Charles Schuler, MD Assistant Professor Allergy and Clinical Immunology & Mary H. Weiser Food Allergy Center University of Michigan

Food Allergy: Test Measuring Water Loss Through Skin (TEWL) May Predict Anaphylaxis Interview with:

Charles Schuler, MDAssistant Professor
Allergy and Clinical Immunology &
Mary H. Weiser Food Allergy Center
University of Michigan

Dr. Schuler

Charles Schuler, MD
Assistant Professor
Allergy and Clinical Immunology &
Mary H. Weiser Food Allergy Center
University of Michigan What is the background for this study?

Response: Anaphylaxis is a severe allergic reaction that may include a skin rash, nausea, vomiting, difficulty breathing, and shock. Food anaphylaxis sends 200,000 people to the emergency room annually in the United States. Oral food challenges are when a patient ingests increasing doses up to a full serving of the suspected food allergen under supervision of a medical provider, usually an allergist. These oral food challenges are the diagnostic standard for food allergy/anaphylaxis as skin and blood allergy tests have high false positive rates. Although a highly accurate test, patients often experience anaphylaxis during oral food challenges necessitating an epinephrine injection. What are the main findings?

Response:  My team at the University of Michigan developed a method that measures water loss from the skin to predict anaphylaxis during oral food challenges before it becomes clinically evident. The results are published in The Journal of Clinical Investigation. We validated the use of transepidermal water loss, a measurement that represents the amount of water that escapes from a given skin area per hour, by comparing its ability to detect anaphylaxis with biochemical and clinical observation methods. We found that transepidermal water loss increases during food allergy reactions and anaphylaxis. The rise in skin water loss correlated with biochemical markers of anaphylaxis and substantially preceded clinical detection of anaphylaxis. This suggests that transepidermal water loss measurements may be able to predict food anaphylaxis before it is clinically evident. Is this TEWL testing the same as is used to measure for eczema/xerosis predisposition?

Response:  It is the same general measurement principle. The main difference here is that we demonstrated that the TEWL measurement changed rapidly over the course of minutes during a food challenge. In most cases, eczema-related TEWL measurements are done longitudinally over months or years and only take a single measurement at one time point. What should readers take away from your report?

Response: We believe we have strong evidence that TEWL predicts food anaphylaxis. We are working to validate that prospectively in a pilot clinical trial and hope that we can develop a clinically-useful measurement in the future. What recommendations do you have for future research as a results of this study?

Response: As above, my research group is currently recruiting participants aged 6 months to 5 years old for a pilot clinical trial, Predicting Peanut Anaphylaxis and Reducing Epinephrine, that monitors transepidermal water loss from the forearm during a peanut allergy food challenge.
We are already pursuing next steps in this area.

Disclosures: We have a patent submitted on this topic. There is no license or commercial activity presently.


Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes

Charles F. Schuler IV, … , Nicholas W. Lukacs, James R. Baker Jr.

Published July 4, 2023
Citation Information: J Clin Invest. 2023;133(16):e168965.


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Last Updated on November 16, 2023 by Marie Benz