Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes
BACKGROUND Food allergy (FA) is a growing health problem requiring physiologic confirmation via the oral food challenge (OFC). Many OFCs result in clinical anaphylaxis, causing discomfort and risk while limiting OFC utility. Transepidermal water loss (TEWL) measurement provides a potential solution...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
American Society for Clinical Investigation
2023-08-01
|
| Series: | The Journal of Clinical Investigation |
| Subjects: | |
| Online Access: | https://doi.org/10.1172/JCI168965 |
| _version_ | 1797634419032326144 |
|---|---|
| author | Charles F. Schuler IV Kelly M. O’Shea Jonathan P. Troost Bridgette Kaul Christopher M. Launius Jayme Cannon David M. Manthei George E. Freigeh Georgiana M. Sanders Simon P. Hogan Nicholas W. Lukacs James R. Baker Jr. |
| author_facet | Charles F. Schuler IV Kelly M. O’Shea Jonathan P. Troost Bridgette Kaul Christopher M. Launius Jayme Cannon David M. Manthei George E. Freigeh Georgiana M. Sanders Simon P. Hogan Nicholas W. Lukacs James R. Baker Jr. |
| author_sort | Charles F. Schuler IV |
| collection | DOAJ |
| description | BACKGROUND Food allergy (FA) is a growing health problem requiring physiologic confirmation via the oral food challenge (OFC). Many OFCs result in clinical anaphylaxis, causing discomfort and risk while limiting OFC utility. Transepidermal water loss (TEWL) measurement provides a potential solution to detect food anaphylaxis in real time prior to clinical symptoms. We evaluated whether TEWL changes during an OFC could predict anaphylaxis onset.METHODS Physicians and nurses blinded to the TEWL results conducted and adjudicated the results of all 209 OFCs in this study. A study coordinator measured TEWL throughout the OFC and had no input on the OFC conduct. TEWL was measured 2 ways in 2 separate groups. First, TEWL was measured using static, discrete measurements. Second, TEWL was measured using continuous monitoring. Participants who consented provided blood samples before and after the OFCs for biomarker analyses.RESULTS TEWL rose significantly (2.93 g/m2/h) during reactions and did not rise during nonreacting OFCs (–1.00 g/m2/h). Systemic increases in tryptase and IL-3 were also detected during reactions, providing supporting biochemical evidence of anaphylaxis. The TEWL rise occurred 48 minutes earlier than clinically evident anaphylaxis. Continuous monitoring detected a significant rise in TEWL that presaged positive OFCs, but no rise was seen in the OFCs that resulted in no reaction, providing high predictive specificity (96%) for anaphylaxis against nonreactions 38 minutes prior to anaphylaxis onset.CONCLUSIONS During OFCs, a TEWL rise anticipated a positive clinical challenge. TEWL presents a monitoring modality that may predict food anaphylaxis and facilitate improvements in OFC safety and tolerability. |
| first_indexed | 2024-03-11T12:07:23Z |
| format | Article |
| id | doaj.art-30425ae9caa646db8d04c8dc2e2c213b |
| institution | Directory Open Access Journal |
| issn | 1558-8238 |
| language | English |
| last_indexed | 2024-03-11T12:07:23Z |
| publishDate | 2023-08-01 |
| publisher | American Society for Clinical Investigation |
| record_format | Article |
| series | The Journal of Clinical Investigation |
| spelling | doaj.art-30425ae9caa646db8d04c8dc2e2c213b2023-11-07T16:20:43ZengAmerican Society for Clinical InvestigationThe Journal of Clinical Investigation1558-82382023-08-0113316Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomesCharles F. Schuler IVKelly M. O’SheaJonathan P. TroostBridgette KaulChristopher M. LauniusJayme CannonDavid M. MantheiGeorge E. FreigehGeorgiana M. SandersSimon P. HoganNicholas W. LukacsJames R. Baker Jr.BACKGROUND Food allergy (FA) is a growing health problem requiring physiologic confirmation via the oral food challenge (OFC). Many OFCs result in clinical anaphylaxis, causing discomfort and risk while limiting OFC utility. Transepidermal water loss (TEWL) measurement provides a potential solution to detect food anaphylaxis in real time prior to clinical symptoms. We evaluated whether TEWL changes during an OFC could predict anaphylaxis onset.METHODS Physicians and nurses blinded to the TEWL results conducted and adjudicated the results of all 209 OFCs in this study. A study coordinator measured TEWL throughout the OFC and had no input on the OFC conduct. TEWL was measured 2 ways in 2 separate groups. First, TEWL was measured using static, discrete measurements. Second, TEWL was measured using continuous monitoring. Participants who consented provided blood samples before and after the OFCs for biomarker analyses.RESULTS TEWL rose significantly (2.93 g/m2/h) during reactions and did not rise during nonreacting OFCs (–1.00 g/m2/h). Systemic increases in tryptase and IL-3 were also detected during reactions, providing supporting biochemical evidence of anaphylaxis. The TEWL rise occurred 48 minutes earlier than clinically evident anaphylaxis. Continuous monitoring detected a significant rise in TEWL that presaged positive OFCs, but no rise was seen in the OFCs that resulted in no reaction, providing high predictive specificity (96%) for anaphylaxis against nonreactions 38 minutes prior to anaphylaxis onset.CONCLUSIONS During OFCs, a TEWL rise anticipated a positive clinical challenge. TEWL presents a monitoring modality that may predict food anaphylaxis and facilitate improvements in OFC safety and tolerability.https://doi.org/10.1172/JCI168965ImmunologyInflammation |
| spellingShingle | Charles F. Schuler IV Kelly M. O’Shea Jonathan P. Troost Bridgette Kaul Christopher M. Launius Jayme Cannon David M. Manthei George E. Freigeh Georgiana M. Sanders Simon P. Hogan Nicholas W. Lukacs James R. Baker Jr. Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes The Journal of Clinical Investigation Immunology Inflammation |
| title | Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes |
| title_full | Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes |
| title_fullStr | Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes |
| title_full_unstemmed | Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes |
| title_short | Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes |
| title_sort | transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes |
| topic | Immunology Inflammation |
| url | https://doi.org/10.1172/JCI168965 |
| work_keys_str_mv | AT charlesfschuleriv transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT kellymoshea transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT jonathanptroost transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT bridgettekaul transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT christophermlaunius transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT jaymecannon transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT davidmmanthei transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT georgeefreigeh transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT georgianamsanders transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT simonphogan transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT nicholaswlukacs transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes AT jamesrbakerjr transepidermalwaterlossrisesbeforefoodanaphylaxisandpredictsfoodchallengeoutcomes |