Which infants with eczema are at risk of food allergy? Results from a population-based cohort

被引:247
作者
Martin, P. E. [1 ,2 ]
Eckert, J. K. [1 ]
Koplin, J. J. [1 ,3 ]
Lowe, A. J. [3 ]
Gurrin, L. C. [3 ]
Dharmage, S. C. [3 ]
Vuillermin, P. [1 ,2 ,4 ,5 ]
Tang, M. L. K. [1 ,2 ,6 ]
Ponsonby, A. -L. [1 ]
Matheson, M. [3 ]
Hill, D. J. [2 ]
Allen, K. J. [1 ,2 ,6 ,7 ]
机构
[1] Royal Childrens Hosp, Murdoch Childrens Res Inst, Parkville, Vic 3052, Australia
[2] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia
[3] Univ Melbourne, Sch Populat & Global Hlth, Ctr Biostat & Epidemiol, Carlton, Vic 3053, Australia
[4] Barwon Hlth, Child Hlth Res Unit, Geelong, Vic, Australia
[5] Deakin Univ, Sch Med, Geelong, Vic 3217, Australia
[6] Royal Childrens Hosp, Dept Allergy & Immunol, Parkville, Vic 3052, Australia
[7] Univ Manchester, Manchester, Lancs, England
基金
澳大利亚国家健康与医学研究理事会;
关键词
eczema; egg allergy; food allergy; infants; peanut allergy; population-based cohort; risk factors; ATOPIC-DERMATITIS; EGG ALLERGY; SENSITIZATION; PREVALENCE; SEVERITY; ONSET; GENE;
D O I
10.1111/cea.12406
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
BackgroundThe relationship between early onset eczema and food allergy among infants has never been examined in a population-based sample using the gold standard for diagnosis, oral food challenge. ObjectiveWe characterised the risk of challenge-proven food allergy among infants with eczema in the general population. MethodsOne-year-old infants (n=4453 meeting criteria for this analysis) were assessed for history of eczema, received a nurse-administered eczema examination and underwent skin prick testing to peanut, egg and sesame. Those with a detectable wheal to one of the test foods underwent an oral food challenge irrespective of wheal size. The risk of food allergy, stratified by eczema severity and age of onset, was estimated using multivariate logistic regression with population sampling weights. ResultsOne in five infants with eczema were allergic to peanut, egg white or sesame, compared to one in twenty-five infants without eczema (OR 6.2, 95% CI 4.9, 7.9, P<0.001). The prevalence of peanut allergy was low in the absence of eczema (0.7% 95% CI 0.4, 1.1). Infants with eczema were 11.0 times more likely to develop peanut allergy (95% CI 6.6, 18.6) and 5.8 times more likely to develop egg allergy (95% CI 4.6, 7.4) by 12months than infants without eczema. 50.8% of infants (95% CI 42.8, 58.9) with early eczema onset (<3months) who required doctor-prescribed topical corticosteroid treatment developed challenge-proven food allergy. Conclusion and Clinical RelevanceEczema, across the clinical severity spectrum in infancy, is a strong risk factor for IgE-mediated food allergy. Infants with eczema were six times more likely to have egg allergy and 11 times more likely to have peanut allergy by 12months than infants without eczema. Our data suggest that a heightened awareness of food allergy risk among healthcare practitioners treating infants with eczema, especially if early onset and severe, is warranted.
引用
收藏
页码:255 / 264
页数:10
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