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Validation and interpretation of short form 12 and comparison with dermatology life quality index in atopic dermatitis in adults

Silverberg, Jonathan I; Gelfand, Joel M; Margolis, David J; Boguniewicz, Mark; Fonacier, Luz; Grayson, Mitchell H; Ong, Peck Y; Chiesa Fuxench, Zelma C; Simpson, Eric L
Quality of life (QOL) assessments are not standardized in atopic dermatitis (AD). We sought to determine the validity of Short-Form 12 (SF-12), a generic QOL assessment, in AD and compare its measurement properties with Dermatology Life Quality Index (DLQI). A cross-sectional, population-based study of 3495 adults was performed, including 602 that met a modified UK Working Party Criteria for AD. SF-12 mental component score (MCS) and SF-6D had a strong correlation with each other, and moderate inverse correlations with Patient-Oriented Eczema Measure, Patient Oriented-Scoring AD (PO-SCORAD), PO-SCORAD-itch, PO-SCORAD-sleep, and numerical rating scale of pain (Pearson correlations, P<0.0001 for all). MCS and SF-6D showed good discriminant validity as judged by analysis of variance and receiver operator curves (ROC). SF-12 physical component score (PCS) had weak correlations with AD severity assessments and poor discriminant validity. DLQI had better convergent and discriminant validity than SF-12. SF-12 and DLQI showed good internal consistency (Cronbach's alpha: 0.89 and 0.94). Differential item functioning was found for items in SF-12 and DLQI. There were floor effects for DLQI, but not SF-12 MCS, PCS and SF-6D. Severity thresholds were selected. In conclusion, SF-12 MCS and SF-6D showed good validity in AD, but inferior construct validity than DLQI.
PMID: 31009616
ISSN: 1523-1747
CID: 3854132

Risk stratification of systemic reactions to subcutaneous immunotherapy: A retrospective study

Sani, Sonam; Gupta, Ratika; Fonacier, Luz; Aquino, Marcella
Background: Subcutaneous allergen immunotherapy (SCIT) is a very effective treatment modality; however, it can be associated with both local and systemic reactions (SR). Identifying patient factors that predict SR remains paramount. Objective: Our aim was to identify the rate of SRs to SCIT as well as identify patient risk factors associated with the development of SRs. Methods: We conducted an institutional review board approved 10-year retrospective chart review of 459 patients who received SCIT in our clinic. The patients were placed into cohorts according to age, which included pediatric (5-18 years), adult (19-64 years), and senior (>65 years) patients. Results: An SR (N = 177) was identified in 24.8% of the patients (n = 114). The incidence of SR per injection was 0.2% (177 SRs of 74,183 total injections). SRs were identified as class 1 (n = 152), class 2 (n = 21), class 3 (n = 2), and class 4 (n = 2) according to the 2010 World Allergy Organization's SR grading system. There were no observed differences in the number of SRs with respect to age group. Female patients were more likely to have an SR (p = 0.02) overall as well as more than one reaction (p = 0.002). Other risk factors included the following: a patient-reported history of food allergy (p = 0.05), drug allergy (p = 0.005), or positive skin test result to cat and/or dog (p = 0.01). In addition, patients who were receiving SCIT to cat and/or dog (p = 0.004) or to dust mite (p = 0.03) were more likely to have an SR. Conclusion: In our patient population, the majority of SRs to SCIT occurred in female patients, patients with a history of drug or food allergies, and those who were receiving pet or dust-mite SCIT.
PMID: 31514792
ISSN: 1539-6304
CID: 4112202

Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults

Silverberg, J I; Gelfand, J M; Margolis, D J; Boguniewicz, M; Fonacier, L; Grayson, M H; Ong, P Y; Chiesa Fuxench, Z C; Simpson, E L
BACKGROUND:The relationship between atopic dermatitis (AD), anxiety and depression in the U.S. adult population is not well established. OBJECTIVES/OBJECTIVE:To determine the relationship of AD and its severity with symptoms and diagnosis of anxiety and depression in U.S. adults. METHODS:A cross-sectional, population-based study of 2893 adults was performed. AD was determined using modified U.K. Diagnostic Criteria. RESULTS:Adults with AD vs. those without AD had higher mean Hospital Anxiety and Depression Scale anxiety (HADS-A) (7·7 vs. 5·6) and depression (HADS-D) (6·0 vs. 4·3) scores and higher prevalences of abnormal (≥ 11) HADS-A (28·6% vs. 15·5%) and HADS-D (13·5% vs. 9·0%) scores. In multivariable linear and logistic regression models controlling for sociodemographics, AD was associated with significantly higher mean HADS-A and HADS-D scores (7·7 and 6·0) and higher odds of abnormal HADS-A [odds ratio (OR) 2·19, 95% confidence interval (CI) 1·65-2·91] and HADS-D scores (OR 1·50, 95% CI 1·04-2·17) (P ≤ 0·03 for all). Mean and abnormal HADS-A and HADS-D scores were increased in moderate and severe/very severe self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD), PO-SCORAD itch and sleep (P < 0·0001 for all). All respondents with severe PO-SCORAD, POEM and PO-SCORAD itch had borderline or abnormal HADS-A and HADS-D scores. Adults with AD vs. those without AD had higher prevalence of self-reported healthcare-diagnosed anxiety or depression in the past year (40·0% vs. 17·5%). Many adults with AD who had borderline and/or abnormal HADS-A or HADS-D scores reported no diagnosis of anxiety or depression. CONCLUSIONS:AD is associated with significantly increased anxiety and depression, which may go undiagnosed.
PMID: 30838645
ISSN: 1365-2133
CID: 3783522

Distribution of atopic dermatitis lesions in United States adults

Silverberg, J I; Margolis, D J; Boguniewicz, M; Fonacier, L; Grayson, M H; Ong, P Y; Chiesa Fuxench, Z C; Simpson, E L; Gelfand, J M
BACKGROUND:The distribution of atopic dermatitis (AD) lesions and its impact on quality of life (QOL) is not well-established in the US adult population. OBJECTIVE:To elucidate the distribution of AD lesions and its impact on QOL in US adults with AD. METHODS:A cross-sectional, population-based study of 602 adults was performed. AD was determined using modified UK Diagnostic Criteria, and its lesional distribution was assessed. QOL was assessed using Dermatology Life Quality Index (DLQI). Latent class analysis (LCA) was used to determine distinct phenotypes of AD lesional distribution. Multivariable logistic regression was used to determine the relationship between DLQI and distinct phenotypes. RESULTS:The most common sites of skin lesions were reported to be the popliteal fossae, lower legs, dorsal feet and antecubital fossae. Most persons reported partial (19.0%) or complete (63.0%) symmetry of lesions on the extremities. Lesions on the trunk were significantly more common in blacks and Hispanics. Age ≥60 years was associated with significantly lower proportions of active lesions on the face and scalp, and significantly higher proportion of lesions on the buttocks or genitals. LCA identified 5 classes of lesional distribution: 1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites. Class-2 (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 7.19 [3.21-16.07], class-3 (7.11 [3.20-15.80]), class-4 (6.90 [3.07-15.50]) and class-5 (7.92 [3.54-17.71]) were all significantly associated with higher DLQI scores compared to class 1. CONCLUSION/CONCLUSIONS:AD is associated with heterogeneous distribution of AD lesions, and distinct phenotypes that are associated with QOL impact.
PMID: 30883885
ISSN: 1468-3083
CID: 3783582

Measurement Properties of the Hospital Anxiety and Depression Scale Used in Atopic Dermatitis in Adults

