Abstract
BackgroundLoss-of-function variants in the gene encoding filaggrin (FLG) are major determinants of eczema. We hypothesized that weakening of the physical barrier in FLG-deficient individuals may potentiate the effect of environmental exposures. Therefore, we investigated whether there is an interaction between FLG loss-of-function mutations with environmental exposures (pets and dust mites) in relation to the development of eczema.Methods and FindingsWe used data obtained in early life in a high-risk birth cohort in Denmark and replicated the findings in an unselected birth cohort in the United Kingdom. Primary outcome was age of onset of eczema; environmental exposures included pet ownership and mite and pet allergen levels. In Copenhagen (n = 379), FLG mutation increased the risk of eczema during the first year of life (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.27–4.00, p = 0.005), with a further increase in risk related to cat exposure at birth amongst children with FLG mutation (HR 11.11, 95% CI 3.79–32.60, p < 0.0001); dog exposure was moderately protective (HR 0.49, 95% CI 0.24–1.01, p = 0.05), but not related to FLG genotype. In Manchester (n = 503) an independent and significant association of the development of eczema by age 12 mo with FLG genotype was confirmed (HR 1.95, 95% CI 1.13–3.36, p = 0.02). In addition, the risk increased because of the interaction of cat ownership at birth and FLG genotype (HR 3.82, 95% CI 1.35–10.81, p = 0.01), with no significant effect of the interaction with dog ownership (HR 0.59, 95% CI 0.16–2.20, p = 0.43). Mite-allergen had no effects in either cohort. The observed effects were independent of sensitisation.ConclusionsWe have demonstrated a significant interaction between FLG loss-of-function main mutations (501x and 2282del4) and cat ownership at birth on the development of early-life eczema in two independent birth cohorts. Our data suggest that cat but not dog ownership substantially increases the risk of eczema within the first year of life in children with FLG loss-of-function variants, but not amongst those without. FLG-deficient individuals may need to avoid cats but not dogs in early life.
Highlights
We have demonstrated a significant interaction between FLG loss-of-function main mutations (501x and 2282del4) and cat ownership at birth on the development of early-life eczema in two independent birth cohorts
Our data suggest that cat but not dog ownership substantially increases the risk of eczema within the first year of life in children with FLG loss-offunction variants, but not amongst those without
We recently discovered in the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) that loss-offunction variants in the gene encoding filaggrin (FLG) are major determinants of eczema [1]
Summary
We recently discovered in the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) that loss-offunction variants in the gene encoding filaggrin (FLG) are major determinants of eczema [1]. This finding has since been replicated in other populations [2,3,4], and the population attributable risk for eczema estimated at 11% [2]. Loss-of-function variants in the gene encoding filaggrin (FLG) are major determinants of eczema. There is no cure for eczema but it can be controlled by avoiding anything that makes its symptoms worse These triggers include irritants such as wool, strong soaps, perfumes, and dry environments. A good skin-care routine and frequent moisturizing can help to keep eczema under control, but in many cases, corticosteroid creams and ointments may be necessary to reduce inflammation
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