Presence of Eczema May Affect Infant Food Allergies

Larry Hand

July 18, 2013

Infants with atopic dermatitis (AD), also known as atopic eczema, may be more likely than infants without AD to be sensitized to commonly allergenic foods, according to an article published online July 18 in the Journal of Investigative Dermatology.

Carsten Flohr, PhD, from the St. John's Institute, Guy's and St. Thomas' Hospital National Health Service Foundation Trust, London, United Kingdom, and colleagues conducted a study of 619 exclusively breastfed infants at 3 months of age. They examined the infants for AD and disease severity and screened for filaggrin loss-of-function (FLG) gene mutations. They performed skin-prick tests against 6 foods: cow's milk, egg, cod fish, wheat, sesame, and peanut.

Of the 619 children in the study, 154 (24.9%) had clinical AD, including 85.7% with mild AD and 14.3% with moderate to severe AD. Higher transepidermal water loss (TEWL) was associated with more severe disease. Of the children, 75 (12.1%) carried at least a single FLG mutation, and 37 (24.0%) children with AD were FLG mutation carriers. FLG mutations were significantly associated with incidence of AD (odds ratio [OR], 3.55; 95% confidence interval [CI], 2.16 - 5.84; P < .001) and higher median TEWL, relative to severity of AD. Although children with AD were significantly more likely to be sensitized to foods (adjusted OR, 6.18; 95% CI, 2.94 - 12.98; P < .001), the effect was not related to FLG mutation inheritance. However, a strong association existed between AD severity and sensitization (adjusted OR, 3.91; 95% CI, 1.70 - 9.00; P = .001).

The researchers also found positive associations between AD and specific foods. For instance, egg had an adjusted OR of 9.48 (95% CI, 3.77 - 23.83; P < .001), cow's milk an adjusted OR of 9.11 (95% CI, 2.27 - 36.59; P = .002), and peanut an adjusted OR of 4.09 (95% CI, 1.00 - 16.76; P = .05). All OR estimates were adjusted for sex.

With AD being the main skin-related risk factor for food sensitization in infants, the researchers write, "In exclusively breastfed children this suggests that allergic sensitization to foods can be mediated by cutaneous antigen-presenting cells."

J Invest Dermatol. Published online July 18, 2013.

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