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J Allergy Clin Immunol. 2019 May 29. pii: S0091-6749(19)30611-6. doi: 10.1016/j.jaci.2019.04.025. [Epub ahead of print]

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

Author information

1
Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
2
Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
3
Division of Hematology-Oncology, Department of Medicine, University of California, San Francisco, Calif.
4
University of Southampton and Southampton NIHR Biomedical Research Centre, Southampton, United Kingdom; David Hide Centre, Isle of Wight, United Kingdom.
5
Rho Federal Systems Division, Chapel Hill, NC.
6
Immune Tolerance Network, San Francisco, Calif.
7
National Institute of Allergy and Infectious Diseases, Bethesda, Md.
8
Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: gideon.lack@kcl.ac.uk.

Abstract

BACKGROUND:

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.

OBJECTIVE:

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 S aureus colonization with eczema severity and persistence.

METHODS:

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.

RESULTS:

Skin S aureus colonization was significantly associated with eczema severity across the LEAP study, whereas at 12 and 60 months 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 72 months 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.

CONCLUSION:

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.

KEYWORDS:

Food sensitization; Learning Early About Peanut Allergy; Staphylococcus aureus; atopic dermatitis; eczema; egg allergy; food allergy; microbiome; peanut allergy; prevention

PMID:
31160034
DOI:
10.1016/j.jaci.2019.04.025

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