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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 402-418 |
| Number of pages | 17 |
| Journal | Clinical and Experimental Allergy |
| Volume | 51 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2021 |
Keywords
- atopic dermatitis
- food allergy
- prevention
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
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In: Clinical and Experimental Allergy, Vol. 51, No. 3, 03.2021, p. 402-418.
Research output: Contribution to journal › Review article › peer-review
}
TY - JOUR
T1 - Skincare interventions in infants for preventing eczema and food allergy
T2 - A cochrane systematic review and individual participant data meta-analysis
AU - Kelleher, Maeve M.
AU - Cro, Suzie
AU - Van Vogt, Eleanor
AU - Cornelius, Victoria
AU - Lodrup Carlsen, Karin C.
AU - Ove Skjerven, Håvard
AU - Rehbinder, Eva Maria
AU - Lowe, Adrian
AU - Dissanayake, Eishika
AU - Shimojo, Naoki
AU - Yonezawa, Kaori
AU - Ohya, Yukihiro
AU - Yamamoto-Hanada, Kiwako
AU - Morita, Kumiko
AU - Cork, Michael
AU - Cooke, Alison
AU - Simpson, Eric L.
AU - McClanahan, Danielle
AU - Weidinger, Stephan
AU - Schmitt, Jochen
AU - Axon, Emma
AU - Tran, Lien
AU - Surber, Christian
AU - Askie, Lisa M.
AU - Duley, Lelia
AU - Chalmers, Joanne R.
AU - Williams, Hywel C.
AU - Boyle, Robert J.
N1 - Funding Information: MK has received honoraria for speaking at educational conferences organized by Nutricia, which does not manufacture/market any of the interventions or potential comparators in this review. KCL has received money from multiple sources: the Regional Health Board South East, the Norwegian Research Council, Oslo University Hospital, the University of Oslo, Health and Rehabilitation Norway, Østfold Hospital Trust, Norwegian Association of Asthma and Allergy, the Kloster Foundation, Norwegian society of Dermatology and Venereology, Arne Ingel's scholarship, First Medical Laboratory, the Foundation for Healthcare and Allergy Research in Sweden, the Vårdal Foundation, Swedish Asthma and Allergy Association's Research Foundation, Swedish Research Council, the Initiative for Clinical Therapy Research, the Swedish Heart‐Lung Foundation, SFO‐V Karolinska Institutet, Hesselman Research Foundation, and Thermo Fisher, Uppsala, Sweden; and received an honorarium and travel expenses from Thermo Fisher, Uppsala, Sweden, for a lecture at the European Academy of Allergy and Clinical Immunology (EAACI) Congress 2018. HOS has received money for the PreventADALL study (Lødrup 2018) from the two largest governmental grant agencies in Norway, the South‐Eastern Norway Regional Health Authority and the Norwegian Research Council, which are not commercial sponsors. EMR declared no real or perceived conflict of interest for the present review; however, he has received honoraria for presentations on atopic dermatitis and psoriasis from Sanofi‐Genzyme, Perrigo, MEDA, Novartis and Norwegian patient organizations for atopic dermatitis and psoriasis in the last 36 months. AL has received grant funding from the National Health and Medical Research Council to undertake a skin barrier intervention study; and also declared that Primus Pharmaceuticals have donated EpiCeram (a skin barrier treatment) for the use in these studies, free of charge. KY has received grants from the Mitsubishi Foundation and Mishima Kaiun Memorial Foundation that supported the research of this review and also from Hoyu Science Foundation and JSPS KAKENHI Grant Number 17 K17676 for other research. YO has received honorarium for lectures from AbbVie, Kao, Kyorin Pharmaceutical, Maruho, Mylan, Natural science, Sanofi, Taiho Pharma and Torii pharmaceutical, and payment for consultancy for opening a forum from Maruho. KYH has received payment for lectures from Sato Pharmaceutical and travel expenses from Thermo Fisher Scientific. KM has received speakers’ honoraria from Maruho Japan and Astellas Pharma, Japan, outside this work. CS has received money for consultancy, lectures and development of educational presentations from LEO Pharma (Switzerland, Germany & Denmark), explaining galenical concepts including supersaturation; and for lectures and development of educational presentations for explaining galenical concepts including nanoemulsions, from Almirall, Germany. MC has received fees, grants, support for travel to meetings, consultancy or honorarium from Hyphens Pharma, L'Oreal (La Roche‐Posay) and Johnson & Johnson; has received grants