18 July 2013
Eczema may play a key role in the development of food allergy in infants, study suggests
A breakdown of the skin barrier and inflammation in the skin that occurs in eczema could play a key role in triggering food
sensitivity in babies, a new study reveals. Scientists say this finding indicates that food allergies may develop via immune
cells in the skin rather than the gut, highlighting eczema as a potential target for preventing food allergy in children.
A link between eczema and food allergy has been known for some time, but researchers from King's College London and the
University of Dundee say this study, published in the Journal of Investigative Dermatology, adds to growing evidence of the
skin barrier's role in this process.
Almost 1 in 12 children in the UK have a food allergy and 1 in 5 suffer from eczema. Both diseases have a significant impact
on patients and their families, often requiring treatment and in severe cases hospitalisation.
Previous studies show that people with a skin barrier defect such as eczema do not have adequate protection against
environmental allergens. In this study, funded by the Food Standards Agency, Medical Research Council, and the National
Institute for Health Research (NIHR), researchers found that infants with an impaired skin barrier, especially if they
also have eczema, are over six times more likely than healthy infants to be sensitised to a variety of foods such as egg, cow's
milk and peanut.
The researchers at King's and Dundee analysed over 600 three-month-old babies from the EAT (Enquiring About Tolerance)
Study who were exclusively breastfed from birth. They examined the infants for eczema, tested how much water the skin
was able to retain, and screened for gene mutations associated with eczema. They then carried out skin prick tests to see
whether the infants were also sensitised to the six commonest allergenic foods. They found that egg white was the most common
allergen, followed by cow's milk, and peanut. They observed that the more severe the eczema, the stronger the correlation
to food sensitivity, independent of genetic factors. The researchers cautioned, however, that food sensitivity does not
always lead to clinical allergy and further follow up of the EAT Study children is currently underway.
As the infants involved in the study were exclusively breast-fed, and therefore had not ingested any solid foods yet,
this suggests that active immune cells in the skin, rather than the gut, may play a crucial role in food sensitisation. It
is thought that the breakdown of the skin barrier in eczema leaves active immune cells found in skin exposed to environmental
allergens - in this case food proteins - which then triggers an allergic immune response.
Dr Carsten Flohr, NIHR Clinician Scientist and Senior Lecturer at King's College London and Consultant at St John's Institute
of Dermatology at St Thomas' Hospital, said: 'This is a very exciting study, providing further evidence that an impaired skin
barrier and eczema could play a key role in triggering food sensitivity in babies, which could ultimately lead to the development
of food allergies.
'This work takes what we thought we knew about eczema and food allergy and flips it on its head - we thought that food
allergies are triggered from the inside out, but our work shows that in some children it could be from the outside in, via
the skin. The skin barrier plays a crucial role in protecting us from allergens in our environment, and we can see here that
when that barrier is compromised, especially in eczema, it seems to leave the skin's immune cells exposed to these allergens.
'It opens up the possibility that if we can repair the skin barrier and prevent eczema effectively then we might also be
able to reduce the risk of food allergies.'
For further information please contact Emma Reynolds, PR Manager (Health) at King's College London, on 0207 848 4334 or
email emma.reynolds@kcl.ac.uk
Notes to editors:
The EAT Study looks at the effects of introducing allergenic foods from 3 months of age alongside breastfeeding compared to
exclusive breastfeeding for 6 months. The prevalence of food allergies, asthma and eczema will be determined when the children
reach 3 years, and the findings will help to inform policy on the timing of introduction of allergenic foods for future
generations. (www.eatstudy.co.uk)
King's College London is part of King's Health Partners, accredited as an Academic Health Sciences Centre by the Department
of Health. It is a pioneering global collaboration between one of the world's leading research-led universities and three
of London's most successful NHS Foundation Trusts.
King's College London
King's College London is one of the top 30 universities in the world (2011/12 QS World University Rankings), and the fourth
oldest in England. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more
than 10,000 are graduate students) from nearly 140 countries, and some 6,500 employees. King's is in the second phase of a
£1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research
Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities;
over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can
thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an
overall annual income of nearly £450 million.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of
health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs.
It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure
of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre
for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation
Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering
global collaboration between one of the world's leading research-led universities and three of London's most successful
NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information,
visit: www.kingshealthpartners.org.
The University of Dundee is internationally recognised for its excellence in life sciences and medical research with
particular expertise in cancer, diabetes, cardiovascular disease, neuroscience and skin diseases. The University has a
top-rated medical school with research expanding from "the cell to the clinic to the community", while the College of
Life Sciences is home to some of the world's most cited scientists and more than 800 research staff from 60 different
countries. Dundee was voted best in the UK for student experience in the 2012 Times Higher Education Student Experience
Survey. See www.dundee.ac.uk for further details.
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth
of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has
increased the volume of applied health research for the benefit of patients and the public, driven faster translation of
basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who
conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth,
attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together,
the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the
world. For further information, visit the NIHR website (www.nihr.ac.uk).
The Food Standards Agency is an independent government department responsible for food safety and hygiene across the UK.
We work with businesses to help them produce safe food, and with local authorities to enforce food safety regulations.
Everything we do reflects our vision of 'Safer food for the nation'. We aim to ensure that food produced or sold in the
UK is safe to eat, consumers have the information they need to make informed choices about where and what they eat and
that regulation and enforcement is risk-based and focused on improving public health.
Guy's and St Thomas' provides more than 2 million patient contacts in acute and specialist hospital services and community
services every year. As one of the biggest NHS Trusts in the UK, with an annual turnover of £1.2 billion, we employ 13,200 staff.
www.guysandstthomas.nhs.uk
Guy's and St Thomas' is part of King's Health Partners Academic Health Sciences Centre (AHSC), a collaboration between King's
College London, and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts.
www.kingshealthpartners.org
Medical Research Council
Over the past century, the Medical Research Council has been at the forefront of scientific discovery to improve human health.
Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers' money in some of the best medical research in the world
across every area of health. Twenty-nine MRC-funded researchers have won Nobel prizes in a wide range of disciplines,
and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between
smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention
of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs
ever developed.
Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the
rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms.
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