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

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 (PM ₁₀ , PM _2.5 ), nitrogen dioxide, and oxides (NO ₂ , 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/m ³ 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/m ³ PM ₁₀ , PM _2.5 , NO _x , and NO ₂ 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.
Competing Interests: None disclosed.
(© 2023 Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc.)