Eczema In Infants Research Articles

Effects of gut microbiome and environment on the development of eczema in Chinese infants.

Background:Eczema is a relapsing and persistent inflammatory skin disease affecting about one-fifth of children worldwide. As in other developed countries, the prevalence of this chronic disease in Hong Kong is approximately 30%. Moreover, the number of local cases reported has been on a rising trend since 1995. Eczema frequently starts in early infancy. A total of 45% of all cases begin within the first six months of life, 60% during the first year and 85% before the age of 5. The pathophysiology of eczema is multi-factorial and is a complex inter-relationship between skin barrier, genetic predisposition, immunologic development, microbiome, environment, nutrition, and pharmacological and psychological factors.Objective:To characterize the longitudinal changes of gut microbial profile in early childhood and to examine the association between gut microbiome diversity, environmental factors and the development of eczema in early childhood.Method:We will conduct a longitudinal cohort study that follows 1250 Hong Kong Chinese infants for 2 years and assess the gut microbiome and other potential environmental factors in the aetiology of eczema. Parents will be asked to provide demographic data, their infant birth data, allergy condition, diet, environmental conditions as well as the data on maternal stress. Stool specimen will be collected for gut microbiome diversity analysis. We will examine newborn infants at enrollment, at 4 months, 1 year and 2 years after birth.Expected results:This study will evaluate the association between gut microbiome, environmental factors and the development of eczema in Chinese infants. Findings from this study may be used to develop a predictive path model to guide effective health promotion, disease prevention and management.

Ethnic differences in maternal diet in pregnancy and infant eczema.

BackgroundThe global prevalence of childhood eczema has increased over the last few decades, with a marked increase in high-income countries. Differences in prevalence of childhood eczema between countries and ethnicities suggest that genetic and early modifiable environmental factors, such as dietary intake, may underlie this observation. To investigate the association between pregnancy diet and infant eczema in a consortium of prospective Canadian birth cohorts predominantly comprised of white Europeans and South Asians.MethodsWe evaluated the association of maternal dietary patterns reported during pregnancy (assessed at 24–28 weeks gestation using a semi-quantitiative food-frequency questionnaire) with parent-reported physician-diagnosed infant eczema at 1-year from 2,160 mother-infant pairs. Using three dietary patterns (“Western”, “plant-based”, and “Balanced”) previously derived in this cohort using principal component analysis, we used multivariable logistic regression to determine the association of these dietary patterns with infant eczema, adjusted for potential confounders.ResultsWe observed a lower odds of eczema in the full sample combining white Europeans and South Asians with greater adherence to a plant-based (OR = 0.65; 95% CI: 0.55, 0.76; <0.001) and Western dietary pattern (OR = 0.73; 95% CI: 0.60, 0.89; P<0.01), after adjusting for other known predictors of eczema, including ethnicity, which was not significant. No associations were observed for the balanced diet. An interaction between the Western diet and ethnicity was observed (P<0.001). Following stratification by ethnicity, a protective association between the plant-based diet and infant eczema was confirmed in both white Europeans (OR = 0.59; 95% CI: 0.47, 0.74; P<0.001) and South Asians (OR = 0.77; 95% CI: 0.61, 0.97; P = 0.025). In white Europeans only, a Western diet was associated with a lower odds of infant eczema (OR = 0.69; 95% CI: 0.56, 0.87; P = 0.001) while a balanced diet increased the odds of infant eczema (OR = 1.23; 95% CI: 1.02, 1.49; P = 0.03). Beyond a plant-based diet, no significant associations with other dietary patterns were observed in South Asians.ConclusionA plant-based diet during pregnancy is associated with a lowered odds of infant eczema at 1 year in all participants. Future studies of the components of plant-based diet which underlie the lower risk of eczema are needed.

Association between prenatal depressive symptoms and eczema in infants: The Born in Guangzhou Cohort Study.

