@article{47bebbf0f1b0492388c1cb84a4417a98,
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 1303 infants enrolled in the EAT study, 91·3% (n = 1189) attended the final clinic visit and 94·0% (n = 1225) of participants{\textquoteright} 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.",
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 = "Funding Information: We would like to thank the parents and children of the EAT study for taking part. We thank our trial steering committee, which included Graham Roberts (chair), David Strachan (vice chair), Mary Fewtrell, Christine Edwards, David Reading, Ian Kimber, Anne Greenough and Andy Grieve, for all their work; Mary Feeney, Kate Grimshaw, Judy More, Debbie Palmer and Carina Venter for their contributions to the study design; Monica Basting and Gemma Deutsch for project management coverage; Helen Fisher, Una O'Dwyer-Leeson, Amy Nixon, Louise Coverdale and Muhsinah Adam for nursing support; Alicia Parr for dietetic support; George Du Toit and Susan Chan for assistance with medical supervision; Jenna Heath and Kathryn Hersee for play-specialist support; and Joelle Buck, Sarah Hardy, Elizabeth Kendall, Erin Oliver and Shuhana Begum of the Food Standards Agency, for their support and commitment to the trial. Members of the EAT Study Team include the following. Nursing staff: Louise Young, RN Children; Victoria Offord, BSc Nursing; Mary DeSousa, BSc Nursing; Jason Cullen, BSc Nursing; and Katherine Taylor, MRes. Dietitians: Anna Tseng, MPH Nutrition; Bunmi Raji, MSc Nutrition; Sarah Byrom, BSc Human Nutrition and Dietetics; Gillian Regis, BSc Human Nutrition and Dietetics; Charlie Bigwood; and Charlotte Stedman, PG Dip Dietetics. Study management and administration: Sharon Tonner, PhD; Emily Banks; Yasmin Kahnum; Rachel Babic, BA; Ben Stockwell, BSc; Erin Thompson, BSc; and Lorna Wheatley, BSc. Phlebotomist: Devi Patkunam. Laboratory projects: Kerry Richards, MSc Medicine; Ewa Pietraszewicz, MSc; Alick Stephens, PhD; Asha Sudra, MSc; and Victor Turcanu, PhD. Publisher Copyright: {\textcopyright} 2019 British Association of Dermatologists",
year = "2020",
month = aug,
day = "1",
doi = "10.1111/bjd.18597",
language = "English",
volume = "183",
pages = "285--293",
journal = "British Journal of Dermatology",
issn = "0007-0963",
publisher = "John Wiley & Sons, Ltd (10.1111)",
number = "2",
}