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Possible AD subtype may help identify food allergy risk

In a new study, children with both atopic dermatitis (AD) and food allergies had different structural and molecular changes in the skin near their AD lesions than were found near lesions in children with AD alone. The authors suggest these findings could be used to predict which children with AD are at elevated risk of food allergy, in their paper published in Science Translational Medicine (Feb. 20, 2019; 11(480):eaav2685).

“Children and families affected by food allergies must constantly guard against an accidental exposure to foods that could cause life-threatening allergic reactions,” said Dr. Anthony S. Fauci, in a press release. “Eczema is a risk factor for developing food allergies, and thus early intervention to protect the skin may be one key to preventing food allergy.”

Dr. Fauci is the director of the National Institute of Allergy and Infectious Diseases (NIAID), which supported the research. NIAID is part of the U.S. National Institutes of Health.

In the study, investigators enrolled 62 children aged four to 17 years who either had AD and peanut allergy, AD and no evidence of allergy, or neither condition. The researchers examined the stratum corneum both in areas of AD lesions and in adjacent normal-looking skin through tape stripping.

A researcher demonstrates the minimally invasive collection of skin samples using small, clear tape strips Photo by - National Jewish Health

While the lesional skin of children with both AD and food allergy was indistinguishable from that of children with AD alone, significant differences were found in the structure and molecular composition of the top layer of skin in children with both conditions compared to that of those with AD alone.

Non-lesional skin from children with AD and food allergy was more prone to water loss, had an abundance of Staphylococcus aureus, and had gene expression typical of an immature skin barrier.

These abnormalities also were seen in skin with active AD lesions, suggesting that skin abnormalities extend beyond the visible lesions in children with AD and food allergy but not in those with AD alone.

“Our team sought to understand how healthy-looking skin might be different in children who develop both atopic dermatitis and food allergy compared to children with atopic dermatitis alone,” said lead author Dr. Donald Y.M. Leung, professor and head of the division of pediatric allergy and immunology in the department of pediatrics at National Jewish Health in Denver.

“Interestingly, we found those differences not within the skin rash but in samples of seemingly unaffected skin inches away,” said Dr. Leung. “These insights may help us not only better understand atopic dermatitis, but also identify children most at risk for developing food allergies before they develop overt skin rash and, eventually, fine tune prevention strategies so fewer children are affected.”

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