Predictive value of food sensitization and filaggrin mutations in children with eczema - 30/11/11
, Christina Schnopp, MD c, , Dietrich Berdel, MD b, Aline Naumann, MSc d, Simon Sedlmeier c, Anna Onken, MD c, Elke Rodriguez, MSc e, Regina Fölster-Holst, MD e, Hansjörg 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, PhD i, Irina Lehmann, PhD j, Beate Schaaf, MD k, Sibylle Koletzko, MD l, Heinz-Erich Wichmann, MD, PhD a, Joachim Heinrich, PhD a, ⁎ 
, Stephan Weidinger, MD e, GINIplus and LISAplus study groups‡
Corresponding author: Joachim Heinrich, PhD, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.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.
Le texte complet de cet article est disponible en PDF.Key words : Eczema, atopic dermatitis, asthma, food sensitization, food allergy, filaggrin, prediction
Abbreviations used : DBPCFC, FLG, GINI, LISA, MAS, NPV, PLR, PPV, RR, sIgE
Plan
| Supported by a grant of the German Ministry of Education and Research (BMBF) as part of the National Genome Research Network (NGFN 01GS 0818) and the Christiane Kühne Center for Allergy Research and Education (www.ck-care.ch/). The German Infant Nutritional Intervention study was supported for the first 3 years by grants of the Federal Ministry for Education, Science, Research and Technology (grant no. 01 EE 9401-4). The 6-year follow-up was partly funded by the Federal Ministry for Environment (IUF, FKZ 20462296) and by the GSF National Research Centre for the Environment and Health. The LISA birth cohort was funded by grants of the Federal Ministry for Education, Science, Research and Technology (grant no. 01 EG 9705/2 and 01EG9732) and the Federal Ministry for Environment (IUF, FKZ 20462296). S.W. is supported by a Heisenberg professorship of the DFG (WE 2678/4-1). |
|
| Disclosure of potential conflict of interest: M. Ollert has received honoraria from Phadia. J. Ring has received research support from ALK-Abelló, Allergopharma, Almirall-Hermal, Astellas, Bavarian Nordic, Bencard, Biogen-Idec, Galderma, GlaxoSmithKline-Stiefel, Leo, MSD, Novartis, Phadia, PLS Design, Procter & Gamble, Sanofi Aventis, and Stallergenes. C. P. Bauer has received honoraria from MSD and Nestlé. The rest of authors declare that they have no relevant conflicts of interest. |
Vol 128 - N° 6
P. 1235 - décembre 2011 Retour au numéro
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