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Impaired skin barrier and allergic sensitization in early infancy
Sabina Wärnberg Gerdin1,2, Anine Lie3,4, Anna Asarnoj1,2
1Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Insights
Infant eczema, dry skin, and high transepidermal water loss (TEWL) at 3 months predict allergic sensitization by 6 months. These early skin indicators are crucial for identifying infants at risk of developing allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Neonatal Research
Background:
- Predicting allergic sensitization in early infancy remains a challenge.
- Understanding early-life factors is crucial for allergy prevention strategies.
Purpose of the Study:
- To determine if eczema, dry skin, and high transepidermal water loss (TEWL) at 3 months predict allergic sensitization at 6 months.
- To assess the predictive value of these skin characteristics for sensitization development between 3 and 6 months of age.
Main Methods:
- A population-based cohort of 1,994 infants (PreventADALL) was studied in Norway and Sweden.
- Eczema, dry skin, and TEWL (impaired skin barrier) were assessed at 3 months.
- Allergic sensitization was evaluated at 6 months using skin prick tests and allergen-specific IgE levels.
Main Results:
- Allergic sensitization was identified in 9.9% of infants, predominantly to food allergens.
- Eczema, dry skin, and high TEWL at 3 months significantly increased the risk of allergic sensitization at 6 months.
- High TEWL demonstrated the highest specificity (78.1%) in predicting sensitization.
Conclusions:
- Eczema, dry skin, and high TEWL at 3 months are significant predictors of allergic sensitization by 6 months of age.
- These early skin indicators can aid in identifying infants at risk for developing allergies.
Background:
Factors predicting allergic sensitization in the first 6 months of life are poorly understood. We aimed to determine whether eczema, dry skin, and high transepidermal water loss (TEWL) at 3 months were associated with allergic sensitization at 6 months of age and, secondarily, to establish whether these characteristics predicted sensitization from 3 to 6 months of age.
Methods:
At 3 months of age, 1,994 infants from the population-based PreventADALL birth cohort in Norway and Sweden were assessed for eczema and dry skin on the cheeks and/or extensors; impaired skin barrier function, defined as TEWL in the upper quartile (>9.4 g/m2 /h), and allergen-specific IgE levels <0.1 kUA /L, available in 830. At 6 months, we assessed allergic sensitization to any food (egg, cow's milk, peanut, wheat, soy) or inhalant (birch, timothy grass, dog, and cat) allergen by a skin prick test wheal diameter ≥2 mm larger than negative control.
Results:
Any sensitization was found in 198 of the 1,994 infants (9.9%), the majority to food allergens (n = 177, 8.9%). Eczema, dry skin, and high TEWL at 3 months increased the risk of sensitization at 6 months; adjusted odds ratios 4.20 (95% CI 2.93-6.04), 2.09 (95% CI 1.51-2.90) and 3.67 (95% CI 2.58-5.22), respectively. Eczema predicted sensitization with 55.6% sensitivity and 68.1% specificity; dry skin with 65.3% sensitivity and 57.3% specificity; and high TEWL with 61.7% sensitivity and 78.1% specificity.
Conclusion:
Eczema, dry skin, and high TEWL at 3 months predicted allergic sensitization at 6 months of age.
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