Predictive value of food sensitization and filaggrin mutations in children with eczema

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• 作者：Birgit Filipiak-Pittroff MSc^a ;   ; ^b ;   ; ^&lowast ; ; Christina Schnopp MD^c ;   ; ^&lowast ; ; Dietrich Berdel MD^b ; Aline Naumann MSc^d ; Simon Sedlmeier^c ; Anna Onken MD^c ; Elke Rodriguez MSc^e ; Regina Fö ; lster-Holst MD^e ; Hansjö ; rg Baurecht MSc^e ;   ; ^f ; Markus Ollert MD^c ; Johannes Ring MD ; PhD^c ; Claudia Cramer MSc^g ; Andrea von Berg MD^b ; Carl Peter Bauer MD^h ; Olf Herbarth PhDⁱ ; Irina Lehmann PhD^j ; Beate Schaaf MD^k ; Sibylle Koletzko MD^l ; Heinz-Erich Wichmann MD ; PhD^a ; Joachim Heinrich PhD^a ;   ; ^{joachim.heinrich@helmholtz-muenchen.de} ; Stephan Weidinger MD^e ;   ; ^&lowast ; ; GINIplus ; LISAplus study groups
• 关键词：Eczema ; atopic dermatitis ; asthma ; food sensitization ; food allergy ; filaggrin ; prediction
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：128
• 期：6
• 页码：1235-1241.e5
• 全文大小：200 K

文摘

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lass=""h4"">Background

It was reported that in infants with eczema and food sensitization, the presence of a filaggrin lns="""">(FLG) null mutation predicts future asthma with a specificity and positive predictive value of 100 % .

lass=""h4"">Objectives

We sought to evaluate the predictive value of food sensitization and food allergy, lns="""">FLG haploinsufficiency, and their combination in infants with early-onset eczema for persistent eczema and childhood asthma.

lass=""h4"">Methods

The German Infant Nutritional Intervention (GINI) and Influence of Lifestyle-related Factors on the Immune System and the Development of Allergies in Childhood (LISA) birth cohorts, as well as a collection of 65 cases of early-onset eczema with and without food allergy were investigated.

lass=""h4"">Results

The risk for asthma was significantly increased by food sensitization (positive diagnostic likelihood ratios [PLRs] of 1.9 [95 % CI, 1.1-3.4] in the GINI cohort and 5.5 [95 % CI, 2.8-10.8] in the LISA cohort) and the presence of an lns="""">FLG mutation (PLRs of 2.9 [95 % CI, 1.2-6.6] in the GINI cohort and 2.8 [95 % CI, 1.0-7.9] in the LISA cohort) with a rather high specificity (79.1 % and 92.9 % in the GINI cohort and 89.0 % and 91.7 % in the LISA cohort, respectively) but low sensitivity (40.0 % and 39.3 % in the GINI cohort and 31.6 % and 23.5 % in the LISA cohort, respectively). Likewise, the risk for persistent eczema was increased. In the clinical cases neither food allergy nor lns="""">FLG mutations had a significant effect. The combination of both parameters did not improve prediction and reached positive predictive values of 52.3 % (GINI cohort), 66.9 % (LISA cohort), and 30.6 % (clinical cases), assuming an asthma prevalence in children with early eczema of 30 % .

lass=""h4"">Conclusion

Early food sensitization and the presence of an lns="""">FLG mutation in infants with early eczema increase the risk for later asthma, but the combination of the 2 factors does not represent a clinically useful approach to reliably identify children at risk.