Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch

Abstract

IMPORTANCE Air pollution is a worldwide public health issue that has been exacerbated by recent wildfires, but the relationship between wildfire-associated air pollution and inflammatory skin diseases is unknown.OBJECTIVE To assess the associations between wildfire-associated air pollution and clinic visits for atopic dermatitis (AD) or itch and prescribed medications for AD management. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional time-series study assessed the associations of air pollution resulting from the California Camp Fire in November 2018 and 8049 dermatology clinic visits (4147 patients) at an academic tertiary care hospital system in San Francisco, 175 miles from the wildfire source. Participants included pediatric and adult patients with AD or itch from before, during, and after the time of the fire (October 2018 through February 2019), compared with those with visits in the same time frame of 2015 and 2016, when no large wildfires were near San Francisco. Data analysis was conducted from November 1, 2019, to May 30, 2020.EXPOSURES Wildfire-associated air pollution was characterized using 3 metrics: fire status, concentration of particulate matter less than 2.5 μm in diameter (PM 2.5 ), and satellite-based smoke plume density scores. MAIN OUTCOMES AND MEASURESWeekly clinic visit counts for AD or itch were the primary outcomes. Secondary outcomes were weekly numbers of topical and systemic medications prescribed for AD in adults.RESULTS Visits corresponding to a total of 4147 patients (mean [SD] age, 44.6 [21.1] years; 2322 [56%] female) were analyzed. The rates of visits for AD during the Camp Fire for pediatric patients were 1.49 (95% CI, 1.07-2.07) and for adult patients were 1.15 (95% CI, 1.02-1.30) times the rate for nonfire weeks at lag 0, adjusted for temperature, relative humidity, patient age, and total patient volume at the clinics for pediatric patients. The adjusted rate ratios for itch clinic visits during the wildfire weeks were 1.82 (95% CI, 1.20-2.78) for the pediatric patients and 1.29 (95% CI, 0.96-1.75) for adult patients. A 10-μg/m 3 increase in weekly mean PM 2.5 concentration was associated with a 7.7% (95% CI, 1.9%-13.7%) increase in weekly pediatric itch clinic visits. The adjusted rate ratio for prescribed systemic medications in adults during the Camp Fire at lag 0 was 1.45 (95% CI, 1.03-2.05). CONCLUSIONS AND RELEVANCEThis cross-sectional study found that short-term exposure to air pollution due to the wildfire was associated with increased health care use for patients with AD and itch. These results may provide a better understanding of the association between poor air quality and skin health and guide health care professionals' counseling of patients with skin disease and public health practice.

Phenotypic overlap between atopic dermatitis and autism

“…The prevalence of autism spectrum disorders (ASD) is approaching 2% in populations of all racial, ethnic and socioeconomic groups, with a fourfold male predominance ( https://www.tacanow.org/family-resources/latest-autism-statistics-2/ and https://www.cdc.gov/ncbddd/autism/data.html ). Autism is diagnosed when a patient demonstrates deficits in social interactions; a lack of social or emotional reciprocity; and learning disabilities [ 1 ]. While the diagnosis of ASD is not firmly established until 24 months of age, abnormalities in fMRI scans; preferences for geometric patterns; aberrant social communications; changes in fine motor skills; and/or characteristic eye movements can often be detected as early as 6 months of age [ 2 , 3 ].…”

Climate change and global health: A call to more research and more action

“…Both short‐ and long‐term exposure to wildfire smoke harm health. These health harms include exacerbation of chronic respiratory and cardiovascular conditions; increased occurrence of acute cardiovascular events and metabolic, dermatologic, and mental health disorders; increased susceptibility to respiratory infections such as influenza and SARS‐CoV‐2; immune dysfunction; adverse pregnancy outcomes; sperm damage; infant developmental disorders; and dementia 15,32‐44 . Increases in asthma attacks and asthma hospitalization are associated with wildfires.…”

“…These health harms include exacerbation of chronic respiratory and cardiovascular conditions; increased occurrence of acute cardiovascular events and metabolic, dermatologic, and mental health disorders; increased susceptibility to respiratory infections such as influenza and SARS-CoV-2; immune dysfunction; adverse pregnancy outcomes; sperm damage; infant developmental disorders; and dementia. 15,[32][33][34][35][36][37][38][39][40][41][42][43][44] Increases in asthma attacks and asthma hospitalization are associated with wildfires. A study found that use of prescribed burns, which can decrease size and severity of wildfires, may be beneficial for immune health.…”

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

“…Given the multifactorial nature of CI, it is worth exploring whether environmental factors actually contribute to its presence or intensity. Over the past decade, the associations between CI and air pollution have been explored in the context of children with AD [ 271 , 272 , 273 ]. As reported by Whang et al [ 274 ], internet search queries for the word “itch” in fact correlated with the concurrent concentration of atmospheric particulate matter <2.5 μm (PM 2.5).…”