Adrian J Lowe1, Donald Y M Leung2, Mimi L K Tang3, John C Su4, Katrina J Allen3. 1. Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia. Electronic address: lowea@unimelb.edu.au. 2. Division of Allergy and Immunology, Department of Pediatrics, National Jewish Health, Denver, Colorado. 3. Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia. 4. Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Monash University, Eastern Health Clinical School, Eastern Health, Box Hill, Victoria, Australia.
Abstract
OBJECTIVE: Allergic diseases have increased dramatically in the developed world during the past few decades, yet the understanding of risk factors and effective prevention approaches remain limited. In this review, we summarize the evidence supporting the hypothesis that skin-barrier impairment and early-life atopic dermatitis (AD) could play a causal role in the development of sensitization and subsequent food allergies and allergic airways disease (allergic asthma and rhinitis). We further discuss the potential to target the skin barrier as a means to lower the incidence of allergic disease. DATA SOURCES: Review of published literature. STUDY SELECTIONS: Narrative. RESULTS: There is a strong link between AD and sensitization, food allergy, asthma, and allergic rhinitis, particularly AD that is severe and commences in the first 6 months of life. There also is emerging evidence that regular use of prophylactic emollients can significantly decrease the expression of AD, at least while treatment continues. Studies are exploring whether decreased AD expression might modulate the allergic response at a more fundamental level and potentially alter the association between early-life AD and subsequent development of food allergy and allergic airways disease. CONCLUSION: Although at this point there is only indirect evidence that early-life emollient use might prevent AD and food allergy, early studies are encouraging. The results of high-quality prevention trials that are in progress are eagerly anticipated. If found to be effective, then neonatal emollient use could be a simple public health measure to lower the incidence of AD, food allergies, and allergic airways disease in future generations.
OBJECTIVE:Allergic diseases have increased dramatically in the developed world during the past few decades, yet the understanding of risk factors and effective prevention approaches remain limited. In this review, we summarize the evidence supporting the hypothesis that skin-barrier impairment and early-life atopic dermatitis (AD) could play a causal role in the development of sensitization and subsequent food allergies and allergic airways disease (allergic asthma and rhinitis). We further discuss the potential to target the skin barrier as a means to lower the incidence of allergic disease. DATA SOURCES: Review of published literature. STUDY SELECTIONS: Narrative. RESULTS: There is a strong link between AD and sensitization, food allergy, asthma, and allergic rhinitis, particularly AD that is severe and commences in the first 6 months of life. There also is emerging evidence that regular use of prophylactic emollients can significantly decrease the expression of AD, at least while treatment continues. Studies are exploring whether decreased AD expression might modulate the allergic response at a more fundamental level and potentially alter the association between early-life AD and subsequent development of food allergy and allergic airways disease. CONCLUSION: Although at this point there is only indirect evidence that early-life emollient use might prevent AD and food allergy, early studies are encouraging. The results of high-quality prevention trials that are in progress are eagerly anticipated. If found to be effective, then neonatal emollient use could be a simple public health measure to lower the incidence of AD, food allergies, and allergic airways disease in future generations.
Authors: Elisabet Johansson; Jocelyn M Biagini Myers; Lisa J Martin; Hua He; Patrick Ryan; Grace K LeMasters; David I Bernstein; James Lockey; Gurjit K Khurana Hershey Journal: Clin Exp Allergy Date: 2019-03-27 Impact factor: 5.018
Authors: Sayantani Sindher; Shifaa S Alkotob; Melanie N Shojinaga; Robert Hamilton; Susan Chan; Shu Cao; Henry T Bahnson; Helen A Brough; Gideon Lack; Donald Y M Leung; Kari C Nadeau Journal: Pediatr Allergy Immunol Date: 2020-05-06 Impact factor: 6.377
Authors: Helen A Brough; Kari C Nadeau; Sayantani B Sindher; Shifaa S Alkotob; Susan Chan; Henry T Bahnson; Donald Y M Leung; Gideon Lack Journal: Allergy Date: 2020-05-18 Impact factor: 13.146