COVID-19与过敏性皮肤病加重之间的关联：中国西部一项基于问卷的回顾性横断面研究

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中文摘要

2019冠状病毒病（COVID-19）已被认为与全身免疫失调及多种皮肤表现相关，但其与慢性过敏性皮肤病（包括特应性皮炎（AD）和慢性荨麻疹（CU））的关联仍不明确。这项基于问卷的回顾性横断面研究纳入了来自中国西部一家三级皮肤科门诊中心的AD和/或CU患者。自填式问卷收集了COVID-19感染状态、临床特征、用药情况以及COVID-19症状出现或确诊后14天内自报疾病状态变化的数据。结局为自报结果，而非基于经过验证的严重程度评分，且未进行前瞻性纵向随访。采用多变量logistic回归分析以识别与自报加重相关的因素。协变量基于临床相关性预先选择，且无缺失数据。共纳入509例AD和/或CU患者。与非COVID-19组相比，COVID-19参与者更常报告当前饮酒、COVID-19前使用抗组胺药、失眠、过敏性鼻炎以及停用皮肤病药物。COVID-19感染与过敏性皮肤病的自报加重相关，在基线校正模型（比值比[OR]=4.611，95%置信区间[CI]=2.268-9.377）和完全校正模型（OR=4.445，95%CI=2.159-9.151）中均如此。在COVID-19参与者中，发热、头痛、乏力、味觉丧失、报告使用退热药和抗生素以及紧张在加重组与非加重组之间存在差异。经多变量校正后，乏力（OR=1.601，95%CI=1.049-2.443）、味觉丧失（OR=1.654，95%CI=1.004-2.723）以及报告使用抗生素（OR=1.609，95%CI=1.036-2.499）和退热药（OR=1.575，95%CI=1.037-2.392）与自报加重相关，尽管药物相关关联可能反映了适应证混杂。敏感性分析结果一致。在这项于omicron波期间开展的基于问卷的回顾性横断面研究中，COVID-19感染与AD和CU在症状出现或确诊后14天内的自报加重相关。由于结局基于参与者对症状变化的回忆而非客观临床评估，这些发现应谨慎解读，其外推性受限于单中心、omicron时期设计。与退热药和抗生素的关联可能反映适应证混杂而非直接药理作用。需要采用标准化结局指标的前瞻性多中心研究来验证这些发现。

英文摘要

Coronavirus disease 2019 (COVID-19) has been linked to systemic immune dysregulation and various cutaneous manifestations, but its association with chronic allergic skin diseases, including atopic dermatitis (AD) and chronic urticaria (CU), remains unclear. This retrospective questionnaire-based cross-sectional study enrolled patients with AD and/or CU from a tertiary dermatology outpatient center in Western China. Self-administered questionnaires collected data on COVID-19 infection status, clinical characteristics, medication use, and self-reported changes in disease status within 14 days of COVID-19 symptom onset or diagnosis. Outcomes were self-reported rather than based on validated severity scores, and no prospective longitudinal follow-up was performed. Multivariable logistic regression analyses were conducted to identify factors associated with self-reported exacerbation. Covariates were selected a priori based on clinical relevance, and no missing data were present. A total of 509 patients with AD and/or CU were included. Compared with the non-COVID-19 group, participants with COVID-19 more frequently reported current alcohol consumption, pre-COVID-19 antihistamine use, insomnia, allergic rhinitis, and discontinuation of dermatological medications. COVID-19 infection was associated with self-reported exacerbation of allergic skin diseases in both the baseline-adjusted model (odds ratio [OR] = 4.611, 95% confidence interval [CI] = 2.268-9.377) and the fully adjusted model (OR = 4.445, 95% CI = 2.159-9.151). Among participants with COVID-19, fever, headache, fatigue, taste loss, reported use of antipyretics and antibiotics, and nervousness differed between the exacerbation and non-exacerbation groups. After multivariable adjustment, fatigue (OR = 1.601, 95% CI = 1.049-2.443), taste loss (OR = 1.654, 95% CI = 1.004-2.723), and the reported use of antibiotics (OR = 1.609, 95% CI = 1.036-2.499) and antipyretics (OR = 1.575, 95% CI = 1.037-2.392) were associated with self-reported exacerbation, although the medication-related associations likely reflected confounding by indication. Sensitivity analyses yielded consistent results. In this retrospective questionnaire-based cross-sectional study conducted during the omicron wave, COVID-19 infection was associated with self-reported exacerbation of AD and CU within 14 days of symptom onset or diagnosis. Because the outcome was based on participants' recall of symptom change rather than objective clinical assessment, the findings should be interpreted with caution, and their generalizability is limited by the single-center, omicron-period design. Associations with antipyretics and antibiotics likely reflect confounding by indication rather than direct pharmacological effects. Prospective multicenter studies with standardized outcome measures are needed to validate these findings.