BRIEF COMMUNICATION Year : 2022  |  Volume : 23  |  Issue : 2  |  Page : 123-125

Assessment of coronavirus disease 2019 severity in hospitalized pediatric patients with atopic dermatitis: a case‒control study

Alpana Mohta, Bhikam Chand Ghiya, Rajesh Dutt Mehta, Vijeta Prasad
Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Bikaner, Rajasthan, India

Date of Submission22-Oct-2021Date of Decision25-Jan-2022Date of Acceptance26-Jan-2022Date of Web Publication30-Mar-2022

Correspondence Address:
Dr. Alpana Mohta
Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Bikaner - 324 005, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijpd.ijpd_147_21

Introduction: The Centers for Disease Control and Prevention has included asthma as a risk factor for developing severe coronavirus disease 2019 (COVID-19) illness. Respiratory viruses are known to run a more severe course in patients with underlying respiratory illnesses. However, the reports on the association of atopic dermatitis and COVID-19 infection are contrasting. Aims and Objectives: We aimed at assessing the difference between the severity of COVID-19 illness in patients having concurrent atopic dermatitis compared to those without concurrent atopic dermatitis. Materials and Methods: Study subjects included real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients under the age of 18 years. The patients were divided into two groups, namely, cases and controls. Cases included children with atopic dermatitis diagnosed according to revised Hanifin and Rajka criteria with positive COVID-19 RT-PCR report. Controls were age-and sex-matched children from the same center with COVID-19, without atopic dermatitis. Disease severity was compared between the two groups. In addition, the COVID-19 severity was correlated with the SCORAD in the "cases" group. Results: While assessing the severity of COVID-19 illness on the basis of computed tomography score and clinical severity, there was a higher proportion of "severe" illness in "cases" compared to "controls," however, the difference was statistically insignificant. There was no significant correlation between high SCORAD scores and severe COVID-19 illness. Conclusion: Our study contributes to the ever-growing data suggesting that atopic diathesis is not a risk factor for acquiring COVID-19.

Keywords: Asthma, atopic dermatitis, coronavirus disease 2019, pediatric coronavirus disease 2019, severe acute respiratory syndrome-coronavirus-2

How to cite this article:
Mohta A, Ghiya BC, Mehta RD, Prasad V. Assessment of coronavirus disease 2019 severity in hospitalized pediatric patients with atopic dermatitis: a case‒control study. Indian J Paediatr Dermatol 2022;23:123-5
How to cite this URL:
Mohta A, Ghiya BC, Mehta RD, Prasad V. Assessment of coronavirus disease 2019 severity in hospitalized pediatric patients with atopic dermatitis: a case‒control study. Indian J Paediatr Dermatol [serial online] 2022 [cited 2022 Mar 30];23:123-5. Available from: https://www.ijpd.in/text.asp?2022/23/2/123/341461   Introduction 

It has been widely postulated that the novel coronavirus disease 2019 (COVID-19) leads to more severe disease in patients with allergic conditions. The Centers for Disease Control and Prevention had also included asthma as a risk factor potentially responsible for grave prognosis in infected patients.[1] In addition, other respiratory viruses are already notoriously known to run a more severe course in patients with underlying respiratory illness.[2] However, of late, a handful of case series and studies have concluded against this presumption as far as the COVID-19 infection is concerned, although the data are still conflicting.[3],[4],[5],[6],[7] On the contrary, some studies have also found asthma and atopic dermatitis to be contributing factors for disease severity in COVID-19 patients.[8]

Given such contrasting reports, we aimed at carrying out a case‒control study with the primary objective of assessing the difference between the severity of COVID-19 illness in patients having concurrent atopic dermatitis compared to those without concurrent atopic dermatitis. The secondary objectives involved assessing the differences between the duration of recovery from COVID-19 illness between the two groups. In addition, the severity of atopic dermatitis was correlated with the severity of COVID-19.

  Materials and Methods 

This was an analytical case‒control study conducted in our tertiary care center's inpatient department between July 2020 and September 2021 after obtaining due ethical approval from the institutional ethics committee (F/SPMC/IERB/1903). Written informed consent was taken from parents/guardians of children prior to enrolment. In addition, assent was also taken from children whenever possible. Study subjects included real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients under the age of 18 years. The patients were divided into two groups, namely, cases and controls at the time of admission itself. Cases included children with atopic dermatitis diagnosed according to modified Hanifin and Rajka criteria with positive COVID-19 RT-PCR report. Controls were age-and sex-matched children from the same center with COVID-19, without atopic dermatitis. History for atopic diathesis (asthma, allergic rhinitis, atopic dermatitis, food allergy, food/wool allergy, etc.) was taken. Baseline routine laboratory parameters were noted and repeated every day/every other day during the hospital stay.

