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Targeted Deep Sequencing Detects Risk of Eczema Herpeticum, and more

Targeted Deep Sequencing Detects Risk of Eczema Herpeticum, and more

Targeted Deep Sequencing Detects Risk of ADEH+ 

In a recent study, researchers set out to determine the function of rare variants in interferon pathway genes for the risk of eczema herpeticum (ADEH+). They published their findings in Journal of Allergy and Clinical Immunology

A subset of atopic dermatitis (AD) is associated with increased susceptibility to ADEH+. In a previous report, researchers noted that common single nucleotide polymorphisms (SNPs) in the IFN-γ (IFNG) and IFN-γ receptor 1 (IFNGR1) genes were associated with the ADEH+ phenotype.

Researchers performed targeted sequencing of interferon pathway genes (IFNG, IFNGR1, IFNAR1 and IL12RB1) in 228 European-American participants with AD. Participants were selected according to their ADEH+ status and severity was measured by using the Eczema Area and Severity Index. 

“We identified 494 single nucleotide variants encompassing 105 kb of sequence, including 145 common, 349 (70.6%) rare (minor allele frequency <5%) and 86 (17.4%) novel variants, of which 2.8% were coding synonymous, 93.3% were non-coding (64.6% intronic) and 3.8% were missense. We identified 6 rare IFNGR1 missense variants, including 3 damaging variants (Val14Met [V14M], Val61Ile and Tyr397Cys [Y397C]) conferring a higher risk for ADEH+ (P=.031),” the researchers said. 

It was also confirmed that the variants V14M and Y397C are harmful, which leads to partial IFNGR1 deficiency. Seven common IFNGR1 SNPs, along with common protective haplotypes (2-7 SNPs), presented a reduced risk of ADEH+ (P=.015-.002 and P=.0015-.0004), respectively.

“Our results provide evidence that both genetic variants in the gene encoding IFNGR1 are implicated in susceptibility to the ADEH+ phenotype,” the researchers concluded. 

Gao L, Bin L, Rafaels NM, et al. Targeted deep sequencing identifies rare loss-of-function variants in IFNGR1 for risk of atopic dermatitis complicated by eczema herpeticum. J Allergy Clin Immunol. Published online ahead of print September 3, 2015. 

Childhood Eczema Associated with Increased Headaches  

Sleep disturbances are one of the many side effects of eczema. They can often lead to quality-of-life impairment, including headaches. In a study published in Journal of Allergy and Clinical Immunology, researchers sought to determine whether childhood eczema is also associated with increased headaches and fatigue.

For the study, researchers analyzed data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children’s Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997-2013. Eczema was found to be associated with headaches in 14 of 19 studies.

In a collective analysis of the 19 studies, children with eczema compared with those without eczema had a significantly higher prevalence (10.7%; 95% confidence interval [CI, 10.3%-11.0%) versus 5.4% (95% CI, 5.3%-5.5%) and odds (1.52; 95% CI, 1.45-1.59) of headaches. In addition, mild (1.79; 95% CI, 1.07-2.98) and severe (2.72; 95% CI, 1.33-5.57) eczema were associated with significantly higher odds of headaches. 

“Eczema is associated with increased headaches in childhood, particularly in patients with severe disease accompanied by atopy, fatigue and sleep disturbances,” concluded researchers. 

Silverberg JI. Association between childhood eczema and headaches: An analysis of 19 US population-based studies. J Allergy Clin Immunol. Published online ahead of print August 29, 2015. 

Males with Early Eczema at Highest Risk for Milk and Egg Sensitization 

Food sensitization prevalence is highest in infancy and declines after 12 months of age, according to a study in Pediatric Allergy and Immunology. Researchers observed sensitization to cow’s milk, hen’s egg and peanut through skin prick testing in 620 participants, ages 6 months, 1, 2, 12 and 18 years in a high-risk allergy birth cohort. 

Generalized additive models investigated interactions with sex, eczema and aeroallergen sensitization in infancy. Logistic regression assessed the relationships between early food sensitization and adolescent sensitization and probable food allergy up to 18 years.

The study demonstrated that the prevalence of egg and peanut sensitization peaked at 12 months, while milk sensitization peaked at both 1 and 12 years. Boys with early eczema had the highest prevalence’s of milk and egg sensitization throughout follow-ups. However, neither sex nor eczema influenced the prevalence of peanut sensitization over time. New onset food sensitization beyond the age of 2 was observed in 7% of participants. 

“Food sensitization at 12 months was associated with increased risk of adolescent food sensitization and adolescent probable food allergy, with sensitization to more than one food allergen had the strongest predictor,” they reported.

Overall, boys who have been diagnosed with eczema early on have the highest occurrence of milk and egg sensitization. 

Alduraywish SA, Lodge CJ, Vicendese D, et al. Sensitisation to milk, egg and peanut from birth to 18 years: a longitudinal study of a cohort at risk of allergic disease. Pediatr Allergy Immunol. Published online ahead of print August 27, 2015.

Study: Nummular Eczema a Potential Complication of Breast Reconstruction 

In a study published in Plastic Surgery International, researchers reported clinical cases where nummular eczema, which developed during the course of breast reconstruction by means of implantation, then evaluated the occurrence patterns and ratios of this complication. Nummular eczema presents as coin-shaped rashes on the skin that can itch or burn.

The study included 1,662 patients undergoing breast reconstruction. Patients who developed nummular eczema during the treatment were selected, then given a survey which included 3 items: the stage of the treatment at which nummular eczema developed, time required for the lesion to heal and location of the lesion on the reconstructed breast(s). Histopathological examination was conducted to elucidate the etiology of the lesion. Researchers concluded that 48 patients developed nummular eczema. 

 The findings showed that the timing of onset varied among these patients, with lesions developing after the placement of tissue expanders for 22 patients (45.8%); after the tissue expanders were replaced with silicone implants for 12 patients (25%) and after nipple-areola complex reconstruction for 14 patients (29.2%). Furthermore, nummular eczema developed both in periwound regions (20 cases: 41.7%) and in non-periwound regions (32 cases: 66.7%).

“Surgeons should recognize that nummular eczema is a potential complication of breast reconstruction with tissue expanders and silicone implants,” said the researchers. 

Iwahira Y, Nagaao T, Simizu Y, Kuwata K, Tanaka Y. Nummular eczema of breast: a potential dermatologic complication after mastectomy and subsequent breast reconstruction. Plast Surg Int. 2015;2015:209458.

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