Supplementary Material for: Prediction of Food Sensitization in Children with Atopic Dermatitis Based on Disease Severity and Epidermal Layer Impairment

ABSTRACT Introduction: Atopic dermatitis (AD) is characterized by an impaired epidermal barrier, which could be associated with sensitization to food allergens (FA) and/or inhaled allergens and contribute to the severity of AD. However, no clinical guidance has been established for evaluations of food sensitization (FS) in AD patients. This study investigated how AD severity and epidermal barrier impairment are associated with FS, and factors that can predict FS in children with AD. Methods: This cross-sectional study included 100 children (12–60 months) diagnosed with AD. AD severity was determined using the Scoring Atopic Dermatitis (SCORAD) index. FS was evaluated by measuring serum specific IgE antibodies against 31 FAs using an immunoblotting method. Epidermal barrier impairment was assessed by measuring transepidermal water loss (TEWL) and stratum corneum hydration (SCH) levels. Results: 90% of participants were sensitized to at least one tested FA, with cow’s milk, egg white, beef, almond, egg yolk, and peanut being the most common. Children with moderate-severe AD had lower SCH levels than those with mild AD. Children with AD who were sensitized to > 10 FAs had significantly higher TEWL and lower SCH levels, compared with those sensitized to 1–4 FAs and 5–10 FAs. The SCORAD score and SCH level in lesional skin provided moderately predictive value for sensitization to FAs in children with AD. Conclusion: FS is common in children with AD and closely associate with AD severity as well as epidermal barrier impairment. Evaluations of FS should be considered for children with moderate to severe AD and/or low SCH levels.

摘要：
引言：特应性皮炎（Atopic Dermatitis, AD）以表皮屏障功能受损为特征，该病变可与食物过敏原（Food Allergens, FA）致敏和/或吸入性过敏原致敏相关，并可加重AD的病情严重程度。但目前尚未建立针对AD患者食物致敏（Food Sensitization, FS）评估的临床指南。本研究旨在探讨AD严重程度与表皮屏障受损程度和食物致敏之间的关联，以及可预测AD患儿食物致敏的相关因素。

方法：本项横断面研究纳入了100名确诊为AD的12~60月龄儿童。采用特应性皮炎评分（Scoring Atopic Dermatitis, SCORAD）指数评估AD的严重程度。通过免疫印迹法检测血清中针对31种食物过敏原的特异性IgE抗体，以此评估受试者的食物致敏情况。通过检测经表皮水分流失（Transepidermal Water Loss, TEWL）与角质层含水量（Stratum Corneum Hydration, SCH）水平，评估表皮屏障的受损程度。

结果：90%的受试儿童对至少1种受试食物过敏原致敏，其中最常见的致敏原依次为牛奶、蛋清、牛肉、杏仁、蛋黄与花生。中重度AD患儿的角质层含水量水平显著低于轻度AD患儿。与致敏1~4种、5~10种食物过敏原的AD患儿相比，致敏超过10种食物过敏原的患儿经表皮水分流失水平显著升高，而角质层含水量水平显著降低。皮损区域的SCORAD评分与角质层含水量水平，对AD患儿的食物致敏具有中等程度的预测价值。

结论：食物致敏在AD患儿中极为常见，且与AD严重程度及表皮屏障受损程度密切相关。对于中重度AD患儿和/或角质层含水量较低的患儿，临床应考虑开展食物致敏评估。