The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype

DYM Leung, A Calatroni, LS Zaramela… - Science translational …, 2019 - science.org
DYM Leung, A Calatroni, LS Zaramela, PK LeBeau, N Dyjack, K Brar, G David, K Johnson…
Science translational medicine, 2019science.org
Skin barrier dysfunction has been reported in both atopic dermatitis (AD) and food allergy
(FA). However, only one-third of patients with AD have FA. The purpose of this study was to
use a minimally invasive skin tape strip sampling method and a multiomics approach to
determine whether children with AD and FA (AD FA+) have stratum corneum (SC)
abnormalities that distinguish them from AD without FA (AD FA−) and nonatopic (NA)
controls. Transepidermal water loss was found to be increased in AD FA+. Filaggrin and the …
Skin barrier dysfunction has been reported in both atopic dermatitis (AD) and food allergy (FA). However, only one-third of patients with AD have FA. The purpose of this study was to use a minimally invasive skin tape strip sampling method and a multiomics approach to determine whether children with AD and FA (AD FA+) have stratum corneum (SC) abnormalities that distinguish them from AD without FA (AD FA−) and nonatopic (NA) controls. Transepidermal water loss was found to be increased in AD FA+. Filaggrin and the proportion of ω-hydroxy fatty acid sphingosine ceramide content in nonlesional skin of children with AD FA+ were substantially lower than in AD FA− and NA skin. These abnormalities correlated with morphologic changes in epidermal lamellar bilayer architecture responsible for barrier homeostasis. Shotgun metagenomic studies revealed that the nonlesional skin of AD FA+ had increased abundance of Staphylococcus aureus compared to NA. Increased expression of keratins 5, 14, and 16 indicative of hyperproliferative keratinocytes was observed in the SC of AD FA+. The skin transcriptome of AD FA+ had increased gene expression for dendritic cells and type 2 immune pathways. A network analysis revealed keratins 5, 14, and 16 were positively correlated with AD FA+, whereas filaggrin breakdown products were negatively correlated with AD FA+. These data suggest that the most superficial compartment of nonlesional skin in AD FA+ has unique properties associated with an immature skin barrier and type 2 immune activation.
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