Eczema is a growing threat on infants' health, and the role of maternal depression in the risk of eczema's early onset is unclear. This study aimed to examine the associations of different exposure timing of prenatal depressive symptoms with offspring's eczema in infancy. The study was part of the ongoing prospective Born in Guangzhou Cohort Study. Maternal depressive symptoms were assessed at both early (<20th week of gestation) and late pregnancy (≥33rd week of gestation to delivery) using the Self-Rating Depression Scale. Information on the diagnosis of eczema was collectedwhen the children were 1 year old. Multivariable logistic regression was used to examine the association between prenatal depressive symptoms and infants' eczema and test for moderation by parental history of allergic diseases. In this population, 7.7% (447/5825) of mothers experienced persistent depressive symptoms during pregnancy, 10.1% (590/5825) had depressive symptoms only at early pregnancy, and 8.4% (489/5825) of women experienced depressive symptoms only at late pregnancy. After adjusting for potential confounders, higher risks of eczema were observed in infants of mothers with persistent prenatal depressive symptoms when compared to those children without maternal depressive symptoms throughout pregnancy (OR: 1.55, 95% CI 1.19-2.03). These associations were marginally more pronounced among children in families without parents affected by allergic diseases than in other families (P for interaction=.064 for courses of prenatal depressive symptoms). Persistent maternal depressive symptoms during pregnancy increased the risk of infants' eczema, especially in children without family history of allergic diseases. These associations, if proved to be causal, could be an intervention target not only to improve women's health but also to prevent offspring's eczema.

An Exploratory Birth Cohort Study on the Relationship of Early-Life Gut Microbiome and Lifestyle Factors in the Development of Eczema in Hong Kong Infants

Background: Childhood eczema is common but the prevalence is variable in different regions of the world. Therefore, identification of risk factors of eczema in specific region is important to prevent its occurrence. In this study, we aim to explore the association of various risk factors like microbiome, environment, lifestyle, diet and maternal stress, and the development of eczema in early-life of infants in Hong Kong Methods: At enrolment, the infants’ parents provided demographic data by self-reporting. At enrolment and at one year after birth, the allergy condition and lifestyle of the infants were assessed by the modified parent proxy version of the Comprehensive Early Childhood Allergy Questionnaire. The dietary factors were assessed by the eating-habit module of the Behavioural Risk Factor Surveillance System. Maternal stress was assessed by 10-item Perceived Stress Scale. Infants’ gut microbiome was analysed by 16S RNA sequencing and the longitudinal change of various bacterial strains was compared between healthy and eczema group. Findings: In univariate analysis, it was shown that the mode of delivery, abundance change in Clostridia and Hungatella hathewayi were significantly different between healthy and eczema group. Multivariate analysis, after adjustment for other significant factors, further revealed that the abundance change of Hungatella hathewayi in the gut (p=0.005) were associated with the development of eczema in this study. Interpretation: Increased change in abundance of Hungatella hathewayi were associated with increased risk of eczema development in the infants at one year of age. This study explored the potential risk factors for eczema development in the infants in Hong Kong and sheds light on the possible association between early-life gut microbiome and other environmental factors. Trial Registration: This study was registered on the ISRCTN Registry with reference number ISRCTN44080054. Funding Statement: This study was supported by Department Funding from The Nethersole School of Nursing in The Chinese University of Hong Kong. Declaration of Interests: None. Ethics Approval Statement: The study protocol was approved by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee with reference number 2016.321. Written informed consent were obtained from the participants’ parents prior to data collection.

An algorithm for diagnosing IgE‐mediated food allergy in study participants who do not undergo food challenge

Food allergy diagnosis in clinical studies can be challenging. Oral food challenges (OFC) are time-consuming, carry some risk and may, therefore, not be acceptable to all study participants. To design and evaluate an algorithm for detecting IgE-mediated food allergy in clinical study participants who do not undergo OFC. An algorithm for trial participants in the Barrier Enhancement for Eczema Prevention (BEEP) study who were unwilling or unable to attend OFC was developed. BEEP is a pragmatic, multi-centre, randomized-controlled trial of daily emollient for the first year of life for primary prevention of eczema and food allergy in high-risk infants (ISRCTN21528841). We built on the European iFAAM consensus guidance to develop a novel food allergy diagnosis algorithm using available information on previous allergenic food ingestion, food reaction(s) and sensitization status. This was implemented by a panel of food allergy experts blind to treatment allocation and OFC outcome. We then evaluated the algorithm's performance in both BEEP and Enquiring About Tolerance (EAT) study participants who did undergo OFC. In 31/69 (45%) BEEP and 44/55 (80%) EAT study control group participants who had an OFC the panel felt confident enough to categorize children as "probable food allergy" or "probable no food allergy". Algorithm-derived panel decisions showed high sensitivity 94% (95%CI 68, 100) BEEP; 90% (95%CI 72, 97) EAT and moderate specificity 67% (95%CI 39, 87) BEEP; 67% (95%CI 39, 87) EAT. Sensitivity and specificity were similar when all BEEP and EAT participants with OFC outcome were included. We describe a new algorithm with high sensitivity for IgE-mediated food allergy in clinical study participants who do not undergo OFC. This may be a useful tool for excluding food allergy in future clinical studies where OFC is not conducted.

