Sensitization to peanut, egg or pets is associated with skin barrier dysfunction in children with atopic dermatitis

• Published in: Clinical and experimental allergy 2021-05, Vol.51 (5), p.666-673
• Main Authors: Sherenian, Michael G., Kothari, Arjun, Biagini, Jocelyn M., Kroner, John W., Baatyrbek kyzy, Asel, Johannson, Elisabet, Atluri, Gowtham, He, Hua, Martin, Lisa J., Khurana Hershey, Gurjit K.
• Format: Article
• Language: English
• Subjects: Allergens; allergens and epitopes; Allergies; Animals; Asthma; Atopic dermatitis; Calgranulin A - metabolism; Calgranulin B - metabolism; Cats; Child, Preschool; Children; Dermatitis; Dermatitis, Atopic - immunology; Dermatitis, Atopic - metabolism; Dogs; Eczema; Egg Hypersensitivity - immunology; Egg Hypersensitivity - metabolism; Egg Hypersensitivity - physiopathology; Female; Filaggrin; Filaggrin Proteins - metabolism; Humans; Immunoglobulin E; Infant; Inflammation; Learning algorithms; Machine Learning; Male; Pathogenicity; Peanut Hypersensitivity - immunology; Peanut Hypersensitivity - metabolism; Peanut Hypersensitivity - physiopathology; pediatrics; Pets; Pets - immunology; Skin - metabolism; Skin - physiopathology; Skin diseases; Skin Tests; Water Loss, Insensible
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1111/cea.13866

Background Children with atopic dermatitis (AD) are often sensitized to food and aeroallergens, but sensitization patterns have not been analysed with biologic measures of disease pathogenicity. Objective We sought to define allergen sensitization grouping(s) using unbiased machine learning and determine their associations with skin filaggrin (FLG) and transepidermal water loss (TEWL) (assesses skin barrier integrity), S100A8 and S100A9 expression (assesses skin inflammation) and AD severity. Methods We studied 400 children with AD in the Mechanisms of Progression from Atopic Dermatitis to Asthma in Children (MPAACH) cohort to identify groupings of food and aeroallergen sensitizations. MPAACH is a paediatric AD cohort, aged 1–2, recruited through hospital/community settings between 2016 and 2018. We analysed these groupings' associations with AD biomarkers: skin FLG, S100A8 and S100A9 expression, total IgE, TEWL and AD severity. Results An unbiased machine learning approach revealed five allergen clusters. The most common cluster (N = 131), SPTPEP, had sensitization to peanut, egg and/or pets. Three low prevalence clusters, which included children with allergen sensitization other than peanut, egg or pets, were combined into SPTOther. SPTNEG included children with no sensitization(s). SPTPEP children had higher median non‐lesional TEWL (16.9 g/m2/h) and IgE (90 kU/L) compared with SPTOTHER (8.8 g/m2/h and 24 kU/L; p = .01 and p