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Filipiak-Pittroff, B. ; Schnopp, C.* ; Berdel, D.* ; Naumann, A.* ; Sedlmeier, S.* ; Onken, A.* ; Rodriguez, E.* ; Fölster-Holst, R.* ; Baurecht, H.* ; Ollert, M.* ; Ring, J.* ; Cramer, C.* ; von Berg, A.* ; Bauer, C.P.* ; Herbarth, O.* ; Lehmann, I.* ; Schaaf, B.* ; Koletzko, S.* ; Wichmann, H.-E. ; Heinrich, J. ; Weidinger, S.* ; GINIplus Study Group (Schoetzau, A. ; Mosetter, M. ; Gehring, U. ; Thaqi, A. ; Sausenthaler, S. ; Wichmann, H.-E. ; Heinrich, J. ; Popescu, M. ; Schindler, J. ; Franke, K. ; Laubereau, B. ; Zirngibl, A. ; Zutavern, A.) ; LISAplus Study Group (Schindler, J. ; Höhnke, A. ; Franke, K. ; Laubereau, B. ; Wichmann, H.-E. ; Heinrich, J. ; Bolte, G. ; Belcredi, P. ; Jacob, B. ; Schoetzau, A. ; Mosetter, M. ; Sausenthaler, S. ; Thaqi, A. ; Zirngibl, A. ; Zutavern, A.)

Predictive value of food sensitization and filaggrin mutations in children with eczema.

J. Allergy Clin. Immunol. 128, 1235-1241 (2011)

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BACKGROUND: It was reported that in infants with eczema and food sensitization, the presence of a filaggrin (FLG) null mutation predicts future asthma with a specificity and positive predictive value of 100%. OBJECTIVES: We sought to evaluate the predictive value of food sensitization and food allergy, FLG haploinsufficiency, and their combination in infants with early-onset eczema for persistent eczema and childhood asthma. METHODS: The German Infant Nutritional Intervention (GINI) and Influence of Lifestyle-related Factors on the Immune System and the Development of Allergies in Childhood (LISA) birth cohorts, as well as a collection of 65 cases of early-onset eczema with and without food allergy were investigated. RESULTS: The risk for asthma was significantly increased by food sensitization (positive diagnostic likelihood ratios [PLRs] of 1.9 [95% CI, 1.1-3.4] in the GINI cohort and 5.5 [95% CI, 2.8-10.8] in the LISA cohort) and the presence of an FLG mutation (PLRs of 2.9 [95% CI, 1.2-6.6] in the GINI cohort and 2.8 [95% CI, 1.0-7.9] in the LISA cohort) with a rather high specificity (79.1% and 92.9% in the GINI cohort and 89.0% and 91.7% in the LISA cohort, respectively) but low sensitivity (40.0% and 39.3% in the GINI cohort and 31.6% and 23.5% in the LISA cohort, respectively). Likewise, the risk for persistent eczema was increased. In the clinical cases neither food allergy nor FLG mutations had a significant effect. The combination of both parameters did not improve prediction and reached positive predictive values of 52.3% (GINI cohort), 66.9% (LISA cohort), and 30.6% (clinical cases), assuming an asthma prevalence in children with early eczema of 30%. CONCLUSION: Early food sensitization and the presence of an FLG mutation in infants with early eczema increase the risk for later asthma, but the combination of the 2 factors does not represent a clinically useful approach to reliably identify children at risk.

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