Clinicians should consider atopic disease history when planning and managing reconstructive surgeries, according to two new studies presented this week at the American College of Allergy, Asthma, and Immunology (ACAAI) 2025 Annual Meeting in Orlando, Florida.

Researchers from The University of Texas Medical Branch in Galveston, Texas, along with collaborators in Houston, reported that patients with atopic skin or allergic conditions experienced significantly higher rates of implant and bone graft complications following surgery, even after controlling for other risk factors.

In one retrospective analysis, women with eczema, dermatitis, or other allergic skin conditions who underwent implant-based breast reconstruction were more likely to develop complications than nonatopic patients. Among more than 20,000 matched cases, those with atopic skin conditions had increased risks for implant complications (relative risk [RR], 1.2; P < .0001), capsular contracture at 2 and 3 years post-surgery (RR, 1.2; P ≤ .0005), and revision surgeries at any point (RR, 1.1; P < .001).

Rates of implant removal, rupture, and infection were also significantly higher among the atopic group across multiple postoperative intervals.

The researchers suggested that underlying skin barrier dysfunction and immune dysregulation in atopic patients may predispose them to inflammation, infection, and fibrosis following reconstruction.

A companion multicenter study led by the same research team found similar patterns among patients undergoing bone grafting procedures. Drawing on data from the TriNetX research network, the study compared more than 19,000 patients with atopic disease with a matched nonatopic cohort. Within 90 days, atopic patients had higher risks for wound infection or complications (hazard ratio [HR], 1.19; 95% CI, 1.08-1.32), osteomyelitis (HR, 1.29; 95% CI, 1.12-1.48), and hardware removal (HR, 1.22; 95% CI, 1.05-1.41).

At 2 years, elevated risks persisted for infection, osteomyelitis, hardware removal, mechanical loosening (HR, 1.35; 95% CI, 1.17-1.56), and revision surgery (HR, 1.16; 95% CI, 1.09-1.25). No significant differences were observed in graft failure or fracture rates.

Lead author Philong Nguyen, medical student at The University of Texas Medical Branch who contributed to both studies, said that the current findings should be interpreted in context and warrant additional research.

“Our topic should ideally be further evaluated through prospective cohort studies to establish causation,” Nguyen said. “While our current work leverages a large national database with an extensive sample size, it can only demonstrate associations, not causal relationships.”

He added that the results nonetheless have practical relevance for clinicians.

“For everyday clinicians, recognizing atopic disease as a potential risk factor and effectively communicating this to patients remains essential,” Nguyen said. Ultimately, our study helps lay the groundwork for future research to explore these causal links more directly, he said.

Farah Khan, MD, allergist who was not involved in the studies, said the findings highlight the importance of accurate allergy documentation in surgical care.

“A lot of it has to do with drug allergies,” she said. “When you have a drug allergy list that doesn’t actually reflect what you’re truly allergic to, then surgeons and teams have to reach for alternative antibiotics that are often more costly, with a lot more side effects, which can complicate surgical site healing from infections.”

Khan said collaboration between allergists and surgical teams can improve outcomes, especially for elective procedures.

Ensuring access to allergists, when feasible, and verifying patient allergy histories can streamline care and reduce postoperative complications, she said.

Nguyen and Khan reported having no relevant disclosures.

Lara Salahi is a health journalist based in Boston.