Anatomical distribution of infant eczema predicts food allergy and food sensitization in early childhood.

UNLABELLED: BackgroundInfant eczema is associated with food allergy (FA), but whether the anatomical distribution of eczema influences the risk remains unclear. Skin sites with frequent allergen exposure may confer higher FA and sensitization risk. OBJECTIVE: To investigate associations between eczema location at age 9 months and physician-diagnosed FA and food sensitization at age 18 months. METHODS: This large population-based prospective study included 4456 children from the NorthPop Birth Cohort Study in Sweden. Parent-reported eczema location at age 9 months was categorized as body only, head/neck/hands only, or combined involvement. FA was assessed by parental report of physician diagnosis at age 18 months and immunoglobulin E (IgE) sensitization to common food allergens was measured in a subset (n = 3280). Logistic regression models adjusted for familial, maternal, perinatal, and early-life factors were applied. RESULTS: Eczema location in infancy was associated with FA and food sensitization. Compared with no eczema, eczema involving head/neck/hands was associated with higher odds of FA (aOR 2.30; 95% CI: 1.08-4.69), while combined head/neck/hands + body eczema showed the strongest associations after adjustments (aOR 4.33; 95% CI: 3.18-5.89). Body-only eczema was not associated with increased FA risk. Similar patterns were observed for food sensitization. Among children with eczema, widespread eczema conferred the highest odds of FA and food sensitization. CONCLUSIONS: Eczema affecting allergen-exposed sites, particularly when widespread, was associated with high odds of FA and food sensitization. These findings highlight the importance of considering both eczema distribution and severity in early clinical practice.