Work

Sensitization to peanut, egg or pets is associated with skin barrier dysfunction in children with atopic dermatitis

Year: 2021

Type: article

Abstract: Background Children with atopic dermatitis (AD) are often sensitized to food and aeroallergens, but sensitization patterns have not been analysed with biologic measures of disease pathogenicity. Objective We sought to define allergen sensitization grouping(s) using unbiased machine learning and determine their associations with skin filaggrin (FLG) and transepidermal water loss (TEWL) (assesses skin barrier integrity),S100A8andS100A9expression (assesses skin inflammation) and AD severity. Methods We studied 400 children with AD in the Mechanisms of Progression from Atopic Dermatitis to Asthma in Children (MPAACH) cohort to identify groupings of food and aeroallergen sensitizations. MPAACH is a paediatric AD cohort, aged 1–2, recruited through hospital/community settings between 2016 and 2018. We analysed these groupings' associations with AD biomarkers: skinFLG,S100A8andS100A9expression, total IgE, TEWL and AD severity. Results An unbiased machine learning approach revealed five allergen clusters. The most common cluster (N = 131), SPTPEP,had sensitization to peanut, egg and/or pets. Three low prevalence clusters, which included children with allergen sensitization other than peanut, egg or pets, were combined into SPTOther. SPTNEGincluded children with no sensitization(s). SPTPEPchildren had higher median non‐lesional TEWL (16.9 g/m2/h) and IgE (90 kU/L) compared with SPTOTHER(8.8 g/m2/h and 24 kU/L;p = .01 andp < .001) and SPTNEG(9 g/m2/h and 26 kU/L;p = .003 andp < .001). SPTPEPchildren had lower median lesional (0.70) and non‐lesional (1.09)FLGexpression compared with SPTOTHER(lesional: 0.9;p = .047, non‐lesional: 1.78;p = .01) and SPTNEG(lesional: 1.47;p < .001, non‐lesional: 2.21;p < .001). There were no differences among groupings inS100A8orS100A9expression. Conclusions and clinical relevance In this largely clinic‐based cohort of young children with AD, allergic sensitization to peanut, egg, cat or dog was associated with more severe disease and skin barrier function but not markers of cutaneous inflammation. These data need replicating in a population‐based cohort but may have important implications for understanding the interaction between AD and allergic sensitization.

Source: Clinical & Experimental Allergy

DOI: 10.1111/cea.13866