The Immunological Association between Alopecia Areata and Respiratory Diseases: A Systematic Review

Abstract

Background: While alopecia areata (AA) has been associated with atopy, the immunological relationship is unclear, with the association of specific atopic and systemic respiratory diseases not established. The relationship between T-helper (Th)1-mediated AA and Th2-mediated atopy challenges the conventional Th1/Th2 paradigm of autoimmune disease categorization. Objectives: To determine the association between AA and atopic respiratory diseases in adults and children, and respiratory diseases in general. Method: All primary literature, excluding case reports, were identified within PubMed/MEDLINE, CINAHL, and Web of Science in May 2018 using the following search terms: “(alopecia OR hair loss) AND (respiratory OR pulmonary OR lungs OR asthma OR rhinitis OR bronchitis OR COPD OR atopy OR atopic).” Information from 32 articles meeting the inclusion and exclusion criteria was reviewed. Results: Among the 32 articles identified for inclusion, the prevalence of AA was more strongly associated with allergic rhinitis compared to asthma among pediatric and adult populations. While a significant association was identified between AA, allergic rhinitis, and a late age of onset, the association of AA and asthma remains controversial despite asthma’s prevalence among AA patients. No significant difference was identified with regard to the association of AA and non-atopic respiratory diseases between adult and pediatric patients. Conclusions: Adult and pediatric patients with AA warrant further workup for atopic respiratory diseases such as allergic rhinitis. AA may have an underlying Th2-mediated immunological component, which supports its association with atopic respiratory diseases and provides a new avenue for targeted therapies in select cases.

Prevalence, comorbidities, and treatment patterns of Japanese patients with alopecia areata: A descriptive study using Japan medical data center claims database

“…Lee et al, 21 in a systemic review and meta‐analysis of comorbidities in AA, also reported that patients with AA have higher odds of allergic diseases compared with controls without AA. Consistent with our results, Sung et al 22 found that allergic rhinitis was the most common comorbidity of AA. Allergy disease history has been identified as a risk factor for increased AA susceptibility and a strong genetic link exists between AA and atopy (allergic rhinitis, atopic dermatitis, asthma) through the interleukin 13 and CLEC16A/KIAA0350 susceptibility loci, which have been identified in AA and other diseases such as psoriasis and arthritis.…”

Alopecia areata in children: an overview of clinical features and recent treatment options

“…Sung и соавт. [31], ГА ассоциируется с аллергическим ринитом в большей степени, чем с бронхиальной астмой. Из других сопутствующих заболеваний c более высокой вероятностью возникновения выделяют витилиго, псориаз, целиакию, язвенный колит, системную красную волчанку, ювенильный ревматоидный артрит, ожирение, гиперлипидемию, сахарный диабет [32].…”