Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland.
Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, Lausanne, Switzerland.
Eur J Pediatr. 2020 Sep;179(9):1367-1377. doi: 10.1007/s00431-020-03616-5. Epub 2020 Mar 6.
The influence of environmental factors on atopic dermatitis (AD) has been investigated in many cross-sectional studies. It remains however unclear if they could influence AD development early in life. This prospective birth cohort study aimed to monitor aspects of family lifestyle and child's nutrition within a Caucasian population and to assess its association with AD development over the first 2 years of life. Genetic predisposition was evaluated based on family history and profilaggrin genotyping. Of 149 included children, 36 developed AD. Infants with a family history of atopy developed AD 2.6 times more frequently (30 of 97) than infants without atopic predisposition (6 of 52). Genotyping was carried out on 50% of the children included. Profilaggrin mutations (R501X, 2282del4, R2447X, and S3247X) were infrequent in our population. Lower incidence of AD was observed in infants exposed to a damp housing environment, lower household income, and smoking mothers with a higher but not with a lower education level.Conclusion: Family history of atopy was a significant risk factor for AD regardless of the most common, currently defined, FLG mutations. Humidity at home and passive smoking seem associated with AD development in infancy. What is Known: • Atopic dermatitis (AD) is associated with mutations in various genes of the immune system and the epidermal barrier complex in particular filaggrin (FLG) mutation. • Inherited factors alone cannot explain the rising AD; environmental factors are therefore likely to play a decisive role in this rise but the exact role that these factors may play in increasing AD risk in infancy remains unclear. Moreover, the relationship between environmental factors and AD has been the focus of mostly cross-sectional studies and not prospective studies. What is New: • This prospective birth cohort study demonstrates that family history of atopy is a significant risk factor for AD regardless of the most common, currently defined, FLG mutations. • A lower incidence of AD was observed in infants exposed to a moist housing environment, lower household income, and smoking of mothers with a higher but not with a lower education level.
环境因素对特应性皮炎（AD）的影响已在许多横断面研究中进行了研究。然而，目前尚不清楚它们是否会对生命早期的 AD 发展产生影响。这项前瞻性出生队列研究旨在监测白种人群体中家庭生活方式和儿童营养的各个方面，并评估其与生命前 2 年 AD 发展的关联。遗传易感性是基于家族史和 profilaggrin 基因分型来评估的。在 149 名纳入的儿童中，有 36 名患有 AD。有特应性家族史的婴儿患 AD 的频率是没有特应性倾向婴儿的 2.6 倍（97 名中有 30 名，52 名中有 6 名）。对纳入的 50%的儿童进行了基因分型。在我们的人群中，profilaggrin 突变（R501X、2282del4、R2447X 和 S3247X）并不常见。在暴露于潮湿的住房环境、家庭收入较低以及受教育程度较高但不是较低的母亲吸烟的婴儿中，AD 的发病率较低。结论：特应性家族史是 AD 的一个显著危险因素，无论是否存在目前定义的最常见的 FLG 突变。家庭湿度和被动吸烟似乎与婴儿期 AD 的发展有关。已知的： • 特应性皮炎（AD）与免疫系统和表皮屏障复合物的各种基因的突变有关，特别是 profilaggrin（FLG）突变。 • 仅遗传因素不能解释 AD 的上升；因此，环境因素可能在这一上升中起决定性作用，但这些因素在增加婴儿期 AD 风险方面可能起的具体作用尚不清楚。此外，环境因素与 AD 的关系一直是大多横断面研究而不是前瞻性研究的焦点。新的： • 这项前瞻性出生队列研究表明，特应性家族史是 AD 的一个显著危险因素，无论是否存在目前定义的最常见的 FLG 突变。 • 在暴露于潮湿的住房环境、家庭收入较低以及受教育程度较高但不是较低的母亲吸烟的婴儿中，AD 的发病率较低。
