The role of allergic risk and other factors that affect the occurrence of atopic dermatitis in the first 6 months of life

Abstract

BackgroundAtopic dermatitis (AD) is a chronic inflammation of the skin that often appears in early childhood. The manifestation is related to the tendency towards T helper 2 cytokine immune responses (interleukin (IL)-4, IL-5). Genetic factors are suggested to play important roles in AD, and it can be transmitted to newborns, increasing their risk of developing allergies.ObjectiveTo determine the association between cord-blood cytokine levels (IL-5, interferon (IFN) γ), cord-blood total immunoglobulin E (IgE) level, perinatal environmental exposure, and the risks of allergy as well as the development of AD in the first 6 months of life.MethodsA 6-month cohort study with a nested case-control within was conducted on newborns in Jakarta from December 2008 until May 2009. After the umbilical cord blood samples were taken and stored, subjects were followed up monthly until 6 months old. The occurrence of AD and lifestyle or environmental exposures were recorded. The allergic risk was determined using a modified pediatric allergy immunology work groups scoring system based on allergic history (allergic rhinitis, asthma, AD) in the family. The levels of IL-5 and IFN-γ were measured using ELISA and total IgE by CAP system FEIA. Multivariate analysis was used to evaluate risk factors.ResultsThis study was conducted on 226 subjects. The incidence of AD was 16.4%; of those, 59% had low risk allergy, 38.5% moderate, and 2% high risk. AD mostly occurred at the age of 1 month (57%). Cord blood samples were examined in 37 subjects with AD and 51 without AD; of those, 25% showed high levels of total IgE (>1.2 IU/µL), and 51% showed normally-distributed high absorbance IL-5 values (≥0.0715, absolute value was undetected). The increased level of IL-5 was directly proportional to IgE. High absorbance IFN-γ values (≥0.0795, absolute value = 18.681 pg/µL) were observed in 52% of subjects.ConclusionThe associations between the risk of allergy in the family, cord-blood total IgE, IL-5, IFN levels, and some perinatal environmental exposure with AD in the first 6 months of life have not been established.

Association between Prenatal Exposure to Cadmium and Atopic Dermatitis in Infancy

“…Although IgE antibodies play a pivotal role in atopic dermatitis, cord blood IgE may be less useful test for predicting atopic dermatitis. Munasir et al (33) reported that only 18.9% of the subjects with atopic dermatitis showed high levels of cord blood IgE ( > 1.2 IU/µL) in the first 6 months of life. Some studies have shown that elevated cord blood IgE increases sensitization to aeroallergens, but it does not always lead to a concomitant increase in respiratory or other allergic disorders (34-36).…”

The management of food allergy in Indonesia

“…Indonesia national survey found that only 25.2% infant who had exclusive breastfeeding for 4 months, and 15.3% infants who had exclusive breastfeeding for 6 months [20]. Munasir et al [21] found that breastfeeding has no impact on occurrence of atopic dermatitis. Nevertheless, we still encourage breastfeeding as allergy preventive measure.…”

Study protocol to investigate the environmental and genetic aetiology of atopic dermatitis: the Indonesian Prospective Study of Atopic Dermatitis in Infants (ISADI)

“…It often precedes the occurrences of allergic rhinitis and asthma, which has been referred to as the 'atopic march'. [21][22][23] The worldwide prevalence of AD has increased during the past three decades, and currently 10-20% of children are affected. 1 24-26 AD often begins in very early childhood, with as many as 45% of all cases reported to be manifested in the first 6 months of life.…”