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Original Investigation |

Thymic Stromal Lymphopoietin Variation, Filaggrin Loss of Function, and the Persistence of Atopic Dermatitis

David J. Margolis, MD, PhD1,2; Brian Kim, MD2; Andrea J. Apter, MD, MSc3; Jayanta Gupta, MD, PhD1; Ole Hoffstad, MA1; Maryte Papadopoulos, MBE1; Nandita Mitra, PhD1
[+] Author Affiliations
1Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
2Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
3Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Dermatol. 2014;150(3):254-259. doi:10.1001/jamadermatol.2013.7954.
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Importance  Atopic dermatitis (AD) is a common chronic illness of childhood.

Objective  To evaluate the association between thymic stromal lymphopoietin (TSLP) variation and the persistence of skin symptoms of AD.

Design, Setting, and Participants  A prospective cohort study was conducted in the general community. Participants included 796 children enrolled in the Pediatric Eczema Elective Registry.

Exposure  Evaluation of TSLP variation.

Main Outcomes and Measures  Self-reported outcome of whether a child’s skin had no symptoms of AD and required no medications for 6 months at 6-month intervals.

Results  We evaluated 14 variants of TSLP. The variant rs1898671 was significantly associated with the outcome in white children (P = .01). As measured by overlapping CIs, similar odds ratios (ORs) were noted among whites (OR, 1.72; 95% CI, 1.11-2.66) and African Americans (1.33; 0.52-3.45). Further within the subcohort of individuals with a filaggrin protein (FLG) loss-of-function mutation, those with TSLP variation were more likely to have less-persistent disease (OR, 4.92; 95% CI, 2.04-11.86).

Conclusions and Relevance  The TSLP variation is associated with less persistent AD. Therefore, TSLP may be a potential therapeutic target for the treatment of AD, especially in individuals with diminished barrier function due to FLG mutations. This is an attractive hypothesis that can be tested in clinical trials.

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Figure.
Age by Category and the Absence of Symptoms

The child’s age at the time a survey was received is presented. The individuals were monitored over time and provided more than 1 survey. TSLP is thymic stromal lymphopoietin.

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