients so they are in an ideal position to recognise and treat HSP early on. Admission of a child into hospital is a stressful event for the parents and child; the nurse can help by ensuring prompt admission to hospital and offering support and reassurance to the family.
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Xu Y, Wang JJ, Liu FF, Wu Y, Wu YF, Samadli S, Luo HH, Zhang DD, Hu P. Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China. J Investig Med 2018; 67:771-778. [PMID: 30530785 DOI: 10.1136/jim-2018-000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
Henoch-Schönlein purpura (HSP) is a common autoimmune vasculitis in childhood. The detailed pathogenesis of HSP is still unclear, whereas several types of predisposing factors have been proved to be the initial step. The objectives of present study were to analyze the distribution of predisposing factors, association of the predisposing factors with clinical manifestations and HSP relapse/recurrence. 1200 children with HSP were recruited between January 2015 and December 2017. We reviewed their laboratory tests and medical histories associated with HSP onset. The annual incidence of HSP was 8.13-9.17 per 100 000 in Anhui province. HSP occurred more commonly in spring and winter than in summer with an obvious west-to-east gradient. Cutaneous purpura was the most prevalent manifestation (100%), followed by arthritis/arthralgias (43.67%), abdominal pain (40.17%) and renal involvement (18.17%). On admission, series of potential infections were identified in 611 patients (50.92%). The histories of allergy, injury, surgery, vaccination and tick bite were declared by 231 patients (19.25%), 15 patients (1.25%), 12 patients (1.00%), 4 patients (0.33%) and 3 patients (0.25%), respectively. However, predisposing factors could not be identified in 521 children with HSP (43.42%) yet. 123 cases (10.25%) relapsed or recurred more than one time; the mean number was 2.92, and the mean interval was 11.4 weeks. The infection is the most frequent predisposing factor regardless of clinical phenotypes and relapse/recurrence, whereas the clinical manifestations exhibit an obvious heterogenicity according to different predisposing factors.
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Affiliation(s)
- Yao Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Jing Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei Fei Liu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Fang Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sama Samadli
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huang Huang Luo
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong Dong Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Hu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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7
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Lei WT, Tsai PL, Chu SH, Kao YH, Lin CY, Fang LC, Shyur SD, Lin YW, Wu SI. Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatr Rheumatol Online J 2018; 16:25. [PMID: 29661187 PMCID: PMC5902957 DOI: 10.1186/s12969-018-0247-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/11/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The recurrence rate of Henoch-Schönlein purpura (HSP) is 2.7%-30%, with varied average intervals between the first and second episodes. Few studies have explored the incidence and risk factors for recurrent HSP. METHODS We used a 16-year nationwide database to analyze the incidence of recurrent HSP. Patients with HSP were identified, and risk factors for recurrent HSP were explored. Kaplan-Meier and Cox regression model analyses were performed, and covariates were adjusted in the multivariate model. RESULTS From January 1, 1997 to December 31, 2012, among 2,886,836 individuals in the National Health Insurance Research Database, 1002 HSP patients aged < 18 years were identified. Among them, 164 had ≥2 HSP episodes (recurrence rate, 16.4%; incidence of recurrent HSP, 7.05 per 100 person-years); 83.6% patients with one HSP episode remained free of secondary HSP. The average time intervals between the first and second and second and third HSP episodes were 9.2 and 6.4 months, respectively. After adjusting for demographic parameters, comorbidities, and socioeconomic status, recurrent HSP was found to occur more frequently in patients who had renal involvement (adjusted hazard ratio, 2.41; 95% confidence interval [CI], 1.64-3.54; p < 0.001), were receiving steroid therapy for > 10 days (adjusted hazard ratio, 8.13; 95%CI, 2.51-26.36; p < 0.001), and had allergic rhinitis (adjusted hazard ratio, 1.63; 95%CI, 1.06-2.50; p = 0.026). CONCLUSIONS The annual incidence of recurrent HSP was low. However, children who had underlying allergic rhinitis, presented with renal involvement, and received steroid treatment for > 10 days should be notified regarding the possibility of recurrence.
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Affiliation(s)
- Wei-Te Lei
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Po-Li Tsai
- Division of Colorectal Surgery, Department of Surgery, Mackey Memorial Hospital, Taipei, Taiwan
| | - Szu-Hung Chu
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Hsuan Kao
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Li-Ching Fang
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Shyh-Dar Shyur
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Wen Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan. .,Audiology and Speech Language Pathology, Mackay Medical College, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan. .,Department of Psychiatry, Mackay Memorial Hospital, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan.