Organic food and health.

The popularity of organic foods grows systematically. In the last decade, several critical reviews and meta-analysis concerning organic food consumption and their effect on some chosen health problems have been published. The aim of the work was to present the current state of knowledge regarding the influence of organic food consumption on human health. On average, organic food of plant origin is characterized by a trace presence of pesticides, a lower content of nitrates and an increased content of polyphenols and vitamin C. Organic products of animal origin contain more beneficial for health unsaturated fatty acid. Organic dairy products, in contrast to meat products, are characterized by a higher content of protein and saturated fatty acids, however, the differences more result from the length of the grazing period and access to fresh forage than to the production system. Although generally, the consumption of organic food does not provide a significant nutritional advantage compared to a conventional diet, regular and frequent consumption of organic products generally reduces the risk of overweight and obesity, both for women and men, as well as non-Hodgkin lymphoma in case of women. Besides those, consumption of organic fruits and vegetables, as well as dairy products significantly reduces the risk of pre-eclampsia in pregnancy and eczema in infants, respectively. Positive effect on selected health problems probably results from a reduced amount of pesticide residues and an increased secondary plant metabolites intake which characterize organic food. This review showed that there is a need for further, especially, large cohort studies concerning the effect of organic food consumption on specific diseases development.

The Relationship of Breastfeeding and Infant Eczema: The Role of Reverse Causation.

Aim: Although reverse causation is well known in the breastfeeding-allergy arena, only a few studies have used a valid statistical method to test its occurrence. This study aimed to illustrate reverse causation between eczema and breastfeeding and to examine their effect estimate under this occurrence. Methods: Time-to-event data from the Infant Feeding Practices Study II were used. Model 1: early signs of eczema were modeled as a time-varying covariate to assess reverse causation using survival analysis approach. Model 2 examined the crude and adjusted relative risk between breastfeeding and early signs of eczema using generalized linear model. Results: Overall, 2,350 mother-infant pairs were included. On average, infants with early signs of eczema versus without, breastfed for 5.2 ± 0.2 months compared with 4.10 ± 0.1, respectively. Model 1, an early sign of eczema, was associated with approximately a 16% (95% confidence interval 2-28) reduction in the risk of ceasing breastfeeding indicating reverse causation. Model 2, each month of breastfeeding increased the risk for early signs of eczema by 3%. Conclusion: Modeling early signs of eczema as a time-varying covariate using survival analysis approach detects reverse causation and children with early signs of eczema were breastfed for longer duration. Failure to account for reverse causation may create biased result and a conclusion where breastfeeding increases the risk for early signs for eczema. Future studies should perceive reverse causation by using time-varying covariate in survival analysis approach.

Earlier aggressive treatment to shorten the duration of eczema in infants resulted in fewer food allergies at 2 years of age

Earlier aggressive treatment to shorten the duration of eczema in infants resulted in fewer food allergies at 2 years of age

