title: Skin barrier impairment at birth predicts food allergy at 2 years of age.
abstract: BACKGROUND
  Transcutaneous exposure to food allergens can lead to food sensitization (FS)/food allergy (FA). We measured skin barrier function in early infancy and related it to the later development of FS/FA at age 2 years.
  
  
  OBJECTIVE
  We sought to examine the relationship between early life skin barrier function and FA in infancy.
  
  
  METHODS
  Infants in the Babies After Scope: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE) birth cohort had transepidermal water loss (TEWL) measured in the early newborn period and at 2 and 6 months of age. At age 2 years, infants had FS/FA screening with skin prick tests and oral food challenges.
  
  
  RESULTS
  One thousand nine hundred three infants were enrolled. One thousand three hundred fifty-five were retained to age 2 years, and 1260 underwent FS screening. FS was present in 6.27% (79/1260; 95% CI, 4.93% to 7.61%), and FA prevalence was 4.45% (56/1258; 95% CI, 3.38% to 5.74%). Egg was the most prevalent allergen (2.94%), followed by peanut (1.75%) and cow's milk (0.74%). Day 2 upper-quartile TEWL (>9 g water/m(2)/h) was a significant predictor of FA at age 2 years (odds ratio [OR], 4.1; 95% CI, 1.5-4.8). Seventy-five percent of children with FA at 2 years of age had day 2 TEWL in the upper quartile. Even in those without atopic dermatitis (AD), infants with upper-quartile day 2 TEWL were 3.5 times more likely to have FA at 2 years than infants in the lowest quartile (95% CI, 1.3-11.1; P = .04).
  
  
  CONCLUSIONS
  Neonatal skin barrier dysfunction predicts FA at 2 years of age, supporting the concept of transcutaneous allergen sensitization, even in infants who do not have AD. TEWL could be used for stratifying infants in the first few days of life before development of AD or FA for targeted intervention studies to potentially alter the atopic march.
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: Maeve M
authors.initials: MM
authors.lastname: Kelleher
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: Audrey
authors.initials: A
authors.lastname: Dunn-Galvin
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: Claire
authors.initials: C
authors.lastname: Gray
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland; National Children's Research Centre, Dublin, Ireland.
authors.forename: Deirdre M
authors.initials: DM
authors.lastname: Murray
authors.affiliation: Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
authors.forename: Mairead
authors.initials: M
authors.lastname: Kiely
authors.affiliation: Irish Centre for Fetal and Neonatal Translational Research, University College Cork, and Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Louise
authors.initials: L
authors.lastname: Kenny
authors.affiliation: Dermatology and Genetic Medicine, University of Dundee, Dundee, United Kingdom.
authors.forename: W H Irwin
authors.initials: WHI
authors.lastname: McLean
authors.affiliation: National Children's Research Centre, Dublin, Ireland; Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland; Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Irvine
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland; National Children's Research Centre, Dublin, Ireland. Electronic address: J.Hourihane@ucc.ie.
authors.forename: Jonathan O'B
authors.initials: JO
authors.lastname: Hourihane
mesh_terms: D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000150:complications; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012879:Skin Physiological Phenomena; D014867:Water / Q000502:physiology
chemical_list: D014867:Water
keywords: Infant; atopic dermatitis; food allergy; food sensitization; prediction; skin barrier; transepidermal water loss