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Thyssen JP, Skov L, Egeberg A. Cause-specific mortality in adults with atopic dermatitis. J Am Acad Dermatol 2017; 78:506-510. [PMID: 29102489 DOI: 10.1016/j.jaad.2017.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/19/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adult atopic dermatitis (AD) has been associated with several comorbidities, but cause-specific mortality risk is unknown. OBJECTIVE To examine cause-specific death rates and risk in adults with AD. METHODS We performed cross-linkage of nationwide health care and cause of death registers. Adult patients with AD were matched with 10 controls per study subject. We calculated incidence rates per 1000 person-years and hazard ratios (HRs) of cause-specific death with 95% confidence intervals (95% CIs) using Cox proportional hazards models. RESULTS A total of 8686 patients and 86,860 matched controls were studied. The risk for death due to any cause was significantly increased in patients with AD (HR 1.27, 95%CI 1.11-1.45). Significant causes included cardiovascular (HR 1.45; 95% CI 1.07-1.96), infectious (HR 3.71; 95% CI 1.43-9.60), and urogenital diseases (HR 5.51; 95% CI 1.54-19.80). No increased risk for death due to cancer, endocrine, neurologic, psychiatric, respiratory, or gastroenterologic disease was observed. LIMITATIONS The results might not be generalizable to patients seen exclusively by primary care physicians. CONCLUSION Adults with atopic dermatitis had slightly increased risk for death during follow-up. While the risk for death from cardiovascular, urogenital, and infectious diseases was slightly elevated among patients with AD, the absolute risk was very low.
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Affiliation(s)
- Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; National Allergy Research Centre, Gentofte, Denmark.
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Barrick BJ, Jalan S, Tollefson MM, Milbrandt TA, Larson AN, Rank MA, Lohse CM, Davis DMR. Associations of self-reported allergic diseases and musculoskeletal problems in children: A US population-based study. Ann Allergy Asthma Immunol 2017; 119:170-176. [PMID: 28668547 DOI: 10.1016/j.anai.2017.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have found increased rates of musculoskeletal problems in adults with allergic disease, but whether this association holds true for children is unknown. OBJECTIVE To investigate the association of bone, joint, and muscle problems in children with a history of allergic disease. METHODS Data were obtained from the 2007 Child and Adolescent Health Measurement Initiative. Univariable and multivariable logistic regression models accounting for the sampling design were used to evaluate associations of bone, joint, and muscle problems with allergic diseases, such as asthma, hay fever, food allergies, and eczema. Associations were summarized with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The survey included 91,642 individuals aged 0 to 17 years. Multivariable modeling found statistically significant associations between the number of allergic diseases and bone, joint, and muscle problems (1 allergic disease: adjusted OR, 1.28; 95% CI, 1.04-1.56; P = .02; 2 allergic diseases: adjusted OR, 2.55; 95% CI, 1.92-3.39; P < .001; 3 allergic diseases: adjusted OR, 2.70; 95% CI, 1.88-3.86; P < .001; and 4 allergic diseases: adjusted OR, 4.35; 95% CI, 2.46-7.69; P < .001). Severe eczema (but not mild eczema) was associated with bone, joint, and muscle problems (adjusted OR, 2.81; 95% CI, 1.64-4.81; P < .001) and with bone problems (adjusted OR, 6.08; 95% CI, 1.94-19.12; P = .002). CONCLUSION Self-reported allergic diseases in children were associated with bone, joint, and muscle problems, and associations strengthened with allergic disease severity and number of allergic diseases. Severe eczema may be associated with bone problems in children. Bone, joint, and muscle problems must be considered in children with severe allergic disease, and prospective studies are necessary to define this association.
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Affiliation(s)
| | - Somya Jalan
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona; Division of Otolaryngology Head and Neck Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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Abstract
BACKGROUND Comorbidities of cardiovascular diseases (CVDs), metabolic syndrome and autoimmune diseases with systemic inflammation are recent topics in medicine. Inflammatory skin diseases such as atopic dermatitis and psoriasis are an active source of diverse proinflammatory cytokines and chemokines, which are readily detectable in the circulation and are likely to be involved in developing comorbidities. EVIDENCE Both atopic dermatitis and psoriasis are frequently comorbid with CVD, metabolic syndrome and autoimmune diseases, the consequence of which is called "inflammatory skin march", "psoriatic march" or "march of psoriasis". CONCLUSION In this review, we summarize the epidemiological evidence and pathogenetic concepts regarding inflammatory skin march in atopic dermatitis and psoriasis.
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Affiliation(s)
- Masutaka Furue
- Department of Dermatology, Kyushu University, Maidashi 3-1-1, Higashiku, Fukuoka, 812-8582, Japan.
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
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11
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Andersen YM, Egeberg A, Skov L, Thyssen JP. Comorbidities of Atopic Dermatitis: Beyond Rhinitis and Asthma. CURRENT DERMATOLOGY REPORTS 2017; 6:35-41. [PMID: 28890845 PMCID: PMC5556128 DOI: 10.1007/s13671-017-0168-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW In this review article, we summarize the current evidence about atopic dermatitis (AD)-associated comorbidities, beyond the traditional atopic and allergic conditions. RECENT FINDINGS Patients with AD may have an increased risk of cardiovascular diseases, certain malignancies, autoimmune diseases, and neuropsychiatric diseases. The causes of these associations are likely multifactorial and may include genetic predispositions, systemic low-grade inflammation, environmental exposures, medication, and lifestyle and behavioral risk factors. There appears to be geographical variations in prevalence of comorbidities in patients with AD, indicating that differences in ethnicity and lifestyle factors may significantly influence the risk of certain comorbidities. SUMMARY The reported comorbidities in recent literature emphasize the burden of disease in patients with AD. Early appropriate AD therapy, in combination with reduction of risk factors, may help prevention of certain comorbidities. The reported observations may generate hypotheses for future investigations in underlying risk factors for AD-associated comorbidities.
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Affiliation(s)
- Yuki M.F. Andersen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
| | - Jacob P. Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900 Hellerup, Denmark
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