The severity of COVID-19 illness was categorized according to computed tomography (CT) score and clinical spectrum of COVID-19 [Table 1]. The severity of atopic dermatitis was assessed according to the SCORAD[9] (SCORing Atopic Dermatitis) score which ranges between 0 and 103 points. The disease was labeled as mild if SCORAD <25, moderate if 25≤SCORAD ≤50, and severe if SCORAD >50.

Sample size calculation was done using the expected odds ratio between exposed and nonexposed groups, the probability of exposure in cases, and control. Using a statistical power of 0.8 and a significance level of 0.05, a sample size of 50 per group was taken.

  Results 

One hundred and sixteen patients completed this study, with 58 patients in each group. The most commonly encountered age group was between 11 and 15 years in both groups (n = 33, 56.9% in cases and n = 38, 65.5% in controls). Since the cases and controls were age-and sex-matched, their characteristics were comparable between the two groups [Table 2].

While assessing the severity of COVID-19 illness on the basis of CT score and clinical severity, there was a higher proportion of "severe" illness in "cases" compared to "controls," however, the difference was statistically insignificant [Table 3] although, "cases" required a longer duration of higher dose medication for managing COVID-19 compared to controls. Twenty eight (48.3%) "cases" and 11 (18.9%) "controls" required systemic steroid therapy to manage their COVID-19 viral pneumonia. Twelve (20.7%) cases and 9 (15.5%) controls required resuscitative measures as well. Of these, 4 cases and 3 controls succumbed to their illness and died.

While comparing the severity of atopic dermatitis (using SCORAD) with the severity of COVID-19 illness, no significant correlation was observed [Table 4]. Interestingly, there was a slight difference in the sociodemographic data of the two groups as well. We found that overall "cases" belonged to a higher socioeconomic family status compared to controls.

Table 4: Correlation of coronavirus disease 2019 disease severity with the severity of atopic dermatitis

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  Discussion 

According to previously published work, there is no increase in severity of COVID-19 illness in patients suffering from any atopic diathesis.[3] The results of our study also found the same and supported their findings. There was a high burden of asthma in the "cases" group (60.34%) compared to controls in our study (15.51%). These findings were contrasting to studies conducted in the USA which had found the prevalence rate of asthma ranging from 9.4% to 21.8%.[3] These findings also suggest that patients with asthma are more likely to seek hospital admission in view of the severity of their symptoms. Conversely, this could also mean that asthma makes pediatric patients more prone to contracting COVID-19. However, a detailed immunological examination is required to establish this hypothesis.

Our study also observed that there is no correlation between the severity of atopic dermatitis and that of COVID-19 illness. This suggests that the severity of preexisting atopic dermatitis has no influence on the outcome of COVID-19 disease severity.

  Conclusion 

Our study contributes to the ever-growing data suggesting that atopic diathesis is not a risk factor for acquiring COVID-19, however, much larger studies conducted over a longer amount of time with immunological analysis are necessary to establish this theory.

Declaration of consent

The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s) of the patient. In the form the parent(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Centers for Disease Control and Prevention. COVID19 People with Moderate to Severe Asthma; c2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/asthma.html. [Last accessed on 2021 Sep 21].  
    2.Busse WW, Lemanske RF Jr., Gern JE. Role of viral respiratory infections in asthma and asthma exacerbations. Lancet 2010;376:826-34.  
    3.Timberlake DT, Narayanan D, Ogbogu PU, Raveendran R, Porter K, Scherzer R, et al. Severity of COVID-19 in hospitalized patients with and without atopic disease. World Allergy Organ J 2021;14:100508.  
    4.Chhiba KD, Patel GB, Vu TH, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol 2020;146:307-14.e4.  
    5.Lieberman-Cribbin W, Rapp J, Alpert N, Tuminello S, Taioli E. The impact of asthma on mortality in patients with COVID-19. Chest 2020;158:2290-1.  
    6.Yang JM, Koh HY, Moon SY, Yoo IK, Ha EK, You S, et al. Allergic disorders and susceptibility to and severity of COVID-19: A nationwide cohort study. J Allergy Clin Immunol 2020;146:790-8.  
    7.Scala E, Abeni D, Tedeschi A, Manzotti G, Yang B, Borrelli P, et al. Atopic status protects from severe complications of COVID-19. Allergy 2021;76:899-902.  
    8.Shi T, Pan J, Katikireddi SV, McCowan C, Kerr S, Agrawal U, et al. Risk of COVID-19 hospital admission among children aged 5-17 years with asthma in Scotland: A National Incident Cohort Study. Lancet Respir Med 2022;10:191-8.  
    9.Severity scoring of atopic dermatitis: The SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.  
    

 
 

  [Table 1], [Table 2], [Table 3], [Table 4]