Reviewing comorbidities associated with atopic dermatitis and management of chronic pruritis.

August 12, 2019

Good August to everybody! School already has, or will soon start, for learners from kindergarten to medical school. The heat of the summer is in full blast in most of North America and many of us are getting ready for fall weed season. It is a very busy time for us all, yet we still are committed to providing the best care possible for our patients who depend upon us for relief from their allergies, asthma and immune-based illnesses. It remains an integral part of our lives to look for and digest new and important information that will help our clinical practices. That remains the central goal for the Annals of Allergy, Asthma and Immunology which presents this month a group of papers that will inform, educate and (at least a few) actually entertain you. The emphasis this month is cutaneous allergy and we have several excellent articles to share with you. I will just highlight a few.

The first is an article by Jonathan Silverberg, MD from Chicago who presents a highly relevant review of the comorbidities associated with atopic dermatitis (AD) and how this adversely impacts patient and family lives. Importantly (and somewhat alarmingly), he reviews the literature that demonstrates increased psychological dysfunction (anxiety, depression and even increased suicidality) associated with the pruritic and inflammatory changes in AD. This disease is no longer confined to infants and small children – it can be seen throughout the age spectrum of our patients. This serves as sort of call to arms for us, as allergy-immunology specialists to be vigilant about doing a good psychological assessment in all of our patients -  but particularly those with more severe forms of disease.

Another paper that should be of great interest is by Emilie Fowler, BS and Gil Yosapovitch, MD from Miami that reviews management of chronic pruritus. It includes information to help us focus on treating nonimmune pathways that mediate itch. This article provides excellent suggestions and rationale for targeting the actual nerves associated with the itch response rather than just inflammation (such as topical steroids). There is a common belief among many patients and primary care providers that all chronic itching is due to some sort of itching. The lack of responsiveness in patients to a standard anti-inflammatory and antihistaminic approach is often frustrating. This article is a must read for practicing allergists-immunologists.

As always, we hope you enjoy reading your copy of the August 2019 Annals. We would love to have your feedback about what you did and did not like, what you would like to see more of, or if there is something we have not covered that you would find useful in your practice. Feel free to reach out directly to me.

Gailen D. Marshall, Jr., MD PhD FACAAI