How to Manage Atopic Comorbidities Among Atopic Dermatitis Patients, with Anne Marie Singh, MD

Anne Marie Singh, MD, associate professor and interim chief of the University of Wisconsin, Madison School of Medicine and Public Health division of allergy, immunology, and rheumatology, spoke in a presentation titled ‘Two for one: managing atopic comorbidities of atopic dermatitis.’

Singh’s talk was given at the Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting in Chicago, Illinois. She discussed several important elements related to atopic dermatitis (AD) comorbidity management among children.

“You can see there’s a lot of co-expression of allergic diseases,” Singh said. “Sometimes it’s asthma, sometimes it’s rhinitis, rhinitis and asthma without the AD. So the question is, how does this happen? And how can we use that understand our therapeutic options?”

Singh spoke on the onset of allergic diseases in children. She highlighted several points her talk, including speaking to the importance of understanding the phenotypic expression of aging in children to uncover underlying mechanisms and identify potential therapeutic targets.

A significant portion of Singh’s talk focused on food and its connection to atopic dermatitis.

“What’s really interesting is that early AD is associated with food allergy diagnosis and, later especially, the AD is associated with allergic rhinitis and asthma, as you can kind of see on this slide,” Singh said. “The other thing I want to say about this data that early AD increases your risk for food allergy throughout childhood. So up until their 20s, these kids still have a higher risk for food allergy, even when the eczema gets better.”

Later, Singh noted that recent analyses have shed light on several key factors regarding data on the presence of food-triggered atopic dermatitis. Specifically, Singh noted that food-triggered eczema is not as common as is believed.

“True food-triggered AD, where the food is actually the trigger, it does happen,” Singh said. “So I don’t want to say that it never happens. It’s just much less common.”

Singh expressed that there are many places in which it is believed that around a third of patients with moderate-to-severe atopic dermatitis have food-triggered diseases. However, it is often not the case.

“Now we know that that’s not the case, because these early studies conflated AD with the immediate reactions,” Singh explained.

She added that clinicians should not test for foods and opt instead for sending to an allergist if considering the possibility.

“I really advocate a step-wise approach,” Singh said. “The first time someone comes to see me, they are not getting any allergy testing on the visit. In the first visit we are optimizing skincare.”

Singh also noted that in kids who removed a food for this purpose, explaining that around 40% were found to have developd an IgE-mediated hypersensitivity upon the food’s reintroduction. Even if the food product is triggering their eczema, removal could lead to such downstream effects.

For additional information on this topic and related subjects, view our RAD 2024 conference coverage.

The quotes contained in this summary were edited for clarity.