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

IMPORTANCE: Atopic dermatitis (AD) is a common chronic illness of childhood. OBJECTIVE: The goal of this study was to evaluate the association between Thymic stromal lymphopoietin (TSLP) variation and the persistence of skin symptoms of AD. DESIGN: Prospective cohort study SETTING: General community PARTICIPANTS: Children enrolled in the Pediatric Eczema Elective Registry. EXPOSURES: Evaluation of TSLP variation. Main outcomes and measures: Self-reported outcome of whether or not a child’s skin was AD symptom-free for 6-months at 6 month intervals. RESULTS: We evaluated 14 variants of TSLP. TSLP variant rs1898671 was significantly associated with the outcome in white subjects (p = 0.014). As measured by overlapping confidence intervals, similar ORs were noted among whites (1.72 (1.11, 2.65)) and African-American (1.34(0.51, 3.51)). Further within the subcohort of individuals with a FLG loss of function mutation, those with TSLP variation were more likely to have less persistent disease ((4.92 (2.04, 11.86)). CONCLUSIONS AND RELEVANCE: With respect to the clinical persistence of AD, TSLP variation is associated with less persistent disease. Therefore, TSLP may be a potential therapeutic target for the treatment of AD, especially in those with diminished barrier function due to FLG mutations. This is an attractive hypothesis that can be tested in clinical trials.