In Reply We thank Tsai and Ma for their interest in our article¹ and appreciate the opportunity to discuss the points raised.

Previous studies on cognition in atopic dermatitis (AD) are heterogeneous in their methods and findings.^2-4 In our current study,¹ AD was associated with greater odds of memory or learning difficulties among US children, but this association was primarily limited to children with known neurodevelopmental comorbidities such as attention-deficit/hyperactivity disorder (ADHD) or learning disabilities.

Tsai and Ma raise concerns with our stratified analyses among children with learning disabilities, which showed that children with both AD and learning disability had lower odds of learning difficulties. However, we note that these lower odds are relative to children with learning disabilities but no AD, not to children without learning disabilities as interpreted by Tsai and Ma. Although the latter comparison was not presented in our article, we note here that among children with AD, the presence of any neurodevelopmental comorbidity (ie, ADHD, developmental delay, or learning disability) was associated with a 25-fold higher odds of learning difficulties (adjusted odds ratio, 24.96; 95% CI, 12.94-48.15). Similarly, children with both AD and learning disability had a 30-fold higher odds of learning difficulties than children with AD but no learning disability (adjusted odds ratio, 30.73; 95% CI, 15.19-62.20).