Study Finds No Significant Link Between Atopic Dermatitis Severity Scores, Peanut Sensitivity

Sara Bilimoria, MD

A recent study found no significant relationship between atopic dermatitis (AD) severity, as measured by patient-oriented scoring of atopic dermatitis (PO-SCORAD) and Patient Oriented Eczema Measure (POEM) surveys, and peanut sensitivity.

The study’s investigators measured peanut sensitivity through Immunoglobulin E (IgE) or skin prick test levels. The study was led by Sara Bilimoria, MD, of the Northwestern University Feinberg School of Medicine.

The investigators noted that AD was a primary risk factor for the developing food sensitisation and IgE-mediated food allergies, which prompted further examination in the study itself. The study population was acknowledged to be smaller and consequently the subject may warrant further research.

“Despite no significant relationship found between PO-SCORAD or POEM score and peanut sensitivity, the hypothesis that AD severity can predict risk of peanut sensitivity may still be valid based on a growing body of evidence,” Bilimoria and colleagues wrote. “The negative results of this study are likely due to the small study population used due to limitations of the COVID-19 pandemic. Moreover, evaluating AD severity through PO-SCORAD and POEM surveys may not be ideal for pediatric patients.”

Background

The investigators recruited study participants between the ages of 3 months and 18-years-old without a previous diagnosis of peanut allergy who were receiving IgE or skin prick testing for peanut allergies. They were pulled from 2 allergy clinics around the Chicago area, with participants or their guardians filling out both a PO-SCORAD survey and a POEM survey.

The PO-SCORAD score is determined 60% through clinical signs and 20% through participants’ subjective symptoms, and possible PO-SCORAD scores can be anywhere from 0 to 83, with 83 being the highest AD severity.

The POEM is made up of 7 questions asking about the frequency of AD-related itch, sleep disturbance, cracked skin, weeping, bleeding, oozing, flaking, and dryness within the past week, with a score range of 0 to 28. A 0 points to being clear or almost clear of AD, whereas a score ranging from 25 to 28 points to significant AD severity.

Findings

The study reported that 20 total patients were able to meet inclusion criteria in their required time frame, with the mean age of patients recruited being 19.9 months.

The researchers found no significant difference between sexes or age categories in severity of AD as assessed by POEM or PO-SCORAD scores (≥12 months compared to <12 months). They also did not identify a significant relationship between PO-SCORAD or POEM scores and the rate of peanut sensitivity.

The investigators stress that the study’s negative results may be due to the smaller population tested, which they connected to COVID-19 pandemic limitations.

“If providers continue to use the (National Institute of Allergy and Infectious Disease)’s guidelines to direct their clinical decisions, it is crucial to identify those at highest risk of epicutaneous exposure and subsequent peanut allergy by using a tool to objectively evaluate AD severity,” they wrote. “At the same time, recent consensus guidelines…recommend introducing peanuts into children's diets at 6 months of age, irrespective of their baseline risk, as the potential benefit of introducing peanuts early outweighs delayed peanut introduction.”

The study, “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 the Journal of the European Academy of Dermatology and Venereology.