Kridin Khalaf, Renert-Yuval Yael, Guttman-Yassky Emma, Cohen Arnon D
Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
J Allergy Clin Immunol Pract. 2020 Apr;8(4):1323-1328.e1. doi: 10.1016/j.jaip.2020.01.052. Epub 2020 Feb 6.
Evidence of T1/IFN-γ overactivation as a major pathogenic driver somewhat conflicts with data supporting robust allergic background in patients with alopecia areata (AA). Previous investigations of immunological dysregulations show that both T1- and T2-related markers are overexpressed in AA. Clinical correlations in large populations may shed light on the immune pathways most likely to result in the clinical phenotype of AA.
To investigate the atopic comorbidities among patients with AA in a large population-based study.
This is a cross-sectional retrospective study of patients with AA and a matched comparison group, analyzing the associations between AA and 4 atopic comorbidities: asthma, atopic dermatitis (AD), allergic rhinitis, and allergic conjunctivitis. χ and t tests were used for univariate analysis, and logistic regression model was used for multivariate analysis. The study was performed using the computerized database of the Clalit Health Services, encompassing more than 4.4 million subjects.
The study population included 51,561 patients with AA and 51,410 matched control subjects. The prevalence of asthma (7.8% vs 6.5%; odds ratio [OR], 1.22; 95% CI, 1.17-1.28; P < .001), AD (3.9% vs 2.6%; OR, 1.55; 95% CI, 1.44-1.66; P < .001), allergic rhinitis (16.0% vs 12.8%; OR, 1.29; 95% CI, 1.25-1.34; P < .001), and allergic conjunctivitis (23.5% vs 19.6%; OR, 1.27; 95% CI, 1.23-1.30; P < .001) was significantly higher among patients with AA as compared with matched control subjects. Patients with AA also had a significantly higher probability of having more than 1 atopic comorbidity, with increasing OR as the number of concomitant atopic conditions increased.
Our analysis supports the previous literature and provides strong generalizability of significant atopy in patients with AA, suggesting T2 pathogenicity in AA, and challenging the traditional view of AA as a single-axis, T1-centered disease.
T1/IFN-γ过度激活作为主要致病驱动因素的证据，与支持斑秃（AA）患者存在强烈过敏背景的数据存在一定冲突。先前对免疫失调的研究表明，T1和T2相关标志物在AA中均有过表达。对大量人群的临床相关性研究可能有助于揭示最有可能导致AA临床表型的免疫途径。
在一项基于人群的大型研究中，调查AA患者的特应性共病情况。
这是一项对AA患者和匹配对照组的横断面回顾性研究，分析AA与4种特应性共病（哮喘、特应性皮炎（AD）、过敏性鼻炎和过敏性结膜炎）之间的关联。采用χ检验和t检验进行单因素分析，采用逻辑回归模型进行多因素分析。该研究使用了克拉利特医疗服务公司的计算机数据库，涵盖了超过440万受试者。
研究人群包括51561例AA患者和51410例匹配的对照受试者。与匹配的对照受试者相比，AA患者中哮喘（7.8%对6.5%；比值比[OR]，1.22；95%置信区间[CI]，1.17 - 1.28；P <.001）、AD（3.9%对2.6%；OR，1.55；95% CI，1.44 - 1.66；P <.001）、过敏性鼻炎（16.0%对12.8%；OR，1.29；95% CI，1.25 - 1.34；P <.001）和过敏性结膜炎（23.5%对19.6%；OR，1.27；95% CI，1.23 - 1.30；P <.001）的患病率显著更高。AA患者同时患有1种以上特应性共病的可能性也显著更高，随着伴随特应性疾病数量的增加，OR值也随之升高。
我们的分析支持了先前的文献，并有力地证明了AA患者存在显著特应性这一结论具有广泛的适用性，提示AA存在T2致病性，并挑战了将AA视为单轴、以T1为中心疾病的传统观点。
