Domestic violence, abuse associated with increased risks for atopic disease

Sep 07, 2023

Nash K, et al. J Allergy Clin Immunol Pract. 2023;doi:10.1016/j.jaip.2023.03.016.

Nash K, et al. J Allergy Clin Immunol Pract. 2023;doi:10.1016/j.jaip.2023.03.016.

Women who have been exposed to domestic violence and abuse are at greater risk for asthma, atopic eczema and allergic rhinoconjunctivitis, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

Public health approaches addressing domestic violence and abuse may reduce the burden of atopic disease, Joht Singh Chandan, PhD, clinical associate professor in public health, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, and colleagues wrote.

Previous research has indicated that heightened allostatic load and physiologic stress responses to trauma lead to changes in neuro-immunoregulation and increases in proinflammatory cytokines and neuropeptides. Also, individuals who have been exposed to stress experience increased levels of IgE due to a shift from Th1 cells to Th2 cells.

Individuals who have been exposed to domestic violence and abuse therefore may be more likely to produce IgE antibodies in response to common environmental allergens and develop atopic eczema, asthma and allergic rhinoconjunctivitis, the researchers said.

The population-based, retrospective, open cohort study involved 13,852 women identified with exposure to domestic violence and abuse matched with 49,036 women with no recorded exposure.

These subjects came from the IQVIA Medical Research Data of primary care patients in the U.K., with a study period of Jan. 1, 1995, to Sept. 30, 2019. None of these patients had a history of atopic disease.

The group with exposure to domestic violence and abuse included 967 women who were diagnosed with atopic disease for an incidence rate of 20.1 per 1,000 person-years. The group that was not exposed included 2,607 women diagnosed with atopic disease for an incidence rate of 13.24 per 1,000 person-years.

The adjusted hazard ratio was 1.52 (95% CI, 1.41-1.64) for developing atopic disease among women with recorded exposure to domestic violence and abuse.

Specific adjusted hazard ratios included 1.69 (95% CI, 1.44-1.99) for asthma, 1.63 (95% CI, 1.45-1.84) for allergic rhinoconjunctivitis and 1.4 (95% CI, 1.26-1.56) for atopic eczema.

Next, the researchers restricted results to 3,047 women whose exposure to domestic violence and abuse occurred during the study period, matched with 10,855 women who did not have this exposure.

Adjusted hazard ratios included 1.18 (95% CI, 1-1.4) for atopic disease and 1.57 (95% CI, 1.12-2.19; P = .009) for asthma, 1.05 (95% CI, 0.82-1.35) for atopic eczema and 1.23 (95% CI, 0.93-1.62) for allergic rhinoconjunctivitis among women with exposure.

Results remained robust with the primary analysis when the researchers included ethnicity as a covariate in the main model as well.

Considering the increasing prevalence of atopic diseases, the researchers suggested that domestic violence and abuse may affect a considerable proportion of these diagnoses, indicating a need for public health measures to reduce both domestic violence and abuse and its secondary consequences.

Further, the researchers called for behavioral and policy interventions to address domestic violence and abuse, with clinicians alert to the potential for domestic abuse and violence among patients who present with atopic disease so they could be treated.