Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
J Allergy Clin Immunol. 2011 Dec;128(6):1235-1241.e5. doi: 10.1016/j.jaci.2011.09.014. Epub 2011 Oct 26.
It was reported that in infants with eczema and food sensitization, the presence of a filaggrin (FLG) null mutation predicts future asthma with a specificity and positive predictive value of 100%.
We sought to evaluate the predictive value of food sensitization and food allergy, FLG haploinsufficiency, and their combination in infants with early-onset eczema for persistent eczema and childhood asthma.
The German Infant Nutritional Intervention (GINI) and Influence of Lifestyle-related Factors on the Immune System and the Development of Allergies in Childhood (LISA) birth cohorts, as well as a collection of 65 cases of early-onset eczema with and without food allergy were investigated.
The risk for asthma was significantly increased by food sensitization (positive diagnostic likelihood ratios [PLRs] of 1.9 [95% CI, 1.1-3.4] in the GINI cohort and 5.5 [95% CI, 2.8-10.8] in the LISA cohort) and the presence of an FLG mutation (PLRs of 2.9 [95% CI, 1.2-6.6] in the GINI cohort and 2.8 [95% CI, 1.0-7.9] in the LISA cohort) with a rather high specificity (79.1% and 92.9% in the GINI cohort and 89.0% and 91.7% in the LISA cohort, respectively) but low sensitivity (40.0% and 39.3% in the GINI cohort and 31.6% and 23.5% in the LISA cohort, respectively). Likewise, the risk for persistent eczema was increased. In the clinical cases neither food allergy nor FLG mutations had a significant effect. The combination of both parameters did not improve prediction and reached positive predictive values of 52.3% (GINI cohort), 66.9% (LISA cohort), and 30.6% (clinical cases), assuming an asthma prevalence in children with early eczema of 30%.
Early food sensitization and the presence of an FLG mutation in infants with early eczema increase the risk for later asthma, but the combination of the 2 factors does not represent a clinically useful approach to reliably identify children at risk.
据报道，在患有特应性皮炎和食物过敏的婴儿中，丝聚蛋白（FLG）缺失突变的存在可预测未来的哮喘，其特异性和阳性预测值均为 100%。
我们旨在评估食物过敏和食物致敏、FLG 杂合性不足及其组合在患有早发性特应性皮炎婴儿中对持续性特应性皮炎和儿童哮喘的预测价值。
对德国婴儿营养干预（GINI）和生活方式相关因素对免疫系统和儿童过敏发展的影响（LISA）两个出生队列，以及一组 65 例早发性特应性皮炎伴或不伴食物过敏的病例进行了研究。
食物致敏显著增加了哮喘的风险（GINI 队列的阳性诊断似然比 [PLR] 为 1.9 [95%CI，1.1-3.4]，LISA 队列为 5.5 [95%CI，2.8-10.8]），FLG 突变的存在（GINI 队列的 PLR 为 2.9 [95%CI，1.2-6.6]，LISA 队列为 2.8 [95%CI，1.0-7.9]），特异性较高（GINI 队列为 79.1%和 92.9%，LISA 队列为 89.0%和 91.7%），但敏感性较低（GINI 队列为 40.0%和 39.3%，LISA 队列为 31.6%和 23.5%）。同样，持续性特应性皮炎的风险也增加了。在临床病例中，食物过敏和 FLG 突变均无显著影响。这两个参数的组合并未改善预测，在假设早发性特应性皮炎儿童哮喘的患病率为 30%的情况下，阳性预测值分别为 52.3%（GINI 队列）、66.9%（LISA 队列）和 30.6%（临床病例）。
早发性食物致敏和婴儿早发性特应性皮炎中存在 FLG 突变会增加日后哮喘的风险，但这两种因素的组合并不能提供一种临床有用的方法来可靠地识别有风险的儿童。
