Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: systematic review and meta-analysisBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2433 (Published 09 July 2009) Cite this as: BMJ 2009;339:b2433
- Rosanne A H M van den Oord, Socrates research student,
- Aziz Sheikh, professor of primary care research and development
- 1Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9DX
- Correspondence to: A Sheikh
- Accepted 4 February 2009
Objective To investigate whether filaggrin gene defects, present in up to one in 10 western Europeans and North Americans, increase the risk of developing allergic sensitisation and allergic disorders.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, ISI Science Citation Index, BIOSIS, ISI Web of Knowledge, UK National Research Register, clinical trials.gov, the Index to Theses and Digital dissertations, and grey literature using OpenSIGLE.
Study selection Genetic epidemiological studies (family, case-control) of the association between filaggrin gene defects and allergic sensitisation or allergic disorders.
Data extraction Atopic eczema or dermatitis, food allergy, asthma, allergic rhinitis, and anaphylaxis, along with relevant immunological variables relating to the risk of allergic sensitisation as assessed by either positive skin prick testing or increased levels of allergen specific IgE.
Data synthesis 24 studies were included. The odds of developing allergic sensitisation was 1.91 (95% confidence interval 1.44 to 2.54) in the family studies and 1.57 (1.20 to 2.07) in the case-control studies. The odds of developing atopic eczema was 1.99 (1.72 to 2.31) in the family studies and 4.78 (3.31 to 6.92) in the case-control studies. Three studies investigated the association between filaggrin gene mutations and allergic rhinitis in people without atopic eczema: overall odds ratio 1.78 (1.16 to 2.73). The four studies that investigated the association between filaggrin gene mutations and allergic rhinitis in people with atopic eczema reported a significant association: pooled odds ratio from case-control studies 2.84 (2.08 to 3.88). An overall odds ratio for the association between filaggrin gene mutations and asthma in people with atopic eczema was 2.79 (1.77 to 4.41) in case-control studies and 2.30 (1.66 to 3.18) in family studies. None of the studies that investigated filaggrin gene mutations and asthma in people without atopic eczema reported a significant association; overall odds ratio was 1.30 (0.7 to 2.30) in the case-control studies. The funnel plots suggested that publication bias was unlikely to be an explanation for these findings. No studies investigated the association between filaggrin gene mutations and food allergy or anaphylaxis.
Conclusions Filaggrin gene defects increase the risk of developing allergic sensitisation, atopic eczema, and allergic rhinitis. Evidence of the relation between filaggrin gene mutations and atopic eczema was strong, with people manifesting increased severity and persistence of disease. Filaggrin gene mutations also increased the risk of asthma in people with atopic eczema. Restoring skin barrier function in filaggrin deficient people in early life may help prevent the development of sensitisation and halt the development and progression of allergic disease.
We thank Tjard Schermer, Chris Burton, Heather McIntosh, Marshall Dozier, Caroline van de Ven, and Christine Campbell for their support and advice, and the reviewers for their comments.
Contributors: AS conceived the study and supervised all aspects of protocol development, searches, quality assessment, data analysis, and interpretation. RAHMvdO did the searches, extracted data, and drafted the paper. Both authors are guarantors.
Competing interests: None declared.
Ethical approval: Not required.
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