On the Surface Skin Microbial Exposure Contributes to

On the Surface Skin Microbial Exposure Contributes to Allergic Disease Stanley B. De. Vore, MS Tammy Gonzalez, Ph. D Michael G. Sherenian, MD Andrew B. Herr, Ph. D Gurjit K. Khurana Hershey, MD, Ph. D Ann Allergy Asthma Immunol. December 2020; 125(6): 628 -638

On the Surface Key Messages • The commensal-epidermal homeostasis within healthy skin protects against allergic disease by inducing epidermal accumulation of commensal-specific type 1 and type 17 immune cells and increasing the expression of antimicrobial peptides and alarmins that target proallergic bacteria. • The composition of skin microbiome and epidermal barrier integrity are interdependent, and disruption in one (eg, filaggrin mutations or dysbiosis) disrupts the other. • Skin microbiome dysbiosis contributes to progression and exacerbation of allergic diseases, such as atopic dermatitis, food allergy, allergic rhinitis, and asthma. • Current and potential treatments affecting the skin microbiome include emollients, restoration of skin commensals and antimicrobial peptides, and anti-TH 2 biologic therapy. • Maintenance of the skin barrier is the primary prevention for the development or exacerbation of atopic disorders; however, studying preventions targeting the skin microbiome is needed. De. Vore, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 628 -638

Properties of the Epidermal Barrier De. Vore, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 628 -638

Adaptive Immunity in Commensal-Epidermal Homeostasis De. Vore, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 628 -638

Effect of the Skin Microbiome on Allergic Disease De. Vore, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 628 -638

Interventions Influencing the Skin Microbiome De. Vore, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 628 -638

Exposomal Research in the Context of Birth Cohorts What Have They Taught Us? Narges Baluch, MD Mallory Gallant, MSc Anne K. Ellis, MD, MSc, FRCPC Ann Allergy Asthma Immunol. December 2020; 125(6): 639 -645

Exposomal Research in the Context of Birth Cohorts Key Messages • Exposome complements the genome by encompassing all human environmental exposures from conception onward. • Exposome is composed of the following 3 overlapping domains of exposures: general external, specific external, and internal. • Assessment of exposome in critical stages of life is important for understanding the link between environmental exposures and health outcomes. • Birth cohorts provide an ideal study setting for exposomal research because environmental exposures can be assessed from prenatal period to years after birth. Baluch, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 639 -645

Exposome Domains Consist of General External, Specific External, and Internal Domains Baluch, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 639 -645

The Hypothesis of “Developmental Origins of Health and Disease” Highlighting the Impact of Genetic and Environmental Factors Baluch, et al. Ann Allergy Asthma Immunol. December 2020; 125(6): 639 -645