Nonlesional Skin in Pediatric Atopic Dermatitis Differs With Food Allergy

Nonlesional skin of children with atopic dermatitis (AD) has different characteristics depending on whether the child has a food allergy, according to a study published online in Science Translational Medicine.

Among the nearly 20% of children worldwide with AD, an estimated 1/3 also has food and respiratory allergies. To better understand the relationship between the inflammatory skin disorder and food allergy, researchers used noninvasive skin tape stripping to study the skin of 21 participants with pediatric AD and food allergy, 19 participants with pediatric AD but no food allergy, and 22 healthy controls.
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Children with AD and food allergy, researchers found, had lower amounts of the skin-associated protein filaggrin, elevated type 2 immune responses, and increased expression of the skin-associated protein keratin in seemingly healthy, nonlesional skin samples, according to the study. Those abnormalities were associated with structural changes in skin barrier architecture.

Children with AD and food allergy also harbored higher amounts of Staphylococcus aureus in nonlesional skin samples compared with children with AD and no food allergy, as well as healthy controls.

“Our findings not only demonstrate that the AD and food allergy group represents a unique AD endotype but also identify a defective stratum corneum as the key abnormality that distinguishes patients with AD and food allergy from patients with AD without food allergy or those with nonatopic,” the researchers wrote.

“It is important to emphasize that our findings of stratum corneum abnormalities were observed in nonlesional AD skin, raising the possibility that these skin changes are occurring before the occurrence of clinical skin lesions and places the patient with AD and food allergy at great risk because their entire skin body surface area may be susceptible to food allergen penetration and allergen sensitization,” the researchers added.

The data suggest treatments for AD and food allergy should focus on improving skin barrier function, the researchers advised, although they noted additional studies are necessary to validate the findings.—Jolynn Tumolo

References

Leung DYM, Calatroni A, Zaramela LS, et al. The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype [published online February 20, 2019]. Sci Transl Med.