Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 134, Issue 4, Pages 818-823Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2014.08.005
Keywords
Atopic dermatitis; eczema; skin barrier; prevention; emollients
Categories
Funding
- National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme [RP-PG-0407-10177]
- Mentored Patient-oriented Research Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health [5K23AR057486]
- Oregon Clinical and Translational Research Institute (OCTRI)
- National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) [5 KL2 RR024141-04]
- NIH Roadmap for Medical Research
- Wellcome Trust [092530/Z/10/Z, 098439/Z/12/Z]
- MRC [G0700314] Funding Source: UKRI
- Medical Research Council [G0700314] Funding Source: researchfish
- National Institute for Health Research [RP-PG-0407-10177] Funding Source: researchfish
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Background: Atopic dermatitis (atopic eczema) is a chronic inflammatory skin disease that has reached epidemic proportions in children worldwide and is increasing in prevalence. Because of the significant socioeconomic effect of atopic dermatitis and its effect on the quality of life of children and families, there have been decades of research focused on disease prevention, with limited success. Recent advances in cutaneous biology suggest skin barrier defects might be key initiators of atopic dermatitis and possibly allergic sensitization. Objective: Our objective was to test whether skin barrier enhancement from birth represents a feasible strategy for reducing the incidence of atopic dermatitis in high-risk neonates. Methods: We performed a randomized controlled trial in the United States and United Kingdom of 124 neonates at high risk for atopic dermatitis. Parents in the intervention arm were instructed to apply full-body emollient therapy at least once per day starting within 3 weeks of birth. Parents in the control arm were asked to use no emollients. The primary feasibility outcome was the percentage of families willing to be randomized. The primary clinical outcome was the cumulative incidence of atopic dermatitis at 6 months, as assessed by a trained investigator. Results: Forty-two percent of eligible families agreed to be randomized into the trial. All participating families in the intervention arm found the intervention acceptable. A statistically significant protective effect was found with the use of daily emollient on the cumulative incidence of atopic dermatitis with a relative risk reduction of 50% (relative risk, 0.50; 95% CI, 0.28-0.9; P = .017). There were no emollient-related adverse events and no differences in adverse events between groups. Conclusion: The results of this trial demonstrate that emollient therapy from birth represents a feasible, safe, and effective approach for atopic dermatitis prevention. If confirmed in larger trials, emollient therapy from birth would be a simple and low-cost intervention that could reduce the global burden of allergic diseases.
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