BackgroundThe influence of early exposure to allergenic foods on the subsequent development of food allergy remains uncertain.ObjectiveWe sought to determine the feasibility of the early introduction of multiple allergenic foods to exclusively breast-fed infants from 3 months of age and the effect on breastfeeding performance.MethodsWe performed a randomized controlled trial. The early introduction group (EIG) continued breastfeeding with sequential introduction of 6 allergenic foods: cow's milk, peanut, hard-boiled hen's egg, sesame, whitefish (cod), and wheat; the standard introduction group followed the UK infant feeding recommendations of exclusive breastfeeding for around 6 months with no introduction of allergenic foods before 6 months of age.ResultsOne thousand three hundred three infants were enrolled. By 5 months of age, the median frequency of consumption of all 6 foods was 2 to 3 times per week for every food in the EIG and no consumption for every food in the standard introduction group (P < .001 for every comparison). By 6 months of age, nonintroduction of the allergenic foods in the EIG was less than 5% for each of the 6 foods. Achievement of the stringent per-protocol consumption target for the EIG proved more difficult (42% of evaluable EIG participants). Breastfeeding rates in both groups significantly exceeded UK government data for equivalent mothers (P < .001 at 6 and at 9 months of age).ConclusionEarly introduction, before 6 months of age, of at least some amount of multiple allergenic foods appears achievable and did not affect breastfeeding. This has important implications for the evaluation of food allergy prevention strategies.

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is due to the high rates of transmission by individuals who are asymptomatic at the time of transmission. Frequent, widespread testing of the asymptomatic population for SARS-CoV-2 is essential to suppress viral transmission and is a key element in safely reopening society. Despite increases in testing capacity, multiple challenges remain in deploying traditional reverse transcription and quantitative PCR (RT-qPCR) tests at the scale required for population screening of asymptomatic individuals. We have developed SwabSeq, a high-throughput testing platform for SARS-CoV-2 that uses next-generation sequencing as a readout. SwabSeq employs sample-specific molecular barcodes to enable thousands of samples to be combined and simultaneously analyzed for the presence or absence of SARS-CoV-2 in a single run. Importantly, SwabSeq incorporates an in vitro RNA standard that mimics the viral amplicon, but can be distinguished by sequencing. This standard allows for end-point rather than quantitative PCR, improves quantitation, reduces requirements for automation and sample-to-sample normalization, enables purification-free detection, and gives better ability to call true negatives. We show that SwabSeq can test nasal and oral specimens for SARS-CoV-2 with or without RNA extraction while maintaining analytical sensitivity better than or comparable to that of fluorescence-based RT-qPCR tests. SwabSeq is simple, sensitive, flexible, rapidly scalable, inexpensive enough to test widely and frequently, and can provide a turn around time of 12 to 24 hours.

Nonwhite ethnicity: • In general a nonsignificant reduc on in food allergy in nonwhite EIG compared with nonwhite SIG Sensi zed: (IgE ≥0.1 kU/l to one or more foods) • EIG 19.2% versus SIG 34.2% developed any food allergy* Visible eczema: (moderate SCORAD 15 to <40) • EIG 22.6% versus SIG 46.7% developed any food allergy* • EIG 16.1% versus SIG 43.3% developed an egg allergy* Sensi zed: (IgE ≥0.1 kU/l to egg) • EIG 20.0% versus SIG 48.6% developed an egg allergy* *p<0.05 EIG: Early Introduc on Group SIG: Standard Introduc on Group Distribu on of enrollment (3 months of age) risk factors associated with a higher risk of developing a food allergy: Sensi za on (IgE ≥ 0.1 kU/l to one or more foods), visible eczema (any) at the clinic visit and nonwhite ethnicity (n=1170) Nonwhite Sensi zed

Background: Domestic water hardness and chlorine have been suggested as important risk factors for atopic dermatitis (AD). Objective: We sought to examine the link between domestic water calcium carbonate (CaCO 3) and chlorine concentrations, skin barrier dysfunction (increased transepidermal water loss), and AD in infancy. Methods: We recruited 1303 three-month-old infants from the general population and gathered data on domestic water CaCO 3 (in milligrams per liter) and chlorine (Cl 2 ; in milligrams per liter) concentrations from local water suppliers. At enrollment, infants were examined for AD and screened for filaggrin (FLG) skin barrier gene mutation status. Transepidermal water loss was measured on unaffected forearm skin. Results: CaCO 3 and chlorine levels were strongly correlated. A hybrid variable of greater than and less than median levels of CaCO 3 and total chlorine was constructed: a baseline group of low CaCO 3 /low total chlorine (CaL/ClL), high CaCO 3 /low total chlorine (CaH/ClL), low CaCO 3 /high total chlorine (CaL/ClH) and high CaCO 3 /high total chlorine (CaH/ClH). Visible AD was more common in all 3 groups versus the baseline group: adjusted odds ratio (AOR) of 1.87 (95% CI, 1.25-2.80; P 5 .002) for the CaH/ClL group, AOR of 1.46 (95% CI, 0.97-2.21; P 5 .07) for the CaL/ClH, and AOR of 1.61 (95% CI, 1.09-2.38; P 5 .02) for the CaH/ClH group. The effect estimates were greater in children carrying FLG mutations, but formal interaction testing between water quality groups and filaggrin status was not statistically significant. Conclusions: High domestic water CaCO 3 levels are associated with an increased risk of AD in infancy. The influence of increased total chlorine levels remains uncertain. An intervention trial is required to see whether installation of a domestic device to decrease CaCO 3 levels around the time of birth can reduce this risk.

Background: Food allergy is thought to develop through transcutaneous sensitization, especially in the presence of skin barrier impairment and inflammation. Regular moisturizer application to infant skin could potentially promote transcutaneous sensitization and the development of food allergy. Objectives: We tested this hypothesis in the Enquiring About Tolerance (EAT) study population. Methods: The EAT study was a population-based randomized clinical trial conducted from January 15, 2008, to August 31, 2015, and recruited 1303 exclusively breastfed 3-month-old infants and their families from England and Wales. At enrollment at 3 months, families completed a questionnaire that included questions about frequency and type of moisturizer applied, use of corticosteroid creams, and parental report of dry skin or eczema. Infants were examined for visible eczema at the enrollment visit. Results: A statistically significant dose-response relationship was observed between parent-reported moisturization frequency at 3 months of age and the subsequent development of food allergy. Each additional moisturization per week was associated with an adjusted odds ratio of 1.20 (95% CI, 1.13-1.27; P < .0005) for developing food allergy. For infants with no visible eczema at the enrollment visit, the corresponding adjusted odds ratio was 1.18 (95% CI, 1.07-1.30; P 5 .001) and for those with eczema at the enrollment visit, 1.20 (95% CI, 1.11-1.31; P < .0005). Moisturizer frequency showed similar dose-response relationships with the development of both food and aeroallergen sensitization at 36 months. Conclusions: These findings support the notion that regular application of moisturizers to the skin of young infants may promote the development of food allergy through transcutaneous sensitization.