title: Atopic dermatitis increases the effect of exposure to peanut antigen in dust on peanut sensitization and likely peanut allergy.
abstract: BACKGROUND
  History and severity of atopic dermatitis (AD) are risk factors for peanut allergy. Recent evidence suggests that children can become sensitized to food allergens through an impaired skin barrier. Household peanut consumption, which correlates strongly with peanut protein levels in household dust, is a risk factor for peanut allergy.
  
  
  OBJECTIVE
  We sought to assess whether environmental peanut exposure (EPE) is a risk for peanut sensitization and allergy and whether markers of an impaired skin barrier modify this risk.
  
  
  METHODS
  Peanut protein in household dust (in micrograms per gram) was assessed in highly atopic children (age, 3-15 months) recruited to the Consortium of Food Allergy Research Observational Study. History and severity of AD, peanut sensitization, and likely allergy (peanut-specific IgE, ≥5 kUA/mL) were assessed at recruitment into the Consortium of Food Allergy Research study.
  
  
  RESULTS
  There was an exposure-response relationship between peanut protein levels in household dust and peanut skin prick test (SPT) sensitization and likely allergy. In the final multivariate model an increase in 4 log2 EPE units increased the odds of peanut SPT sensitization (1.71-fold; 95% CI, 1.13- to 2.59-fold; P = .01) and likely peanut allergy (PA; 2.10-fold; 95% CI, 1.20- to 3.67-fold; P < .01). The effect of EPE on peanut SPT sensitization was augmented in children with a history of AD (OR, 1.97; 95% CI, 1.26-3.09; P < .01) and augmented even further in children with a history of severe AD (OR, 2.41; 95% CI, 1.30-4.47; P < .01); the effect of EPE on PA was also augmented in children with a history of AD (OR, 2.34; 95% CI, 1.31-4.18; P < .01).
  
  
  CONCLUSIONS
  Exposure to peanut antigen in dust through an impaired skin barrier in atopically inflamed skin is a plausible route for peanut SPT sensitization and PA.
authors.affiliation: Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Brough
authors.affiliation: Paediatric Allergy, National Jewish Health, Denver, Colo.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, NY.
authors.forename: Scott
authors.initials: S
authors.lastname: Sicherer
authors.affiliation: Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, United Kingdom.
authors.forename: Kerry
authors.initials: K
authors.lastname: Makinson
authors.affiliation: Department of Public Health Science, School of Medicine, King's College London, London, United Kingdom.
authors.forename: Abdel
authors.initials: A
authors.lastname: Douiri
authors.affiliation: Centre for Dermatology and Genetic Medicine, College of Life Sciences and College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, United Kingdom.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, United Kingdom.
authors.forename: Alick C
authors.initials: AC
authors.lastname: Stephens
authors.affiliation: Centre for Dermatology and Genetic Medicine, College of Life Sciences and College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, United Kingdom.
authors.forename: W H
authors.initials: WH
authors.lastname: Irwin McLean
authors.affiliation: Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, United Kingdom.
authors.forename: Victor
authors.initials: V
authors.lastname: Turcanu
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wood
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark.
authors.forename: Stacie M
authors.initials: SM
authors.lastname: Jones
authors.affiliation: Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
authors.forename: Wesley
authors.initials: W
authors.lastname: Burks
authors.affiliation: EMMES Corporation, Rockville, Md.
authors.forename: Peter
authors.initials: P
authors.lastname: Dawson
authors.affiliation: EMMES Corporation, Rockville, Md.
authors.forename: Donald
authors.initials: D
authors.lastname: Stablein
authors.affiliation: Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, NY.
authors.forename: Hugh
authors.initials: H
authors.lastname: Sampson
authors.affiliation: Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, United Kingdom. Electronic address: Gideon.lack@kcl.ac.uk.
authors.forename: Gideon
authors.initials: G
authors.lastname: Lack
mesh_terms: D000485:Allergens / Q000032:analysis* / Q000276:immunology; D052179:Antigens, Plant / Q000032:analysis* / Q000276:immunology; D010367:Arachis / Q000276:immunology*; D003876:Dermatitis, Atopic / Q000453:epidemiology* / Q000276:immunology; D004391:Dust / Q000032:analysis* / Q000276:immunology; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis; D005260:Female; D006798:Housing; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D021183:Peanut Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D010940:Plant Proteins / Q000032:analysis / Q000276:immunology; D012882:Skin Tests
chemical_list: D000485:Allergens; D052179:Antigens, Plant; D004391:Dust; D010940:Plant Proteins
keywords: Atopic dermatitis; dust; environmental peanut exposure; peanut allergy; peanut sensitization