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. 2020 Aug;183(2):285-293.
doi: 10.1111/bjd.18597. Epub 2019 Dec 22.

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

Z K Jabbar-Lopez  1 , J Craven  2 , K Logan  2 , D Greenblatt  1 , T Marrs  2 , S Radulovic  2 , W H I McLean  3 , G Lack  2 , D P Strachan  4 , M R Perkin  4 , J L Peacock  5 , C Flohr  1
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Longitudinal analysis of the effect of water hardness on atopic eczema: evidence for gene-environment interaction

Z K Jabbar-Lopez et al. Br J Dermatol. 2020 Aug.

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 1303 infants enrolled in the EAT study, 91·3% (n = 1189) attended the final clinic visit and 94·0% (n = 1225) of participants' families completed the 36-month questionnaire. In total, 761 (58·4%) developed AE by 36 months. There was no overall association between exposure to harder (> 257 mg L-1 CaCO3 ) vs. softer (≤ 257 mg L-1 CaCO3 ) water: adjusted hazard ratio (HR) 1·07, 95% confidence interval (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), and statistically significant interactions between hard water plus FLG and both risk of AE (HR 1·80, 95% CI 1·17-2·78) and transepidermal water loss (0·0081 g m-2 h-1 per mg L-1 CaCO3 , 95% CI 0·00028-0·016).

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

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References

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