Predictive value of food sensitization and filaggrin mutations in children with eczema

Birgit Filipiak-Pittroff, Christina Schnopp, Dietrich Berdel, Aline Naumann, Simon Sedlmeier, Anna Onken, Elke Rodriguez, Regina Fölster-Holst, Hansjörg Baurecht, Markus Ollert, Johannes Ring, Claudia Cramer, Andrea Von Berg, Carl Peter Bauer, Olf Herbarth, Irina Lehmann, Beate Schaaf, Sibylle Koletzko, Heinz Erich Wichmann, Joachim Heinrich*Stephan Weidinger

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

31 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1235-1241.e5
JournalJournal of Allergy and Clinical Immunology
Volume128
Issue number6
DOIs
Publication statusPublished - Dec 2011
Externally publishedYes

Keywords

  • Eczema
  • asthma
  • atopic dermatitis
  • filaggrin
  • food allergy
  • food sensitization
  • prediction

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