Direct Infant UV Light Exposure Is Associated With Eczema and Immune Development

To determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development.This study included 197 healthy, term, singleton infants with family history of atopy. Ninety-seven participants were randomly assigned to the intervention vitamin D group, and 98 were randomly assigned to the placebo group. Ninety-two percent of infants attended their appointment at 3 months of age, and 89% of infants attended their appointment at 6 months of age.This study was a double-blind randomized controlled trial of infants born in Australia between October 2012 and January 2017. Newborn infants were randomly assigned to receive vitamin D supplementation (400 IU/day) or a placebo until 6 months of age. Some infants also wore personal UV dosimeters to measure direct UV light exposure. Infant vitamin D levels were measured at 3 and 6 months of age. Eczema, wheeze, and immune function outcomes were assessed at 6 months of age. Eczema was defined by clinical features and graded on the basis of the Scoring Atopic Dermatitis score.At both 3 and 6 months of age, vitamin D levels were greater for the vitamin D group compared with the placebo group; however, there was no difference in eczema incidence between groups. The secondary outcome investigating direct UV light exposure found infants with eczema to have had less UV light exposure compared with those without eczema. Additionally, UV light exposure was also inversely correlated with interleukin-2, granulocyte-macrophage colony-stimulating factor, and eotaxin production to Toll-like receptor ligands.Researchers in this study found that UV light exposure in early infancy was associated with lower incidence of eczema and proinflammatory immune markers by 6 months of age. These findings suggest that UV light exposure may be more beneficial than vitamin D supplementation as an allergy prevention strategy in early life.Although the initial intent of this study was focused on vitamin D, the more remarkable finding related to the demonstrated association between greater direct UV light exposure in early infancy with lower incidence of eczema and proinflammatory immune markers. The lack of effect of vitamin D supplementation is consistent with previous studies in which researchers have reviewed vitamin D supplementation during pregnancy and infancy. Future studies would be ideal, powered for effect of direct UV exposure on the incidence of eczema and involving mechanistic studies. Additionally, future studies are required to determine how much sunlight exposure in infancy is both safe and effective.

Prenatal visits for allergy prevention

Allergic diseases, such as atopic dermatitis, food allergy, asthma, and allergic rhinitis, are common; according to a national birth cohort study in Japan, almost half of pregnant women reported a history of allergic disease.1 Given that genetic factors, including family history, are predictors of allergic diseases in offspring, we expect the birth of many infants with a high risk of developing allergies. Among allergy prevention strategies, the effectiveness of primary prevention of eczema in high-risk infants by the topical application of emollient during the neonatal period has been demonstrated in 2 randomized controlled trials (RCTs).

Maternal exposure to antibiotics increases the risk of infant eczema before one year of life: a meta-analysis of observational studies.

There are some conflicting evidences showing that maternal exposure to antibiotics may increase the risk of infant eczema. The present study aims to estimate the effect of prenatal antibiotics administration on infant eczema. According to the established inclusion criteria, eligible observational studies were collected by comprehensive database search. The qualities of the included studies were assessed using the Newcastle-Ottawa Scale. Effect sizes that were adjusted by multivariable models were extracted and combined. Publication bias was evaluated by visual inspection of funnel plot. A total of seven observational studies were included. The qualities of the included studies were at moderate or high level. Prenatal antibiotics use was positively associated with eczema before one year of age [odds ratio (OR) = 1.93, 95% confidence interval (CI) 1.35-2.76]. In addition, antibiotics exposure in utero was likely to be related to eczema after one year of age (OR 1.21, 95% CI 0.98-1.49). The exposure to antibiotics during third trimester was not associated with infant eczema (OR 0.97, 95% CI 0.86-1.09). Maternal exposure to antibiotics is associated with eczema by one-year age and may have a prolonged effect on eczema after 1-year age. The influence of timing of antibiotics exposure during pregnancy needs more studies to clarify.

Direct infant ultraviolet light exposure is associated with eczema and immune development: a critical appraisal.

Rueter etal. aimed to 'determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development'. This was a double-blind randomized placebo-controlled trial with an additional nonrandomized exploratory analysis on the effects of ultraviolet (UV) exposure led from a hospital setting. Vitamin D (400 iU daily) drops or placebo drops (coconut and palm kernel oil) were allocated randomly to 195 infants born to families with a first-degree relative with atopic disease. Eighty-six of these infants were allocated personal UV dosimeters in a nonrandomized fashion to measure UV light (290-380 nm) exposure until 3 months of age. Eczema and wheeze were assessed at 3 and 6 months, and 25 immune function markers were assessed at 6 months of age. Infant vitamin D levels and immune functions were measured at 6 months of age. Although vitamin D levels were significantly greater in infants in the intervention group than in those in the placebo group at 3 and 6 months of age, there was no difference in eczema between groups at either time point (10·0% vs. 6·7% at 3 months and 21·8 vs. 19·3% at 6 months for the vitamin D and placebo groups, respectively). In the subset of infants given a dosimeter, those with eczema had less UV light exposure (median 555 J m-2 ) than infants who did not develop eczema (median 998 J m-2 ). Across the 25 immune functions, UV light exposure was inversely correlated with interleukin-2, granulocyte macrophage colony-stimulating factor and eotaxin production by Toll-like receptor ligands. Vitamin D supplementation in high-risk infants increased vitamin D levels but did not reduce eczema. Exploratory post-hoc analyses in a nonrandomized subset showed an association between greater direct UV light exposure and reduction of eczema. The authors claim that their 'findings indicate that UV light exposure appears more beneficial than vitamin D supplementation as an allergy prevention strategy in early life'.

