Longitudinal analysis of the effect of water hardness on atopic eczema: evidence for gene-environment interaction

Z. K. Jabbar-Lopez, J. Craven, K. Logan, D. Greenblatt, T. Marrs, S. Radulovic, W. H. I. McLean, G. Lack, D. P. Strachan, M. R. Perkin, J. L. Peacock, C. Flohr (Lead / Corresponding author)

    Research output: Contribution to journalArticle

    Abstract

    Background: Several studies have identified an association between water hardness and atopic eczema (AE), however, there is a paucity of longitudinal data in early life.

    Objectives: To examine whether water hardness is associated with an increased risk of AE and skin barrier dysfunction in infants and to assess effect modification by filaggrin (FLG) loss-of-function variants.

    Methods: We performed a longitudinal analysis of data from infants in the Enquiring About Tolerance (EAT) study, who were enrolled at 3 months and followed up until 36 months of age.

    Results: Of 1,303 infants enrolled in the EAT study, 91.3% (n=1,189) attended the final clinic visit and 94.0% (n=1,225) of participants' families completed the 36-month questionnaire. Of these, 761 (58.4%) developed AE by 36 months. There was no overall association between exposure to harder (>255 mg/L calcium carbonate [CaCO3 ]) versus softer (≤255 mg/L CaCO3 ) water: Adjusted hazard ratio (HR) 1.07 95% CI 0.92, 1.24. However, there was an increased incidence of AE in infants with FLG mutations exposed to hard water: adjusted HR 2.72 95% CI 2.03, 3.66, with a statistically significant interaction between hard water, FLG and risk of AE (HR 2.72 95% CI 2.03, 3.66) and TEWL (0.0081 g/m2 /h per mg/L CaCO3 95% CI 0.00028, 0.016).

    Conclusions: There is evidence of an interaction between water hardness and FLG gene mutations in the development of infantile AE.

    Original languageEnglish
    JournalBritish Journal of Dermatology
    DOIs
    Publication statusE-pub ahead of print - 10 Oct 2019

    Fingerprint

    Gene-Environment Interaction
    Hardness
    Atopic Dermatitis
    Water
    Mutation
    Calcium Carbonate
    Ambulatory Care
    Skin
    filaggrin
    Incidence
    Genes

    Keywords

    • Atopic dermatitis
    • atopic eczema
    • eczema
    • water hardness
    • filaggrin

    Cite this

    Jabbar-Lopez, Z. K. ; Craven, J. ; Logan, K. ; Greenblatt, D. ; Marrs, T. ; Radulovic, S. ; McLean, W. H. I. ; Lack, G. ; Strachan, D. P. ; Perkin, M. R. ; Peacock, J. L. ; Flohr, C. / Longitudinal analysis of the effect of water hardness on atopic eczema : evidence for gene-environment interaction. In: British Journal of Dermatology. 2019.
    @article{545c4702325d4f93bd9c009f8fb9c280,
    title = "Longitudinal analysis of the effect of water hardness on atopic eczema: evidence for gene-environment interaction",
    abstract = "Background: Several studies have identified an association between water hardness and atopic eczema (AE), however, there is a paucity of longitudinal data in early life.Objectives: To examine whether water hardness is associated with an increased risk of AE and skin barrier dysfunction in infants and to assess effect modification by filaggrin (FLG) loss-of-function variants.Methods: We performed a longitudinal analysis of data from infants in the Enquiring About Tolerance (EAT) study, who were enrolled at 3 months and followed up until 36 months of age.Results: Of 1,303 infants enrolled in the EAT study, 91.3{\%} (n=1,189) attended the final clinic visit and 94.0{\%} (n=1,225) of participants' families completed the 36-month questionnaire. Of these, 761 (58.4{\%}) developed AE by 36 months. There was no overall association between exposure to harder (>255 mg/L calcium carbonate [CaCO3 ]) versus softer (≤255 mg/L CaCO3 ) water: Adjusted hazard ratio (HR) 1.07 95{\%} CI 0.92, 1.24. However, there was an increased incidence of AE in infants with FLG mutations exposed to hard water: adjusted HR 2.72 95{\%} CI 2.03, 3.66, with a statistically significant interaction between hard water, FLG and risk of AE (HR 2.72 95{\%} CI 2.03, 3.66) and TEWL (0.0081 g/m2 /h per mg/L CaCO3 95{\%} CI 0.00028, 0.016).Conclusions: There is evidence of an interaction between water hardness and FLG gene mutations in the development of infantile AE.",
    keywords = "Atopic dermatitis, atopic eczema, eczema, water hardness, filaggrin",
    author = "Jabbar-Lopez, {Z. K.} and J. Craven and K. Logan and D. Greenblatt and T. Marrs and S. Radulovic and McLean, {W. H. I.} and G. Lack and Strachan, {D. P.} and Perkin, {M. R.} and Peacock, {J. L.} and C. Flohr",
    note = "{\circledC} 2019 British Association of Dermatologists.",
    year = "2019",
    month = "10",
    day = "10",
    doi = "10.1111/bjd.18597",
    language = "English",
    journal = "British Journal of Dermatology",
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    Jabbar-Lopez, ZK, Craven, J, Logan, K, Greenblatt, D, Marrs, T, Radulovic, S, McLean, WHI, Lack, G, Strachan, DP, Perkin, MR, Peacock, JL & Flohr, C 2019, 'Longitudinal analysis of the effect of water hardness on atopic eczema: evidence for gene-environment interaction', British Journal of Dermatology. https://doi.org/10.1111/bjd.18597

