Association between short-term exposure to environmental air pollution and atopic dermatitis flare in patients treated with dupilumab

Francesco Bellinato; Giovanni Adami; Antonio Furci; Giorgio Cattani; Donatella Schena; Giampiero Girolomoni; Paolo Gisondi

doi:10.1016/j.jdin.2023.01.018

Association between short-term exposure to environmental air pollution and atopic dermatitis flare in patients treated with dupilumab

JAAD Int. 2023 Feb 10:11:72-77. doi: 10.1016/j.jdin.2023.01.018. eCollection 2023 Jun.

Authors

Francesco Bellinato¹, Giovanni Adami², Antonio Furci¹, Giorgio Cattani³, Donatella Schena¹, Giampiero Girolomoni¹, Paolo Gisondi¹

Affiliations

¹ Section of Dermatology and Venereology.
² Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy.
³ Italian Institute for Environmental Protection and Research, Rome, Italy.

Abstract

Background: The magnitude of short/medium-term air pollution exposure on atopic dermatitis (AD) flare has not been fully investigated. The aim of the study was to investigate the association of short/medium-term exposure to airborne pollution on AD flares in patients treated with dupilumab.

Methods: Observational case-crossover study. Patients with moderate-to-severe AD under treatment with dupilumab were included. The exposure of interest was the mean concentrations of coarse and fine particulate matter (PM₁₀, PM_2.5), nitrogen dioxide, and oxides (NO₂, NO_x). Different intervals were considered at 1 to 60 days before the AD flare and control visit, defined as the visit with the highest Eczema Area and Severity Index scores >8 and ≤7, respectively. A conditional logistic regression analysis adjusted for systemic treatments was employed to estimate the incremental odds (%) of flare every 10 μg/m³ pollutant concentration.

Results: Data on 169 of 528 patients with AD having 1130 follow-up visits and 5840 air pollutant concentration measurements were retrieved. The mean age was 41.4 ± 20.3 years; 94 (55%) men. The incremental odds curve indicated a significant positive trend of AD flare for all pollutants in all time windows. At 60 days, every 10 μg/m³ PM₁₀, PM_2.5, NO_x, and NO₂ increase concentration was associated with 82%, 67%, 28%, and 113% odds of flare, respectively.

Conclusions: In patients treated with dupilumab, acute air pollution exposure is associated with an increased risk for AD flare with a dose-response relationship.

Keywords: AD, atopic dermatitis; Air pollution; CO, carbon monoxide; EASI, Eczema Area and Severity Index; IQR, interquartile range; NO, nitrogen monoxide; NO2, nitrogen dioxide; NOx, oxides of nitrogen; PM, particulate matter; SO2, sulfur dioxide; atopic dermatitis; dupilumab; flare; particulate matter.