Overview
This project aims to study the immune responses to peanut allergen in those with a skin barrier defect with and without skin massage, specifically it aims to:
- Establish if peanut allergen components can pass into human skin through regular massage using the peanut protein-containing extract.
- Clarify whether this effect is amplified in those with an impaired skin barrier (AD and dry skin vs healthy controls).
- Assess whether peanut protein components can be detected in interstitial skin fluid (ISF) using a suction device.
- Test whether peanut protein components present in ISF are able to induce activation of basophils in blood of peanut allergic donors.
- Assess whether the transcutaneous uptake of peanut protein can be reduced by the prior use of a barrier enhancing cream.
Description
The study aims to understand how peanut processing methods and peanut co-administration with oils, as is standard during the industrial processing of peanuts, influences the development of peanut allergy through the skin.
Cutaneous exposure of allergens is a crucial, but hitherto under explored route of food sensitisation, that if understood could lead to the development of translatable strategies to prevent food allergy. Food processors require a greater understanding of how allergen exposure cause allergy so that they can adapt their processing methods to counteract these exposure processes. Furthermore, this proposed research aligns with on-going efforts across Europe to address the increasing problems associated with food allergy but it is unique in that it focuses on cutaneous allergen exposure, which is a field in desperate need of more systematic study.
The assembled team of investigators (from the UK, Germany and France) joined by a peanut industry partner (Levantine) and patient and consumer representatives will aim to address the following hypotheses:
Understanding the mechanisms by which:
- Peanut proteins pass into the skin via the appendages to trigger an immune response.
- Skin stretching that occurs during massage opens up the skin appendages allowing more peanut protein into the skin and leads to dendritic cell activation and induction of T helper 2 cell response.
- Co-administration of peanut proteins and an oil to the skin increases allergenicity.
- Skin barrier impairment and inflammation (AD) increases allergenicity.
Test novel approaches to peanut allergy prevention whereby:
- Modifications in peanut processing can reduce allergen exposure via the skin.
- Meticulous hand hygiene reduces skin contamination with peanut protein.
- Application of a barrier enhancing cream can strengthen the skin barrier, in particular in those with atopic dermatitis, and reduce the risk of transcutaneous sensitisation further.
Eligibility
Inclusion Criteria:
- Adult healthy volunteers (50% of the cohort), and adults with dry skin and AD (fulfilling the refined Hanifin and Rajka criteria, 50% of the cohort).
- Willingness to apply the study intervention and to not use any other topical preparations over theforearms during the study period.
Exclusion Criteria:
- History of peanut allergy.
- Positive skin prick test to peanut (>0 mm).
- No regular consumption of peanut products.
- Widespread AD, in particular if this involves the test sites of the forearms.