On the question of the validity of epidemiological data regarding atopic dermatitis

Cover Page

Cite item

Full Text

Abstract

Atopic dermatitis is a heterogeneous disease. Its development is associated with certain genes, features of immune mechanisms, dysfunction of the skin barrier, and the influence of several environmental factors. As recent studies show, clinical symptoms depend on the age of the patient, disease severity, response to therapy, and molecular mechanisms involved (endotypes of atopic dermatitis). The features of atopic dermatitis were revealed depending on the race and/or ethnicity of the patients. In addition, the phenotype and endotype of the disease should be taken into account when making a diagnosis of atopic dermatitis.

Atopic dermatitis is diagnosed clinically, based on the data of the anamnesis of the disease and a doctor’s examination. Due to the variability of clinical manifestations, skin lesions and wave-like course, it is even more difficult to correctly diagnose the disease in population studies. Even if the results are obtained on carefully selected groups in specialized clinics and in cross-sectional studies, they may be subject to systematic error and limited generalizability.

All of the aforementioned strongly influence the epidemiological data regarding atopic dermatitis. Today, the prevalence rates of atopic dermatitis vary widely around the world. Epidemiological data are primarily affected by such factors as the lack of a unified approach to the definition of atopic dermatitis, design and methods of studies, disease codes, and diagnosis. In addition, it is important how accurately the diagnosis is made and what the severity of atopic dermatitis is. Entries in electronic records, including written prescriptions, also do not contribute to a sufficiently accurate identification of such patients. It is necessary to clarify the clinical diagnosis of atopic dermatitis and disease codes, including those misdiagnosed as atopic dermatitis, which directly affects the epidemiological data on atopic dermatitis in general.

Thus, the epidemiology of atopic dermatitis is insufficiently studied and requires a unified approach. To fully understand the true prevalence of this disease, further research is needed, as well as updating the classification of allergic diseases.

About the authors

Dali Sh. Macharadze

Peoples' Friendship University of Russia

Author for correspondence.
Email: dalim_a@mail.ru
ORCID iD: 0000-0001-5999-7085
SPIN-code: 2399-5783

MD, Dr. Sci (Med.)

