Impaired skin barrier and allergic sensitization in early infancy.

Abstract

Factors predicting allergic sensitization in the first 6months of life are poorly understood. We aimed to determine whether eczema, dry skin, and high transepidermal water loss (TEWL) at 3months were associated with allergic sensitization at 6months of age and, secondarily, to establish whether these characteristics predicted sensitization from 3 to 6months of age. At 3months of age, 1,994 infants from the population-based PreventADALL birth cohort in Norway and Sweden were assessed for eczema and dry skin on the cheeks and/or extensors; impaired skin barrier function, defined as TEWL in the upper quartile (>9.4g/m2 /h), and allergen-specific IgE levels <0.1kUA /L, available in 830. At 6months, we assessed allergic sensitization to any food (egg, cow's milk, peanut, wheat, soy) or inhalant (birch, timothy grass, dog, and cat) allergen by a skin prick test wheal diameter ≥2mm larger than negative control. Any sensitization was found in 198 of the 1,994 infants (9.9%), the majority to food allergens (n=177, 8.9%). Eczema, dry skin, and high TEWL at 3months increased the risk of sensitization at 6months; adjusted odds ratios 4.20 (95% CI 2.93-6.04), 2.09 (95% CI 1.51-2.90) and 3.67 (95% CI 2.58-5.22), respectively. Eczema predicted sensitization with 55.6% sensitivity and 68.1% specificity; dry skin with 65.3% sensitivity and 57.3% specificity; and high TEWL with 61.7% sensitivity and 78.1% specificity. Eczema, dry skin, and high TEWL at 3months predicted allergic sensitization at 6months of age.