Maeve M Kelleher1, Suzie Cro2, Eleanor Van Vogt2, Victoria Cornelius2, Karin C Lodrup Carlsen3,4, Håvard Ove Skjerven3, Eva Maria Rehbinder4,5, Adrian Lowe6, Eishika Dissanayake7, Naoki Shimojo8, Kaori Yonezawa9, Yukihiro Ohya10, Kiwako Yamamoto-Hanada10, Kumiko Morita11, Michael Cork12, Alison Cooke13, Eric L Simpson14, Danielle McClanahan14, Stephan Weidinger15, Jochen Schmitt16, Emma Axon17, Lien Tran2, Christian Surber18,19, Lisa M Askie20, Lelia Duley21, Joanne R Chalmers17, Hywel C Williams17, Robert J Boyle1,17. 1. National Heart and Lung Institute, Imperial College London, London, UK. 2. Imperial Clinical Trials Unit, Imperial College London, London, UK. 3. Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. 4. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 5. Department of Dermatology, Oslo University Hospital, Oslo, Norway. 6. Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. 7. Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. 8. Center for Preventive Medical Sciences, Chiba University, Chiba, Japan. 9. Department of Midwifery and Women's Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 10. Allergy Center, National Center for Child Health and Development, Tokyo, Japan. 11. Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan. 12. Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease,, The University of Sheffield, Sheffield, UK. 13. Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK. 14. Oregon Health & Science University, Portland, OR, USA. 15. Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. 16. Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany. 17. Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK. 18. Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. 19. Department of Dermatology, University Hospital Basel, Basel, Switzerland. 20. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia. 21. Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Nottingham, UK.
Abstract
OBJECTIVE: Eczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare interventions can prevent eczema or food allergy. DESIGN: A prospectively planned individual participant data meta-analysis was carried out within a Cochrane systematic review to determine whether skincare interventions in term infants prevent eczema or food allergy. DATA SOURCES: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to July 2020. ELIGIBILITY CRITERIA FOR SELECTED STUDIES: Included studies were randomized controlled trials of infants <1 year with healthy skin comparing a skin intervention with a control, for prevention of eczema and food allergy outcomes between 1 and 3 years. RESULTS: Of the 33 identified trials, 17 trials (5823 participants) had relevant outcome data and 10 (5154 participants) contributed to IPD meta-analysis. Three of seven trials contributing to primary eczema analysis were at low risk of bias, and the single trial contributing to primary food allergy analysis was at high risk of bias. Interventions were mainly emollients, applied for the first 3-12 months. Skincare interventions probably do not change risk of eczema by age 1-3 years (RR 1.03, 95% CI 0.81, 1.31; I2 =41%; moderate certainty; 3075 participants, 7 trials). Sensitivity analysis found heterogeneity was explained by increased eczema in a trial of daily bathing as part of the intervention. It is unclear whether skincare interventions increase risk of food allergy by age 1-3 years (RR 2.53, 95% CI 0.99 to 6.47; very low certainty; 996 participants, 1 trial), but they probably increase risk of local skin infections (RR 1.34, 95% CI 1.02, 1.77; I2 =0%; moderate certainty; 2728 participants, 6 trials). CONCLUSION: Regular emollients during infancy probably do not prevent eczema and probably increase local skin infections.
OBJECTIVE: Eczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare interventions can prevent eczema or food allergy. DESIGN: A prospectively planned individual participant data meta-analysis was carried out within a Cochrane systematic review to determine whether skincare interventions in term infants prevent eczema or food allergy. DATA SOURCES: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to July 2020. ELIGIBILITY CRITERIA FOR SELECTED STUDIES: Included studies were randomized controlled trials of infants <1 year with healthy skin comparing a skin intervention with a control, for prevention of eczema and food allergy outcomes between 1 and 3 years. RESULTS: Of the 33 identified trials, 17 trials (5823 participants) had relevant outcome data and 10 (5154 participants) contributed to IPD meta-analysis. Three of seven trials contributing to primary eczema analysis were at low risk of bias, and the single trial contributing to primary food allergy analysis was at high risk of bias. Interventions were mainly emollients, applied for the first 3-12 months. Skincare interventions probably do not change risk of eczema by age 1-3 years (RR 1.03, 95% CI 0.81, 1.31; I2 =41%; moderate certainty; 3075 participants, 7 trials). Sensitivity analysis found heterogeneity was explained by increased eczema in a trial of daily bathing as part of the intervention. It is unclear whether skincare interventions increase risk of food allergy by age 1-3 years (RR 2.53, 95% CI 0.99 to 6.47; very low certainty; 996 participants, 1 trial), but they probably increase risk of local skin infections (RR 1.34, 95% CI 1.02, 1.77; I2 =0%; moderate certainty; 2728 participants, 6 trials). CONCLUSION: Regular emollients during infancy probably do not prevent eczema and probably increase local skin infections.
Authors: Simon G Danby; Paul V Andrew; Rosie N Taylor; Linda J Kay; John Chittock; Abigail Pinnock; Intisar Ulhaq; Anna Fasth; Karin Carlander; Tina Holm; Michael J Cork Journal: Clin Exp Dermatol Date: 2022-04-12 Impact factor: 4.481
Authors: Vicki McWilliam; Carina Venter; Matthew Greenhawt; Kirsten P Perrett; Mimi L K Tang; Jennifer J Koplin; Rachel L Peters Journal: Pediatr Allergy Immunol Date: 2022-09 Impact factor: 5.464