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Title (Primary) Predictive value of food sensitization and filaggrin mutations in children with eczema
Author Filipiak-Pittroff, B.; Schnopp, C.; Berdel, D.; Naumann, A.; Sedlmeier, S.; Onken, A.; Rodriguez, E.; Foelster-Holst, R.; Baurecht, H.; Ollert, M.; Ring, J.; Cramer, C.; von Berg, A.; Bauer, C.P.; Herbarth, O.; Lehmann, I.; Schaaf, B.; Koletzko, S.; Wichmann, H.-E.; Heinrich, J.; Weidinger, S.;
Journal Journal of Allergy and Clinical Immunology
Year 2011
Department IMMU;
Volume 128
Issue 6
Language englisch;
Keywords Eczema; atopic dermatitis; asthma; food sensitization; food allergy; filaggrin; prediction
Abstract

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

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

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.

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 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 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%.

Conclusion: Early food sensitization and the presence of an 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.

ID 12045
Persistent UFZ Identifier http://www.ufz.de/index.php?en=20939&ufzPublicationIdentifier=12045
Filipiak-Pittroff, B., Schnopp, C., Berdel, D., Naumann, A., Sedlmeier, S., Onken, A., Rodriguez, E., Foelster-Holst, R., Baurecht, H., Ollert, M., Ring, J., Cramer, C., von Berg, A., Bauer, C.P., Herbarth, O., Lehmann, I., Schaaf, B., Koletzko, S., Wichmann, H.-E., Heinrich, J., Weidinger, S. (2011):
Predictive value of food sensitization and filaggrin mutations in children with eczema
J. Allergy Clin. Immunol. 128 (6), 1235 - 1241.e5