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• W3195377225 abstract "To the Editor: We appreciate the interest of Ya et al1Ya Y.C. Chen S.P. Wei J.C.C. Correspondence to “Association between psoriasis and asthma among United States adults in the 2009-2014 national health and nutrition examination survey”.J Am Acad Dermatol. 2022; 86: e117https://doi.org/10.1016/j.jaad.2021.06.899Google Scholar regarding our article “Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.”2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar The authors highlight potential covariates to add to our multivariable logistic regression models. Additionally, they recommend further discussion of the subgroup analyses of obese and nonobese participants. Lastly, they address asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS) and discuss dysregulation of the interleukin (IL) 23/Th17 axis in both asthma and psoriasis.2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar We agree that adding air pollution, family history of asthma, and history of atopy as covariates to the models would further strengthen our study and we thank the authors for their recommendations. However, these variables are not available in the 2009-2014 National Health and Nutrition Examination Survey data. Notably, participants were asked “During the past 12 months, have you had an episode of hay fever?” in these cycles. However, this question does not specifically ask if hay fever was diagnosed by a health care professional and only questions participants about hay fever symptoms within the last year. As such, we do not believe data from this question are reliable enough to properly assess atopic history. Although oral corticosteroids are not generally recommended for treatment of psoriasis due to the risk of flaring with reduction or withdrawal, there is no strong evidence to suggest systemic steroid exposure poses risk of new-onset psoriasis.3Mrowietz U. Domm S. Systemic steroids in the treatment of psoriasis: what is fact, what is fiction?.J Eur Acad Dermatol Venereol. 2013; 27: 1022-1025https://doi.org/10.1111/J.1468-3083.2012.04656.XGoogle Scholar Thus, oral corticosteroids are unlikely to account for a higher prevalence of asthma in adults with psoriasis compared to adults without psoriasis. After adding 25-hydroxyvitamin D levels to the model, the adjusted odds ratio from the primary analyses remained unchanged, indicating this vitamin level is not an important covariate when evaluating the association between asthma and psoriasis. Although subgroup analysis of nonobese participants yielded a higher adjusted odds ratio point estimate compared to subgroup analysis of obese participants, results from an adjusted Wald test (P = .40) suggest the adjusted odds ratio are not significantly different between the 2 groups. Subgroup analysis and full sample analysis are expected to have consistent inferences. Therefore, it is encouraged to use full-sample–based inferences over subgroup-based inferences, which are of lower power and require testing to determine if mean trends are significantly different. We concur that it may be difficult to differentiate isolated asthma from ACOS in certain clinical scenarios. Furthermore, ACOS is a poorly defined entity with evolving diagnostic criteria, making ACOS challenging to assess in epidemiology studies.4Cosío B.G. Dacal D. de Llano L.P. Asthma–COPD overlap: identification and optimal treatment.Ther Adv Respir Dis. 2018; 12 (1753466618805662)https://doi.org/10.1177/1753466618805662Google Scholar Ya et al2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar correctly highlight that our study was limited by the use of questionnaire data. However, the National Health and Nutrition Examination Survey specifically asks subjects if chronic bronchitis and emphysema were diagnosed by a health care professional, who are likely utilizing spirometry to diagnose these diseases, as it is a cornerstone of chronic obstructive pulmonary disease evaluation. Besides promoting Th17 cells, which drive neutrophil recruitment frequently seen in lungs of patients with severe asthma, IL 23 has been shown to mediate Th2 cytokines production and eosinophil infiltration, independent of IL-17.5Li Y. Hua S. Mechanisms of pathogenesis in allergic asthma: role of interleukin-23.Respirology. 2014; 19: 663-669https://doi.org/10.1111/RESP.12299Google Scholar Consequently, as Ya et al2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar suggested, IL-17 and IL-23 warrant further attention as a potential link between asthma and psoriasis. Dr Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Dr. Reddy's Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, Valeant Pharmaceuticals North America LLC, and Zerigo Health. Dr Egeberg has received research funding from Pfizer , Eli Lilly , Novartis , Bristol-Myers Squibb , AbbVie , Janssen Pharmaceuticals , the Danish National Psoriasis Foundation , the Simon Spies Foundation , and the Kgl Hofbundtmager Aage Bang Foundation , and honoraria as consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals. Authors Martin, Thatiparthi, and Liu, and Dr Ge have no conflicts of interest to declare. Correspondence to “Association between psoriasis and asthma among United States adults in the 2009-2014 national health and nutrition examination survey”Journal of the American Academy of DermatologyVol. 86Issue 3PreviewTo the Editor: We read with immense interest the article by Martin et al and believe a few matters could be addressed. First, models in this study were adjusted by age, sex, ethnicity, income, body mass index, tobacco use, and chronic obstructive pulmonary disease. We suggest adding confounders, such as air pollution, atopy, asthma family history and steroid use, as these were found to be strong confounders in our previous study.1 Vitamin D3 levels have been significantly linked to psoriasis2 and asthma. Full-Text PDF" @default.
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• W3195377225 title "Reply to “Correspondence to ‘Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey’”" @default.
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