Paediatrics and Child Health, University College Cork, Cork, Ireland.
Paediatrics and Child Health, University College Cork, Cork, Ireland; National Children's Research Centre, Dublin, Ireland.
J Allergy Clin Immunol. 2016 Apr;137(4):1111-1116.e8. doi: 10.1016/j.jaci.2015.12.1312.
Transcutaneous exposure to food allergens can lead to food sensitization (FS)/food allergy (FA). We measured skin barrier function in early infancy and related it to the later development of FS/FA at age 2 years.
We sought to examine the relationship between early life skin barrier function and FA in infancy.
Infants in the Babies After Scope: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE) birth cohort had transepidermal water loss (TEWL) measured in the early newborn period and at 2 and 6 months of age. At age 2 years, infants had FS/FA screening with skin prick tests and oral food challenges.
One thousand nine hundred three infants were enrolled. One thousand three hundred fifty-five were retained to age 2 years, and 1260 underwent FS screening. FS was present in 6.27% (79/1260; 95% CI, 4.93% to 7.61%), and FA prevalence was 4.45% (56/1258; 95% CI, 3.38% to 5.74%). Egg was the most prevalent allergen (2.94%), followed by peanut (1.75%) and cow's milk (0.74%). Day 2 upper-quartile TEWL (>9 g water/m(2)/h) was a significant predictor of FA at age 2 years (odds ratio [OR], 4.1; 95% CI, 1.5-4.8). Seventy-five percent of children with FA at 2 years of age had day 2 TEWL in the upper quartile. Even in those without atopic dermatitis (AD), infants with upper-quartile day 2 TEWL were 3.5 times more likely to have FA at 2 years than infants in the lowest quartile (95% CI, 1.3-11.1; P = .04).
Neonatal skin barrier dysfunction predicts FA at 2 years of age, supporting the concept of transcutaneous allergen sensitization, even in infants who do not have AD. TEWL could be used for stratifying infants in the first few days of life before development of AD or FA for targeted intervention studies to potentially alter the atopic march.
经皮接触食物过敏原可导致食物致敏（FS）/食物过敏（FA）。我们在婴儿早期测量皮肤屏障功能，并将其与 2 岁时 FS/FA 的后期发展相关联。
我们旨在研究婴儿期早期生活皮肤屏障功能与 FA 之间的关系。
婴儿期后范围评估：使用神经和营养终点（基线）的婴儿队列测量了新生儿期以及 2 个月和 6 个月时的经皮水分丢失（TEWL）。在 2 岁时，婴儿接受了皮肤点刺试验和口服食物挑战的 FS/FA 筛查。
共纳入 1930 名婴儿。1355 名婴儿保留至 2 岁，1260 名婴儿进行了 FS 筛查。FS 的患病率为 6.27%（79/1260；95%CI，4.93%至 7.61%），FA 的患病率为 4.45%（56/1258；95%CI，3.38%至 5.74%）。鸡蛋是最常见的过敏原（2.94%），其次是花生（1.75%）和牛奶（0.74%）。第 2 天的上四分位数 TEWL（>9g 水/m2/h）是 2 岁时 FA 的显著预测因子（比值比[OR]，4.1；95%CI，1.5-4.8）。2 岁时有 FA 的儿童中，有 75%的第 2 天 TEWL 在上四分位数。即使在没有特应性皮炎（AD）的儿童中，上四分位数第 2 天 TEWL 的婴儿发生 FA 的可能性也比最低四分位数的婴儿高 3.5 倍（95%CI，1.3-11.1；P=0.04）。
新生儿皮肤屏障功能障碍可预测 2 岁时的 FA，支持经皮过敏原致敏的概念，即使在没有 AD 的婴儿中也是如此。TEWL 可用于在 AD 或 FA 发生之前对生命早期的婴儿进行分层，以便进行有针对性的干预研究，以潜在地改变特应性发病进程。
