Natural history of allergic sensitization in infants with early-onset atopic 1 dermatitis: results from ORCA Study

Jocelyne Just (1, 2) , Emmanuelle Deslandes-Boutmy (3) , Flore Amat (2, 1) , Kristell Desseaux (3) , Ariane Nemni (2) , Emmanuelle Bourrat (4) , Fatia Sahraoui (2) , Isabelle Pansé (4) , Martine Bagot (4) , Sébastien Fouéré (4)

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 CHU Trousseau [APHP]
3 Service de biostatistique et d'informatique médicale
4 Service de dermatologie [Paris]

BACKGROUND: Early-onset atopic dermatitis (AD) is a particular phenotype that may convey a risk of developing multiple sensitizations to allergens but little is known about the pathway of sensitization. The aims of this study were to describe the natural history of sensitization to allergens for this phenotype and to identify the most predictive marker associated with the risk of developing sensitization to inhaled allergens in a well-selected cohort of infants with AD. METHODS: Infants with active AD were enrolled and prospectively explored for biological markers of atopy every year until the age of 6 yr. Allergic sensitization was defined as the presence of positive specific IgEs to allergens and multiple sensitizations as being sensitized to ≥2 allergens. Elevated blood eosinophilia was defined as an eosinophil blood count ≥470 eosinophils/mm3 and elevated total IgE as a serum IgE level ≥45 kU/l. RESULTS: Two hundred and twenty-nine infants were included. Elevated blood eosinophilia was observed at baseline in 60 children (26.2%) and elevated total IgE in 85 (37.1%). When elevated at baseline, eosinophilia and IgE levels remained significantly higher during the follow-up period. Sensitization to food allergens decreased from 58% to 34%, whereas sensitization to inhaled allergens increased over time from 17% to 67%. Initial multiple sensitizations to food allergens were the most predictive factor for the risk of developing sensitization to inhaled allergens at 6 yr (OR 3.72 [1.68-8.30] p < 0.001). CONCLUSIONS: In the early-onset AD phenotype, multiple sensitization to food allergens conveys a higher risk of sensitization to inhaled allergens than single sensitization.

Mots clés: cohort; phenotypes; food allergens; inhaled allergens; sensitization; atopic dermatitis

Domaines: Pédiatrie; Allergologie

Jocelyne Just, Emmanuelle Deslandes-Boutmy, Flore Amat, Kristell Desseaux, Ariane Nemni, et al.. Natural history of allergic sensitization in infants with early-onset atopic 1 dermatitis: results from ORCA Study. Pediatric Allergy and Immunology, 2014, 25, pp.668-673 ⟨10.1111/pai.12287⟩. ⟨hal-01103219⟩