    Longitudinal analysis of the effect of water hardness on atopic eczema : evidence for gene-environment interaction. / Jabbar-Lopez, Z. K.; Craven, J.; Logan, K.; Greenblatt, D.; Marrs, T.; Radulovic, S.; McLean, W. H. I.; Lack, G.; Strachan, D. P.; Perkin, M. R.; Peacock, J. L.; Flohr, C. (Lead / Corresponding author).

    In: British Journal of Dermatology, 10.10.2019.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Longitudinal analysis of the effect of water hardness on atopic eczema

    T2 - evidence for gene-environment interaction

    AU - Jabbar-Lopez, Z. K.

    AU - Craven, J.

    AU - Logan, K.

    AU - Greenblatt, D.

    AU - Marrs, T.

    AU - Radulovic, S.

    AU - McLean, W. H. I.

    AU - Lack, G.

    AU - Strachan, D. P.

    AU - Perkin, M. R.

    AU - Peacock, J. L.

    AU - Flohr, C.

    N1 - © 2019 British Association of Dermatologists.

    PY - 2019/10/10

    Y1 - 2019/10/10

    N2 - Background: Several studies have identified an association between water hardness and atopic eczema (AE), however, there is a paucity of longitudinal data in early life.Objectives: To examine whether water hardness is associated with an increased risk of AE and skin barrier dysfunction in infants and to assess effect modification by filaggrin (FLG) loss-of-function variants.Methods: We performed a longitudinal analysis of data from infants in the Enquiring About Tolerance (EAT) study, who were enrolled at 3 months and followed up until 36 months of age.Results: Of 1,303 infants enrolled in the EAT study, 91.3% (n=1,189) attended the final clinic visit and 94.0% (n=1,225) of participants' families completed the 36-month questionnaire. Of these, 761 (58.4%) developed AE by 36 months. There was no overall association between exposure to harder (>255 mg/L calcium carbonate [CaCO3 ]) versus softer (≤255 mg/L CaCO3 ) water: Adjusted hazard ratio (HR) 1.07 95% CI 0.92, 1.24. However, there was an increased incidence of AE in infants with FLG mutations exposed to hard water: adjusted HR 2.72 95% CI 2.03, 3.66, with a statistically significant interaction between hard water, FLG and risk of AE (HR 2.72 95% CI 2.03, 3.66) and TEWL (0.0081 g/m2 /h per mg/L CaCO3 95% CI 0.00028, 0.016).Conclusions: There is evidence of an interaction between water hardness and FLG gene mutations in the development of infantile AE.

    AB - Background: Several studies have identified an association between water hardness and atopic eczema (AE), however, there is a paucity of longitudinal data in early life.Objectives: To examine whether water hardness is associated with an increased risk of AE and skin barrier dysfunction in infants and to assess effect modification by filaggrin (FLG) loss-of-function variants.Methods: We performed a longitudinal analysis of data from infants in the Enquiring About Tolerance (EAT) study, who were enrolled at 3 months and followed up until 36 months of age.Results: Of 1,303 infants enrolled in the EAT study, 91.3% (n=1,189) attended the final clinic visit and 94.0% (n=1,225) of participants' families completed the 36-month questionnaire. Of these, 761 (58.4%) developed AE by 36 months. There was no overall association between exposure to harder (>255 mg/L calcium carbonate [CaCO3 ]) versus softer (≤255 mg/L CaCO3 ) water: Adjusted hazard ratio (HR) 1.07 95% CI 0.92, 1.24. However, there was an increased incidence of AE in infants with FLG mutations exposed to hard water: adjusted HR 2.72 95% CI 2.03, 3.66, with a statistically significant interaction between hard water, FLG and risk of AE (HR 2.72 95% CI 2.03, 3.66) and TEWL (0.0081 g/m2 /h per mg/L CaCO3 95% CI 0.00028, 0.016).Conclusions: There is evidence of an interaction between water hardness and FLG gene mutations in the development of infantile AE.

    KW - Atopic dermatitis

    KW - atopic eczema

    KW - eczema

    KW - water hardness

    KW - filaggrin

    U2 - 10.1111/bjd.18597

    DO - 10.1111/bjd.18597

    M3 - Article

    C2 - 31599965

    JO - British Journal of Dermatology

    JF - British Journal of Dermatology

    SN - 0007-0963

    ER -