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Association of Staphylococcus aureus colonization with food allergy occurs independently of eczema severity

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Immune Tolerance Network Learning Early About Peanut Allergy study team, Olympia Tsilochristou, George du Toit, Peter H. Sayre, Graham Roberts, Kaitie Lawson, Michelle L. Sever, Henry T. Bahnson, Suzana Radulovic, Monica Basting, Marshall Plaut, Gideon Lack, S. Chan, Adam Fox, H. Fisher, M. Abraham, Muhsinah Adam, Louise Coverdale, Claire Duncan, Amy Nixon & 31 more Una O'Dwyer-Leeson, Victoria Offord, Aine Sheridan, F. Watson, Natalie Witham, Kathryn Cockerell, Gail Harland, Tiffany Miller, Charlotte Stedman, Catherine Clarke, Richard Cleaver, G. Deutsch, Alicia Parr, Natalia Becares, Matthew Crossley, Natalia do Couto Francisco, K. Richards, Ewa Pietraszewicz, A. Stephens, Asha Sudra, Rianne Wester, Alastair Wilson, Celine Wu, J. Heath, Kathryn Hersee, Devi Patkunam, Adam Asare, Eduard Chani, Judith Evind, Noha Lim, Audrey Plough

Original languageEnglish
Pages (from-to)494-503
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Issue number2
Early online date31 May 2019
Accepted/In press29 Apr 2019
E-pub ahead of print31 May 2019
Published1 Aug 2019


King's Authors


Background: Staphylococcus aureus has been implicated in the pathophysiology of eczema, allergic rhinitis, asthma, and food allergy. S aureus is a marker of more severe eczema, which is a risk factor for food sensitization/allergy. Therefore it might be that the association between S aureus and food allergy in eczematous patients is related to eczema severity. Objective: We sought to investigate the association of S aureus colonization with specific IgE (sIgE) production to common food allergens and allergies in early childhood independent of eczema severity. We additionally determined the association of S aureus colonization with eczema severity and persistence. Methods: In Learning Early About Peanut Allergy (LEAP) study participants eczema severity was assessed, and skin/nasal swabs were cultured for S aureus. Sensitization was identified by measuring sIgE levels. Peanut allergy was primarily determined by means of oral food challenge, and persistent egg allergy was primarily determined by using skin prick tests. Results: Skin S aureus colonization was significantly associated with eczema severity across the LEAP study, whereas at 12 and 60 months of age, it was related to subsequent eczema deterioration. Skin S aureus colonization at any time point was associated with increased levels of hen's egg white and peanut sIgE independent of eczema severity. Participants with S aureus were more likely to have persistent egg allergy and peanut allergy at 60 and 72 months of age independent of eczema severity. All but one of the 9 LEAP study consumers with peanut allergy (9/312) were colonized at least once with S aureus. Conclusion: S aureus, independent of eczema severity, is associated with food sensitization and allergy and can impair tolerance to foods. This could be an important consideration in future interventions aimed at inducing and maintaining tolerance to food allergens in eczematous infants.

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