Russian Federation, Moscow

References

  1. All-Russian public organization “Russian Society of Dermatovenerologists and Cosmetologists”; All-Russian public organization “Russian Association of Allergologists and Clinical Immunologists”; All-Russian public Organization “Union of Pediatricians of Russia” with the participation of the Union “National Alliance of Dermatovenerologists and Cosmetologists”. Clinical recommendations. Atopic dermatitis, 2020. Moscow; 2020. 76 p.
  2. Horii KA, Simon SD, Liu DY, Sharma V. Atopic dermatitis in children in the United States, 1997–2004: visit trends, patient and provider characteristics, and prescribing patterns. Pediatrics. 2007;120(3):527–534. doi: 10.1542/peds.2007-0289
  3. Hobbs FD, Bankhead C, Mukhtar T, et al. National Institute for Health Research School for Primary Care Research. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–2014. Lancet. 2016;387(10035): 2323–2330. doi: 10.1016/S0140-6736(16)00620-6
  4. Silverberg JI, Gelfand JM, Margolis DJ, et al. Health utility scores of atopic dermatitis in US Adults. J Allergy Clin Immunol Pract. 2019;7(4):1246–1252. doi: 10.1016/j.jaip.2018.11.043
  5. Brenninkmeijer EE, Schram ME, Leeflang MM, et al. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008;158(4):754–765. doi: 10.1111/j.1365-2133.2007.08412
  6. De Lusignan S, van Weel C. The use of routinely collected computer data for research in primary care: opportunities and challenges. Fam Pract. 2006;23(2):253–263. doi: 10.1093/fampra/cmi106
  7. Dizon M, Yu A, Singh R, et al. Systematic review of atopic dermatitis disease definition in studies using routinely collected health data. Br J Dermatol. 2018;178(6):1280–1287. doi: 10.1111/bjd.16340
  8. Bylund S, von Kobyletzki LB, Svalstedt M, Svensson А. Prevalence and Incidence of atopic dermatitis: a systematic review. Acta Derm Venereol. 2020;100(12):adv00160. doi: 10.2340/00015555-3510
  9. Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. J Am Acad Dermatol. 2016;75(4):681–687. doi: 10.1016/j.jaad.2016.05.028
  10. Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483–491. doi: 10.1183/09031936.95.08030483
  11. Deckert S, Kopkow C, Schmitt J. Nonallergic comorbidities of atopic eczema: an overview of systematic reviews. Allergy. 2014;69(1):37–45. doi: 10.1111/all.12246
  12. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–836. doi: 10.1016/j.jaci.2003.12.59
  13. Demoly P, Tanno LK, Akdis CA, et al. Global classification and coding of hypersensitivity diseases ― an EAACI ― WAO survey, strategic paper and review. Allergy. 2014;69(5):559–570. doi: 10.1111/all.12386
  14. Kantor R, Thyssen JP, Paller AS, et al. Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of ‘atopic dermatitis’. Allergy. 2016;71(10):1480–1485. doi: 10.1111/all.12982
  15. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl (Stockh). 1980;(92):44–47.
  16. Williams HC, Burney PG, Hay RJ, et al. The U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994;131(3):383–396. doi: 10.1111/j.1365-2133.1994
  17. De Lusignan S, Metsemakers JF, Houwink P, Gunnarsdottir V, van der Lei J. Routinely collected general practice data: goldmines for research? A report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands. Inform Prim Care. 2006;14(3):203–209. doi: 10.14236/jhi.v14i3.632
  18. De Lusignan S, Alexander H, Broderick C, et al. Patterns and trends in eczema management in UK primary care (2009–2018): A population-based cohort study. Clin Exp Allergy. 2021;51(3): 483–494. doi: 10.1111/cea.13783
  19. Abuabara K, Magyari AM, Hoffstad O, et al. Development and validation of an algorithm to accurately identify atopic eczema patients in primary care electronic health records from the UK. J Invest Dermatol. 2017;137(8):1655–1662. doi: 10.1016/j.jid.2017.03.029
  20. Hsu D, Dalal P, Sable K, et al. Validation of International Classification of Disease Ninth Revision codes for atopic dermatitis. Allergy. 2017;72(7):1091–1095. doi: 10.1111/all.13113
  21. De Lusignan S, Alexander H, Broderick C, et al. Epidemiology and management of atopic dermatitis in England: an observational cohort study protocol. BMJ Open. 2020;10(9):037518. doi: 10.1136/bmjopen-2020-037518
  22. Mulder B, Groenhof F, Kocabas LI, et al. Identification of Dutch children diagnosed with atopic diseases using prescription data: a validation study. Eur J Clin Pharmacol. 2016;72(1):73–82. doi: 10.1007/s00228-015-1940-x
  23. Örtqvist AK, Lundholm C, Wettermark B, et al. Validation of asthma and eczema in population-based Swedish drug and patient registers. Pharmacoepidemiol Drug Saf. 2013;22(8):850–860. doi: 10.1002/pds.3465
  24. Anandan C, Gupta R, Simpson CR, et al. Epidemiology and disease burden from allergic disease in Scotland: analyses of national databases. J R Soc Med. 2009;102(10):431–442. doi: 10.1258/jrsm.2009.090027
  25. Punekar YS, Sheikh A. Establishing the incidence and prevalence of clinician-diagnosed allergic conditions in children and adolescents using routinely collected data from general practices. Clin Exp Allergy. 2009;39(8):1209–1216. doi: 10.1111/j.1365-2222.2009.03248
  26. Schmitt J, Williams H. HOME Development Group. Harmonising Outcome Measures for Eczema (HOME). Report from the First International Consensus Meeting (HOME 1), 24 July 2010, Munich, Germany. Br J Dermatol. 2010;163(6):1166–1168. doi: 0.1111/j.1365-2133.2010.10054