Influence of prenatal and early-life exposures on food allergy and eczema in infancy: a birth cohort study

BackgroundFew prospective birth cohort studies are available on the effects of prenatal and early-life exposures on food allergy and eczema among Chinese children. The aim of this study was to evaluate the influence of prenatal and early-life exposures on food allergy and eczema during the first year of life in a prospective birth cohort study.MethodsThis study was based on a prospective, observational birth cohort of 976 mother-child pairs in three Streets in Changsha, China from January to December 2015. Data on prenatal, early-life exposures and allergic outcomes were obtained from questionnaires collected at birth, and 1, 3, 6, 8, and 12 months of age. Multivariate logistic regression models were performed to estimate the effects of prenatal and early-life exposures on food allergy and eczema.ResultsCommon risk factors for food allergy and eczema in infancy were parental history of allergy, while moderate eggs consumption (3–4 times/week) during pregnancy was protective for both of them compared with low consumption (≤ 2 times/week). Factors only associated with food allergy were maternal aquatic products consumption during pregnancy, number of older siblings and age of solid food introduction, whereas factors only associated with eczema were maternal milk or milk products consumption during pregnancy, maternal antibiotic exposure during pregnancy, season of birth and antibiotic exposure through medication during the first year of life.ConclusionOur study suggests that factors associated with food allergy and eczema are multifaceted, which involving hereditary, environmental and nutritional exposures. Furthermore, differential factors influence the development of food allergy and eczema in infants.

Supporting a Healthy Microbiome for the Primary Prevention of Eczema.

Eczema is increasing worldwide with associated increases in health costs and decreases in quality of life. There are many factors that are speculated to interact in the development of eczema including genetics and environmental exposures. Prevention of the development of eczema may prevent the further development of food allergies and asthma. This concept has prompted a variety of research into the area of primary prevention of eczema in infants. This exploration includes a growing body of research examining infants supplemented with probiotics, prebiotics, or both (synbiotics) often compared with their breastfed counterparts. The goal of this paper is to examine the evidence for manipulating the microbiome in the prevention of eczema. Several strains of probiotics, compositions of prebiotics, and varied combinations of both are commercially available. Evidence supports altering the microbiome in infants at high risk of atopy who are not able to breastfeed with Lactobacillus strains when given both prenatally followed by prolonged use (greater than 6months) postnatally for the primary prevention of eczema. Prebiotics have also been shown beneficial for primary prevention of eczema in formula-fed infants with prolonged use greater than 6months. These findings are in keeping with the World Allergy Organization (WAO) recommendations that support interventions to manipulate the microbiome with both probiotics and prebiotics.

Association of Staphylococcus aureus colonization with food allergy occurs independently of eczema severity

Staphylococcus aureus has been implicated in the pathophysiology of eczema, allergic rhinitis, asthma, and food allergy. S aureus is a marker of more severe eczema, which is a risk factor for food sensitization/allergy. Therefore it might be that the association between S aureus and food allergy in eczematous patients is related to eczema severity. We sought to investigate the association of S aureus colonization with specific IgE (sIgE) production to common food allergens and allergies in early childhood independent of eczema severity. We additionally determined the association of Saureus colonization with eczema severity and persistence. In Learning Early About Peanut Allergy (LEAP) study participants eczema severity was assessed, and skin/nasal swabs were cultured for S aureus. Sensitization was identified by measuring sIgE levels. Peanut allergy was primarily determined by means of oral food challenge, and persistent egg allergy was primarily determined by using skin prick tests. Skin S aureus colonization was significantly associated with eczema severity across the LEAP study, whereas at 12 and 60months of age, it was related to subsequent eczema deterioration. Skin S aureus colonization at any time point was associated with increased levels of hen's egg white and peanut sIgE independent of eczema severity. Participants with S aureus were more likely to have persistent egg allergy and peanut allergy at 60 and 72months of age independent of eczema severity. All but one of the 9 LEAP study consumers with peanut allergy (9/312) were colonized at least once with S aureus. S aureus, independent of eczema severity, is associated with food sensitization and allergy and can impair tolerance to foods. This could be an important consideration in future interventions aimed at inducing and maintaining tolerance to food allergens in eczematous infants.

