Burden and risk of asthma and rhinitis in people with atopic dermatitis: global estimates from a hierarchical Bayesian model

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Asthma prevalence 20.1%, rhinitis 45.1%, allergic rhinitis 41.4%

• Primary Outcome: Global prevalence of respiratory comorbidities in atopic dermatitis patients

• Nnt Or Sensitivity: OR for asthma 2.73 (1.59-6.64), rhinitis 2.98 (1.73-7.23), rhinoconjunctivitis 4.21 (2.45-10.19)

• Confidence Interval: Country-specific ranges provided (e.g., asthma 2.5%-59.4%)

Clinical Application

Highly feasible - supports routine screening protocols in dermatology and primary care Relevant for Australian practice given high AD prevalence; supports RACGP guidelines for comprehensive atopic disease management and potential PBS considerations for combined therapies All patients with atopic dermatitis requiring screening for respiratory comorbidities

Abstract

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with asthma and rhinitis. However, epidemiological evidence on these comorbidities remains fragmented and is largely limited to high-income countries. OBJECTIVES: To provide comprehensive global, regional and country-level estimates of the prevalence and odds ratios (ORs) of asthma, rhinitis and their subtypes among individuals with AD. METHODS: We systematically reviewed 278 studies retrieved from PubMed, Embase, Web of Science and CNKI (China National Knowledge Infrastructure). Standardized prevalence estimates and ORs were derived using a Bayesian hierarchical linear mixed-effects model. RESULTS: Among individuals with AD, the global prevalence estimate of asthma, rhinitis, allergic rhinitis, rhinoconjunctivitis, and coexisting asthma and rhinitis was 20.1% (ranging from 2.5% in Israel to 59.4% in India), 45.1% (ranging from 7.8% in Israel to 82.7% in India), 41.4% (ranging from 6.8% in Israel to 80.3% in India), 30.7% (ranging from 4.3% in Israel to 71.9% in India) and 10.4% (ranging from 1.1% in Israel to 40.8% in India), respectively. Estimates were higher when restricted to patients with AD diagnosed by dermatologists or physicians. The highest comorbid prevalence rates were found for India, Cuba, Finland and Puerto Rico. Compared with healthy control individuals, AD was associated with higher odds of asthma (OR 2.73; ranging from 1.59 in China to 6.64 in Ethiopia), rhinitis (OR 2.98; ranging from 1.73 in China to 7.23 in Ethiopia), allergic rhinitis (OR 2.42; ranging from 1.41 in China to 5.89 in Ethiopia), rhinoconjunctivitis (OR 4.21; ranging from 2.45 in China to 10.19 in Ethiopia), and coexisting asthma and rhinitis (OR 2.42; ranging from 1.41 in China to 5.89 in Ethiopia). CONCLUSIONS: This study provides the first globally standardized estimates of respiratory comorbidities in AD, and can inform clinical practice and public health policy. Atopic dermatitis is a common long-term inflammatory skin disease. It is also called eczema. It affects more than 200 million children and adults worldwide. People with the disease often have other conditions, particularly asthma and rhinitis. Asthma affects breathing and rhinitis causes sneezing or congestion. Most studies on these conditions have been in wealthy countries. They have also used a range of different research methods. This makes it difficult to compare and understand the global situation. In this study, researchers in China and the USA analysed data from 278 studies from around the world. We estimated how common asthma and rhinitis are in people with eczema in different regions and countries. We found that about 1 in 5 people with eczema have asthma and almost half have rhinitis. We also found that people with eczema are 2 to 4 times more likely to have these conditions than people without eczema. Some countries showed particularly high rates of these conditions. Our findings suggest that asthma and rhinitis are common problems for people with eczema. This is true no matter where they live. The information from this study may help doctors recognize and manage these conditions in people with eczema. These findings could also support future research to improve disease prevention and patient care.

References

1. 1.Liu, Y., Ge, J., Xu, G., Cai, C., Chen, D., Tian, J., & Xu, J. (2026). Burden and risk of asthma and rhinitis in people with atopic dermatitis: global estimates from a hierarchical Bayesian model. British Journal of Dermatology. https://doi.org/10.1093/bjd/ljag025