Silverberg, Jonathan I; Gelfand, Joel M; Margolis, David J; Boguniewicz, Mark; Fonacier, Luz; Grayson, Mitchell H; Ong, Peck Y; Chiesa Fuxench, Zelma C; Simpson, Eric L
PMID: 30571970
ISSN: 1523-1747
CID: 3789642

Atopic dermatitis in US adults: from population to healthcare utilization

Silverberg, Jonathan I; Gelfand, Joel M; Margolis, David J; Boguniewicz, Mark; Fonacier, Luz; Grayson, Mitchell H; Ong, Peck Y; Fuxench, Zelma Chiesa; Simpson, Eric L
BACKGROUND:Little is known about the predictors of healthcare utilization among US adults with atopic dermatitis (AD). OBJECTIVES/OBJECTIVE:To determine the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED) and hospital settings in US adults with AD. METHODS:A cross-sectional, population-based study of 3,495 adults was performed. AD was determined using modified United Kingdom Working Party (UKWP) Criteria. AD severity was assessed using Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD) and Numeric rating scale (NRS)-itch. Weighted frequency and prevalence (95% confidence intervals [CI]) of utilization were determined. RESULTS:Overall, 10.42% (95% CI: 8.55-12.28%; weighted frequency: 25,844,871) reported a diagnosis of AD or eczema, 7.39% (5.81-8.97%; 18,324,869) met UKWP criteria, and 3.56% (2.40-4.72%; 8,830,095) met both. 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD and/or NRS-itch, with 4.0% (337,586) having severe scores for all three. Outpatient utilization for AD was low for mild disease (29.3-34.7%) and increased by severity (moderate: 36.2-49.8%; severe: 50.6-86.6%). Timeliness of appointments, expenses and insurance coverage were also predictors of outpatient utilization. Severe POEM, PO-SCORAD and/or NRS-itch were associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had ≥1 urgent care, ED or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, lower household income, lower education level, and AD prescriptions being denied by their insurance company. CONCLUSION/CONCLUSIONS:Adults with AD had low rates of outpatient and high rates of urgent care, ED and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socio-economic and/or healthcare disparities reduce outpatient utilization and increase urgent, ED and hospital utilization.
PMID: 30654197
ISSN: 2213-2201
CID: 3627362

Utilization of high-fidelity simulation for medical student and resident education of allergic-immunologic emergencies

Mawhirt, Stephanie L; Fonacier, Luz; Aquino, Marcella
PMID: 30802501
ISSN: 1534-4436
CID: 3699202

248 Patient and physician perspectives in atopic dermatitis: a population-based cross-sectional study [Meeting Abstract]

Chiesa, Fuxench Z C; Boguniewicz, M; Fonacier, L; Gelfand, J M; Grayson, M H; Margolis, D J; Silverberg, J; Ong, P Y; Simpson, E L
Few studies examine the experience of AD in adults and AD-treating physicians. Our objective was to compare the perspectives on AD among adults with, and AD-treating physicians. A cross-sectional sample of 602 adults who met AD UK Working Party criteria. Severity was assessed using POEM. A national sample of AD-treating physicians in outpatient settings wwere surveyed (N=401). Based on POEM score, 40% patients had moderate/severe AD (MSAD). Itch was reported as the most bothersome symptom for patients (57.5%) and AD-treating physicians. 15% of MSAD patients reported daily sleep disturbance, compared to 7% of physicians who reported that their MSAD patients experience this everyday. 41.4% of MSAD patients reported an average pain level of 7 or greater during the past week compared to 14.0% of physicians who rated their patient's pain. With respect to treatment experience, 29.6% of MSAD patients felt both physician and patient were equally in charge of treatment decisions vs 60.9% of physicians. 67.7% of physicians think their patients are very/somewhat satisfied with treatment vs 72.2% of patients with MSAD. Among those who reported treatment dissatisfaction, the primary reason was that these do not appear to work. Lastly, 1/3 of patients reported not being well informed about the cause of AD, similar to physicians who reported 34.0% of patients were not well informed. Recognition of itch burden, need for improved therapies, and disease education were similar between patients and physicians. Differences were observed in perception of pain and treatment experience. Our findings can help inform strategies to improve the care of adults with AD.
EMBASE:2001808743
ISSN: 1523-1747
CID: 3811722

Health Utility Scores of Atopic Dermatitis in US Adults

Silverberg, Jonathan I; Gelfand, Joel M; Margolis, David J; Boguniewicz, Mark; Fonacier, Luz; Grayson, Mitchell H; Ong, Peck Y; Fuxench, Zelma Chiesa; Simpson, Eric L
BACKGROUND:The impact of atopic dermatitis (AD) on health-related quality of life and health utility in the US adult population is not well established. OBJECTIVE:To determine the health utilities and quality-adjusted life-years (QALYs) lost in adults with AD versus without AD in the US population. METHODS:A cross-sectional, population-based study of 3495 adults was performed. AD was determined using modified UK diagnostic criteria for AD. AD severity was assessed using self-reported global AD severity, the Patient-Oriented Eczema Measure, the Patient-Oriented Scoring AD, and the Patient-Oriented Scoring AD itch and sleep. Six-dimensional health state short form (SF-6D) health utility scores and total QALY loss were assessed. RESULTS:The mean SF-6D score was lower in adults with AD compared with healthy adults (0.69 [95% CI, 0.68-0.70] versus 0.79 [95% CI, 0.77-0.79]). In particular, those with moderate-to-severe AD (mean, 0.53-0.66) had similar or lower SF-6D scores compared with those with all other self-reported disorders examined, except autoimmune disorders. Adults with AD and atopic comorbidities had significantly lower SF-6D scores compared with those without atopic comorbidities. Among the 7 disorders examined, AD was associated with higher total QALY loss than autoimmune disorders, diabetes, food allergy, and heart disease in both males and females. The largest QALY loss was for moderate AD in females and mild AD in males. CONCLUSIONS:Moderate-to-severe AD is associated with significant decrements of health utility in the US population. These data illustrate the heavy societal burden of moderate and severe AD and provide important insight for prioritization of resource allocation and cost-effectiveness research.
PMID: 30537560
ISSN: 2213-2201
CID: 3809712

Atopic Dermatitis in America Study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population

Chiesa Fuxench, Zelma C; Block, Julie; Boguniewicz, Mark; Boyle, John; Fonacier, Luz; Gelfand, Joel M; Grayson, Mitchell H; Margolis, David J; Mitchell, Lynda; Silverberg, Jonathan I; Schwartz, Lawrence; Simpson, Eric L; Ong, Peck Y
Population-based estimates on the prevalence of atopic dermatitis in adults vary widely. The objectives of the present study were to determine the prevalence of atopic dermatitis in the population of the United States, distribution of disease severity, and assess its impact on health-related quality of life. Among 1,278 participating adults, the prevalence (95%CI) of atopic dermatitis was 7.3% (5.9-8.8). 60.1% (56.1-64.1%) of participants were classified as mild 28.9% (25.3-32.7%) as moderate and 11% as severe (8.6-13.7%). Patients with atopic dermatitis and those with more severe disease had higher scores in the dermatology life quality index (mean [SD] AD: 4.71 [6.44] vs. controls: 0.97 [2.12] (<0.001), and the hospital anxiety (mean [SD] AD: 7.03 [4.80] vs. controls: 4.73 [4.8], and depression (mean (SD) AD: 5.83 [4.54] vs. controls: 3.62 [3.61]) scale indicating a worse impact on quality of life and an increased likelihood of anxiety or depression. Based on our prevalence estimates 16.5 million adults would have a diagnosis of atopic dermatitis with 6.6 million meeting criteria for moderate-to-severe disease. Our study confirms the high prevalence and disease burden of atopic dermatitis in this population.
PMID: 30389491
ISSN: 1523-1747
CID: 3431972