Eczema-protective probiotic alters infant gut microbiome functional capacity but not composition: sub-sample analysis from a RCT.

Probiotic Lactobacillus rhamnosus HN001 given in early life has been shown to reduce infant eczema risk, but its effect on gut microbiota development has not been quantitatively and functionally examined. The aim of this study was to investigate the impact of early life probiotic exposure on the composition and functional capacity of infant gut microbiota from birth to 2 years considering the effects of age, delivery mode, antibiotics, pets and eczema. We performed shotgun metagenomic sequencing analysis of 650 infant faecal samples, collected at birth, 3, 12, and 24 months, as part of a randomised, controlled, 3-arm trial assessing the effect of L. rhamnosus HN001, Bifidobacterium animalis subsp. lactis HN019 supplementation on eczema development in 474 infants. There was a 50% reduced eczema risk in the HN001 probiotic group compared to placebo. Both mothers (from 35 weeks gestation until 6 months post-partum if breastfeeding) and infants (from birth to 2 years) received either a placebo or one of two probiotics, L. rhamnosus HN001 (6×109 cfu), or B. animalis subsp. lactis HN019 (9×109 cfu). L. rhamnosus HN001 probiotic supplementation was associated with increased overall glycerol-3 phosphate transport capacity and enrichment of L. rhamnosus. There were no other significant changes in infant gut microbiota composition or diversity. Increased capacity to transport glycerol-3-phosphate was positively correlated with relative abundance of L. rhamnosus. Children who developed eczema had gut microbiota with increased capacity for glycosaminoglycan degradation and flagellum assembly but had no significant differences in microbiota composition or diversity. Early life HN001 probiotic use is associated with both increased L. rhamnosus and increased infant gut microbiota functional capacity to transport glycerol-3 phosphate. The mechanistic relationship of such functional alteration in gut microbiota with reduced eczema risk and long-term health merits further investigation.

INFANT’S SKIN AND CARE NEEDS WITH SPECIAL CONSIDERATION TO FORMULATION ADDITIVES

Infancy is the time of adaptation from intrauterine life to the rather dry and cold, environment. Infant skin is more sensitive due to the immature immune system, hence, effortlessly prone to complications. Children from different age groups face diverse skin problems such as cradle cap, infant eczema, diaper rash, prickly heat, and many more. During early infancy, the products such as mild cleansers and lotions are used, and later, massage oils, creams, lotions, soaps, bubble bath, and other products are utilized for another few years, as a part of routine care. The preterm infants are more prone to skin damage and percutaneous toxicity from topically applied products. The ingredients incorporated in infant care products require special attention while choosing a product for them. Topical application of any such product requires thorough screening for potentially harmful ingredients before its exposure to the infant’s skin. Products used for infants should be safe and restricted of fragrance, coloring agents, parabens, plant oils, extracts, and other obnoxious ingredients. The literature is flooded with the list of safer excipients that can be utilized for the development of skin care products for infants and children.

Faltering of prenatal growth precedes the development of atopic eczema in infancy: cohort study.