  27. Chalmers JR, Schmitt J, Apfelbacher C, et al. Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME). Br J Dermatol. 2014;171(6):1318–1325. doi: 10.1111/bjd.13237
  28. Spuls PI, Gerbens LA, Simpson E, et al. HOME initiative collaborators. Patient-Oriented Eczema Measure (POEM), a core instrument to measure symptoms in clinical trials: a Harmonising Outcome Measures for Eczema (HOME) statement. Br J Dermatol. 2017;176(4):979–984. doi: 10.1111/bjd.15179
  29. Thomas KS, Apfelbacher CA, Chalmers JR, et al. Recommended core outcome instruments for health-related quality of life, long-term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting. Br J Dermatol. 2021;185(1):139–146. doi: 10.1111/bjd.19751
  30. Flohr C, Weinmayr G, Weiland SK, et al.; ISAAC Phase Two Study Group. How well do questionnaires perform compared with physical examination in detecting flexural eczema? Findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two. Br J Dermatol. 2009;161(4):846–853. doi: 10.1111/j.1365-2133.2009.09261
  31. Strina A, Barreto ML, Cunha S, et al. Validation of epidemiological tools for eczema diagnosis in Brazilian children: the ISAAC’s and UK Working Party’s criteria. BMC Dermatol. 2019;10:11. doi: 10.1186/1471-5945-10-11
  32. Boguniewicz M, Alexis AF, Beck LA, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5(6):1519–1531. doi: 10.1016/j.jaip.2017.08.005
  33. Ellwood P, Asher MI, Beasley R, et al.; ISAAC Steering Committee. The international study of asthma and allergies in childhood (ISAAC): phase three rationale and methods. Int J Tuberc Lung Dis. 2005;9(1):10–16.
  34. Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999;103(1 Pt 1):125–138. doi: 10.1016/s0091-6749(99)70536-1
  35. Odhiambo JA, Williams HC, Clayton TO, et al.; ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009; 124(6):1251–1258. doi: 10.1016/j.jaci.2009.10.009
  36. Mallol J, Crane J, von Mutius E, et al.; ISAAC Phase Three Study Group. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergol Immunopathol (Madr). 2013;41(2):73–85. doi: 10.1016/j.aller.2012.03.001
  37. Barbarot S, Auziere S, Gadkari A. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy. 2018;73(6):1284–1293 doi: 10.1111/all.13401
  38. Khaitov RM, Luss LV, Aripova TU. Prevalence of symptoms of bronchial asthma, allergic rhinitis and allergic dermatoses in children according to ISAAC criteria. Allergy, asthma and clinical immunology. 1998;(9):58–69. (In Russ).
  39. Macharadze DS, Tarasova SV. The prevalence of asthma and atopy symptoms among children in the North-Eastern Administrative District of Moscow according to ISAAC criteria and objective data. Int J Immunorehabil. 1998;(10):168–173. (In Russ).
  40. Macharadze DS, Tarasova SV. Dynamics of the prevalence of symptoms of allergic diseases according to ISAAC data (1997–2000, Moscow). Allergology Immunol. 2002;(3):300–302. (In Russ).
  41. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527–1534. doi: 10.1038/jid.2013.446
  42. Chiesa Fuxench ZC, Block JK, et al. Atopic Dermatitis in America Study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol. 2019;139(3):583–590. doi: 10.1016/j.jid.2018.08.028
  43. Ilyina NI, Luss LV, Nazarova EV. Environment and allergies. Med Opponent. 2019;2(6):12–17. (In Russ).
  44. Kubanov AA, Bogdanova EV. Organization and results of medical care in the field of dermatovenerology in the Russian Federation. Results of 2018. Bulletin Dermatol Venereol. 2019;95(4):8–23. (In Russ). doi: 10.25208/0042-4609-2019-95-4-8-23
  45. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66(Suppl 1):S8–16. doi: 10.1159/000370220
  46. Weidinger S, Beck LA, Bieber T, et al. Atopic dermatitis. Nat Rev Dis Primers. 2018;4(1):1. doi: 10.1038/s41572-018-0001-z
  47. Mortz CG, Andersen KE, Dellgren C, et al. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy. 2015;70(7):836–845. doi: 10.1111/all.12619
  48. Rönmark EP, Ekerljung L, Lötvall J, et al. Eczema among adults: prevalence, risk factors and relation to airway diseases. Results from a large-scale population survey in Sweden. Br J Dermatol. 2012;166(6):1301–1308. doi: 10.1111/j.1365-2133.2012.10904
  49. Vinding GR, Zarchi K, Ibler KS, et al. Is adult atopic eczema more common than we think? A population-based study in Danish adults. Acta Dermato Venereologica. 2014;94(4):480–482. doi: 10.2340/00015555-1761
  50. Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Inv Dermatol. 2013;133(7):1752–1759. doi: 10.1038/jid.2013.19
  51. Sacotte R, Silverberg J. Epidemiology of adult atopic dermatitis. Clin Dermatol. 2018;36(5):595–605. doi: 10.1016/j.clindermatol.2018.05.007
  52. Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br J Dermatol. 2020;182(1):47–54. doi: 10.1111/bjd.17896
  53. Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis (AD): a systematic review and meta-analysis. J Am Acad Dermatol. 2016;75(4):681–687. doi: 10.1016/j.jaad.2016.05.028
  54. Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14): 1483–1494. doi: 10.1056/NEJMra074081
  55. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016; 387(10023):1109–1122. doi: 10.1016/S0140-6736(15)00149-X
  56. Apfelbacher C, Diepgen T, Schmitt J. Determinants of eczema: population-based cross-sectional study in Germany. Allergy. 2011; 66(2):206–213. doi: 10.1111/j.1398-9995.2010.02464

Copyright (c) 2022 Pharmarus Print Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies