Hyperlinear palms as a clinical finding in peanut allergy
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It is well accepted that atopic dermatitis (AD) and peanut allergy (PA) are associated with filaggrin (FLG) mutations. Patients with AD with FLG mutations have more severe, more persistent, and earlier onset AD. Clinical features of skin barrier abnormality in AD and FLG mutation include xerosis, hyperlinear palms (HP), keratosis pilaris (KP), and ichthyosis vulgaris. HP reflect abnormalities in keratinization and can be defined as more than 5 prominent lines longer than 1 cm running across the palm, particularly in the area of the thenar eminence.

Peanut-allergic children were identified based on the following diagnostic criteria: peanut skin prick test wheal more than 8 mm and previous history of positive oral food challenge to peanut or convincing history of an immediate allergic reaction to peanut. The children with AD were assessed for AD severity using the SCORing Atopic Dermatitis (SCORAD), Nottingham Eczema Severity Score (NESS), and Eczema Area and Severity Index (EASI), and both AD groups were balanced for AD severity using NESS scores. Physical examinations were performed by a board-certified allergist, and the presence of HP, KP, and IV was identified based on first glance.

Little is understood about the mechanism of the development of HP. Previous studies suggest that HP are found in a minority of patients with AD at 2 years of life. The clinical finding of HP was associated with differences in skin barrier composition. AD subjects with HP had an altered ratio of EOS CER to NS CER. This ratio of ultralong-chain lipids to short-chain lipids reflects deficiencies in the skin integrity as these ultralong-chain lipids bind with epidermal structural proteins, such as involucrin, loricrin, and periplakin. An altered lipid composition results in loss of epidermal hydrophobicity and increased allergen penetration.

source: https://www.jaci-inpractice.org/article/S2213-2198(20)30416-5/abstract
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