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Direct infant UV light exposure is associated with eczema and immune development

  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Kristina Rueter
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    School of Medicine, University of Western Australia, Crawley, Australia

    Princess Margaret Hospital, Subiaco, Australia

    inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, NJ
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Anderson P. Jones
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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  • Aris Siafarikas
    Affiliations
    School of Medicine, University of Western Australia, Crawley, Australia

    Princess Margaret Hospital, Subiaco, Australia

    Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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  • Ee-Mun Lim
    Affiliations
    Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia

    Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia
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  • Natasha Bear
    Affiliations
    Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Australia
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  • Paul S. Noakes
    Affiliations
    School of Medicine, University of Western Australia, Crawley, Australia

    Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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  • Susan L. Prescott
    Affiliations
    School of Medicine, University of Western Australia, Crawley, Australia

    Princess Margaret Hospital, Subiaco, Australia

    inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, NJ

    Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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  • Debra J. Palmer
    Correspondence
    Corresponding author: Debra J. Palmer, PhD, Telethon Kids Institute, Nedlands, Western Australia, 6008, Australia.
    Affiliations
    School of Medicine, University of Western Australia, Crawley, Australia

    Telethon Kids Institute, University of Western Australia, Subiaco, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ These authors contributed equally to this work.
Published:October 23, 2018DOI:https://doi.org/10.1016/j.jaci.2018.08.037

      Background

      Suboptimal vitamin D levels during critical periods of immune development have emerged as an explanation for higher rates of allergic diseases associated with industrialization and residing at higher latitudes.

      Objective

      We sought to determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development.

      Methods

      By using a double-blind randomized controlled trial, newborn infants were randomized to receive vitamin D supplementation (400 IU/d) or a placebo until 6 months of age. Some infants also wore personal UV dosimeters to measure direct UV light (290-380 nm) exposure. Infant vitamin D levels were measured at 3 and 6 months of age. Eczema, wheeze, and immune function outcomes were assessed at 6 months of age.

      Results

      At 3 (P < .01) and 6 (P = .02) months of age, vitamin D levels were greater for the vitamin D–supplemented group than the placebo group, but there was no difference in eczema incidence between groups. Infants with eczema were found to have had less UV light exposure (median, 555 Joules per square meter [J/m2; interquartile range, 322-1210 J/m2]) compared with those without eczema (median, 998 J/m2 [interquartile range, 676-1577 J/m2]; P = .02). UV light exposure was also inversely correlated with IL-2, GM-CSF, and eotaxin production to Toll-like receptor ligands.

      Conclusion

      This study is the first to demonstrate an association between greater direct UV light exposures in early infancy with lower incidence of eczema and proinflammatory immune markers by 6 months of age. Our findings indicate that UV light exposure appears more beneficial than vitamin D supplementation as an allergy prevention strategy in early life.

      Graphical abstract

      Key words

      Abbreviations used:

      IQR (Interquartile range), J/m2 (Joules per square meter), 25(OH)D (25-Hydroxyvitamin D), OVA (Ovalbumin), RCT (Randomized controlled trial), TLR (Toll-like receptor)
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