Interaction between filaggrin null mutations and tobacco smoking in relation to asthma

Background: The mechanisms underlying the association between filaggrin (FLG) deficiency and asthma are not known. It has been hypothesized that FLG deficiency leads to enhanced percutaneous exposure to environmental substances that might trigger immune responses. We hypothesized that interactions between FLG deficiency and environmental exposures play a role in asthma development. Objective: We sought to investigate possible interactions between FLG null mutations and tobacco smoking in relation to asthma. Methods: A total of 3471 adults from a general population sample participated in a health examination. Lung function and serum specific IgE levels to inhalant allergens were measured, and information on asthma and smoking was obtained by means of questionnaire. Participants were genotyped for the 2 most common FLG null mutations in white subjects: R501X and 2282del4. Another Danish population was used for replication. Results: The FLG null mutation genotype was significantly associated with a higher prevalence of asthma and decreased FEV ₁/forced vital capacity ratio. In logistic regression analyses with asthma as the outcome, a significant interaction was found between FLG null mutations and smoking status (P =.02). This interaction was confirmed, although it was not statistically significant, in another Danish population study. Interactions between FLG genotype and cumulated smoking exposure were found in relation to asthma (P =.03) and decreased FEV₁/forced vital capacity ratio (P =.03). A 3-way interaction was found among FLG genotype, smoking, and asthma, suggesting that the FLG-smoking interaction mainly played a role in nonatopic subjects. Conclusion: FLG null mutations modified the effects of smoking on the risk of asthma. This finding might have implications for risk stratification of the population.