Is there any association between atopic dermatitis severity and peanut sensitivity? Study sheds light

Despite the study's negative results, the researchers add that the "hypothesis that AD can predict peanut sensitivity risk may still be justifiable based on growing evidence. The study results may be due to the use of a small study population due to the limitations of the COVID-19 pandemic. Also, evaluating AD severity through patient-oriented scoring of atopic dermatitis (PO-SCORAD) and Patient-Oriented Eczema Measure (POEM) surveys may be better for pediatric patients.

There is yet to be a widely accepted method for AD severity evaluation among clinicians. Current guidelines from the NIAID (National Institute of Allergy and Infectious Disease) are based on the results of the LEAP Study (Learning Early About Peanut Allergy Study). They recommend the introduction of the early peanut to children with AD, depending on their disease severity.

Against the above background, Sara Bilimoria, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, and colleagues aimed to determine the association between AD severity (as measured by PO-SCORAD and POEM surveys) and peanut sensitivity as measured by skin prick test or immunoglobulin E (IgE) levels. Secondarily, they also aimed to determine the peanut sensitisation rate in patients with 'mild AD' as defined by a POEM score of 0-7 and a PO-SCORAD score of 1−27.

For this purpose, the researchers recruited patients between the age of 3 months and 18 years undergoing IgE or skin prick testing for peanut allergy from two allergy clinics. Patients or their guardians completed a POEM survey and a PO-SCORAD survey.

Between September 2019 and March 2021, 20 patients met the inclusion criteria. The patients' mean age was 19.9 months.

The study led to the following findings:

· Within the 'mild' AD group (PO-SCORAD score 1−27 or POEM score 0−7), the rate of peanut sensitisation was 44% compared to 55% peanut sensitisation amongst all patients participating.

· The type of allergy testing the subjects underwent was left to the treating physician's discretion and was determined before study enrolment.

· Sixteen of the 20 subjects underwent SPT only, two underwent IgE blood testing, and 2 underwent both skin and IgE blood testing.

• There was no significant difference in AD severity measured by PO-SCORAD or POEM score between sexes or age groups (<12 months vs≥12 months).
• No significant relationship was found between POEM or PO-SCORAD scores and the rate of peanut sensitivity.

"We did not find any notable relationship between POEM or PO-SCORAD score and peanut sensitivity; despite this, the hypothesis that AD severity can predict peanut sensitivity may still be justifiable based on a growing body of evidence," the researchers wrote in their study.

Reference:

The study titled "Evaluating the predictive utility of patient-oriented scoring of atopic dermatitis (PO-SCORAD) versus Patient-Oriented Eczema Measure (POEM) for peanut sensitivity in patients with atopic dermatitis" was published in JEADV Clinical Practice.DOI: https://doi.org/10.1002/jvc2.69