BackgroundInfants with atopic eczema have an increased risk of impaired growth, but the origin of this impairment is unclear. The aim of this study was to examine fetal and infant growth in relation to infantile atopic eczema.MethodsWithin the UK Southampton Women’s Survey, 1,759 infants with known maternal menstrual data had anthropometric measurements at 11, 19, and 34 weeks’ gestation, birth, and ages 6 and 12 months, enabling derivation of growth velocity SD scores. Infantile atopic eczema at ages 6 and/or 12 months was ascertained using modified UK Working Party diagnostic criteria.ResultsExpressed per SD increase, higher femur length and abdominal circumference at 34 weeks’ gestation were associated with decreased risks of atopic eczema (eczema OR/SD increase 0.81 [95% CI 0.69–0.96], P=0.017 and 0.78 [95% CI 0.65–0.93], P=0.006, respectively), while every SD increase in head to abdominal circumference ratio (indicating disproportionate growth) was associated with an increase in risk of atopic eczema (1.37 [1.15–1.63], P=0.001). Lower velocities of linear growth from 11 weeks’ gestation to birth and birth to age 6 months were associated with atopic eczema (atopic eczema OR/SD increase 0.80 [0.65–0.98], P=0.034 and 0.8 [1 0.66–1.00], P=0.051, respectively). Infants with atopic eczema at age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks’ gestation (atopic eczema OR/SD increase 0.67 [0.51–0.88], P=0.003).ConclusionInfants with atopic eczema demonstrate altered patterns of fetal growth, including faltering of linear growth in utero, prior to the clinical onset of atopic eczema. These findings suggest growth falters prior to the start of clinical atopic eczema and its treatment.

Maternal Cytokine Profiles during Pregnancy Predict Asthma in Children of Mothers without Asthma.

Little is known about whether maternal immune status during pregnancy influences asthma development in the child. We measured cytokine production in supernatants from mitogen-stimulated peripheral blood immune cells collected during and after pregnancy from the mothers of children enrolled in the Tucson Infant Immune Study, a nonselected birth cohort. Physician-diagnosed active asthma in children through age 9 and a history of asthma in their mothers were assessed through questionnaires. Maternal production of each of the cytokines IL-13, IL-4, IL-5, IFN-γ, IL-10, and IL-17 during pregnancy was unrelated to childhood asthma. However, IFN-γ/IL-13 and IFN-γ/IL-4 ratios during pregnancy were associated with a decreased risk of childhood asthma (n = 381; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.17-0.66; P = 0.002; and n = 368; OR, 0.36; 95% CI, 0.18-0.71; P = 0.003, respectively). The inverse relations of these two ratios with childhood asthma were only evident in mothers without asthma (n = 309; OR, 0.18; 95% CI, 0.08-0.42; P = 0.00007; and n = 299; OR, 0.17; 95% CI, 0.07-0.39; P = 0.00003, respectively) and not in mothers with asthma (n = 72 and 69, respectively; P for interaction by maternal asthma = 0.036 and 0.002, respectively). Paternal cytokine ratios were unrelated to childhood asthma. Maternal cytokine ratios in mothers without asthma were unrelated to the children's skin-test reactivity, total IgE, physician-confirmed allergic rhinitis at age 5, or eczema in infancy. To our knowledge, this study provides the first evidence that cytokine profiles in pregnant mothers without asthma relate to the risk for childhood asthma, but not allergy, and suggests a process of asthma development that begins in utero and is independent of allergy.

Direct infant UV light exposure is associated with eczema and immune development

Suboptimal vitamin D levels during critical periods of immune development have emerged as an explanation for higher rates of allergic diseases associated with industrialization and residing at higher latitudes. We sought to determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development. By using a double-blind randomized controlled trial, newborn infants were randomized to receive vitamin D supplementation (400 IU/d) or a placebo until 6months of age. Some infants also wore personal UV dosimeters to measure direct UV light (290-380nm) exposure. Infant vitamin D levels were measured at 3 and 6months of age. Eczema, wheeze, and immune function outcomes were assessed at 6months of age. At 3 (P<.01) and 6 (P=.02) months of age, vitamin D levels were greater for the vitamin D-supplemented group than the placebo group, but there was no difference in eczema incidence between groups. Infants with eczema were found to have had less UV light exposure (median, 555Joules per square meter [J/m2; interquartile range, 322-1210J/m2]) compared with those without eczema (median, 998J/m2 [interquartile range, 676-1577J/m2]; P=.02). UV light exposure was also inversely correlated with IL-2, GM-CSF, and eotaxin production to Toll-like receptor ligands. This study is the first to demonstrate an association between greater direct UV light exposures in early infancy with lower incidence of eczema and proinflammatory immune markers by 6months of age. Our findings indicate that UV light exposure appears more beneficial than vitamin D supplementation as an allergy prevention strategy in early life.