Editors' ChoiceALLERGIC DISEASE

Barriers in food allergy prevention

Science Translational Medicine  16 Mar 2016:
Vol. 8, Issue 330, pp. 330ec45
DOI: 10.1126/scitranslmed.aaf6184

Exposure to food antigens, especially on inflamed skin, may promote the development of food allergy in some people. Identifying who is at risk is difficult because food allergy occurs at such a young age. Now, Kelleher and colleagues describe a significant association between skin barrier dysfunction in 2-day-old babies and the diagnosis of food allergy at age 2. These data may aid early identification of infants who can benefit from preventative interventions.

The authors measured transepidermal water loss (TEWL), a measure of skin barrier function, at birth and at 2 and 6 months in 1903 infants. Later, when the children were 2 years of age, they screened 1260 for food sensitization and food allergy. The mean newborn TEWL was 7.32 gwater/m2/h, which increased to 10.97 at 2 months and 10.71 at 6 months. There were significant associations between atopic dermatitis (an inflammatory skin disease) at all time points and food sensitization and food allergy, as well as with food sensitization/food allergy at 2 years of age. Fully 74.5% of the children who had food allergy at age 2 were in the top 25% for skin barrier dysfunction on day 2 of life. These infants were over 3 times more likely than the others to have food allergies at 2 years of age. Even prior to the diagnosis of atopic dermatitis, infants at high risk of food allergy can be identified at 2 days of life.

The authors also discovered that in children with food allergy but no atopic dermatitis at age 2, 60% had high TEWL at birth and were 3.5 times more likely to have food allergy at 2 years of age. Thus, in the absence of any symptomatic skin inflammation or atopic dermatitis, a dysfunctional skin barrier at 2 days of life increased the risk of food allergy at 2 years of age. A deficient skin barrier can be present without symptoms and may lead to later sensitization and food allergy.

The rising prevalence of food allergy and atopic dermatitis requires both primary and secondary prevention strategies. These new results point to a noninvasive test that may be used in combination with other factors to identify children most at risk for food allergy.

M. M. Kelleher et al., Skin barrier impairment at birth predicts food allergy at 2 years of age. J. Allergy Clin. Immunol. 10.1016/j.jaci.2015.12.1312 (2016). [Abstract]

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