Skin Biomarkers Predict the Development of Food Allergy in Early Life

Background Food allergy (FA) often occurs in early childhood with and without atopic dermatitis (AD). FA can be severe and even fatal. For primary prevention, it is important to find early biomarkers to predict the future onset of FA before any clinical manifestations. Objective To find early predictors of future onset of FA in the stratum corneum (SC). Methods Skin tape strips (STS) were collected from the forearm of newborns (n=129) at the age of 2 months before any signs of clinical FA or AD. Children were clinically monitored until they reached 2 years of age to confirm the presence or absence of FA and AD. STS were subjected to lipidomic analyses by the LC-MS/MS and cytokine determination by Meso Scale Discovery U-Plex assay. Results Overall, 9/129 (7.0%) infants developed FA alone, and 9/129 (7.0%) infants developed FA concomitantly with AD (ADFA). In the SC of future FA and ADFA children, absolute amounts of unsaturated (N24:1)(C18S)Ceramide and (N26:1)(C18S)Ceramide and their relative percentages within the molecular group were increased in comparison to healthy children with p-values between <0.01 and p<0.05, ANOVA. Future AD children had normal levels of these molecules. Interleukin (IL)-33 was upregulated in future FA but not AD infants, whereas thymic stromal lymphopoietin (TSLP) was upregulated in AD but not FA. Logistic regression analysis revealed strong FA predicting power for the combination of dysregulated lipids and cytokines, with an odds ratio reaching 101.4 (95% CI 5.4 – 1910.6). Conclusion Non-invasive STS analysis at 2 months of age can identify infants at risk of future FA.