or has grants pending from Regeneron in Collaboration with Sanofi‐Genzyme, Pfizer, Galapagos and Kymab; has received payment for development of educational presentations from Regeneron in Collaboration with Sanofi‐Genzyme; has been a paid consultant for or received payment for lectures or travel, accommodation or meeting expenses from Regeneron in Collaboration with Sanofi‐Genzyme, Pfizer, Galapagos and Kymab; is/has been a paid consultant for Hyphens Pharma, L'Oreal (La Roche‐Posay) and Johnson & Johnson; and has also received fees and support for travel to meetings from these organizations. AC has received funds from a National Institute for Health Research Doctoral Research Fellowship for the OBSeRvE (Oil in Baby Skincare) study, which was an independent research supported by the National Institute for Health Research (Doctoral Research Fellowship DRF‐2012–05–160); was an invited expert to an advisory panel on infant skincare; has received her consultancy fee from Johnson and Johnson; and was an invited expert speaker at a neonatal skincare symposium at the Royal College of Midwives Annual Conference and at the European Midwives Association Conference, for which she received support from Johnson and Johnson.. JRC has received money from NIHR for a research for patient benefit grant on which he was a co‐applicant; and was co‐applicant on the BEEP trial and the BEEP pilot trial, both of which are likely to be included in this review (Chalmers 2017). HCW was director of the NIHR Health Technology Assessment (HTA) Programme until 1 October 2020, which is part of the NIHR that also supports the NIHR systematic reviews programme from which this work is funded; was also chief investigator of the BEEP study, which was funded by NIHR HTA and is included in this review; and has received funds (Nottingham) from the National Institute for Health Research (public funds) as a result of open competition. RJB has received payment for participating in advisory boards for DBV technologies, Prota therapeutics and ALK‐Abello, who develop allergy diagnostics or treatments; has received payment for designing a clinical trial for Dairy Goat Co‐operative; and has received payment for providing expert testimony in a class action related to an infant formula health claim. SC, VC, EA, ED, NS,LT, LMA, LD and EVV declared none. Funding Information: This systematic review and individual participant data meta‐analysis is funded by the National Institute of Health (NIHR) through a Transitional Research Fellowship for Dr Maeve Kelleher (TRF‐2017‐10‐003) and a Research for Patient Benefit grant to Dr Robert Boyle (PB‐PG‐0317‐20028). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The individual funding for trials included in the meta‐analysis is described in Table 1 . Funding Information: This systematic review and individual participant data meta-analysis is funded by the National Institute of Health (NIHR) through a Transitional Research Fellowship for Dr Maeve Kelleher (TRF-2017-10-003) and a Research for Patient Benefit grant to Dr Robert Boyle (PB-PG-0317-20028). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The individual funding for trials included in the meta-analysis is described in Table?1. We are grateful for the support of the Cochrane Skin Group in preparing and publishing the full Cochrane Review version of this article. We are grateful to Emma Thomas, Boaz Gaventas, Alexa Baracaia and the Centre of Evidence Based Dermatology patient panel for feedback on the prioritization of outcomes and outcome measures?for this systematic review. The draft search strategy for World Health Organization International Clinical Trials Registry Platform was developed with advice from Douglas Grindlay, Information Specialist at the Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK. We are extremely grateful to Liz Doney, Business Manager and Information specialist at Nottingham University who ran the search of?Cochrane Skin Specialised Register, the CENTRAL database, MEDLINE and Embase?both in October 2019 and the update in July 2020. We gratefully acknowledge all members of the wider SCiPAD group and especially those who contributed to discussion and input at the annual meetings in Munich 2018 and Lisbon 2019, and online results meeting 2020, including Sarah Brown, Carsten Flohr, Elisabeth Harberl, Jonathan Hourihane, Alan Irvine and Michael Perkin. We are also indebted to all participants of the individual studies whose contribution has furthered our knowledge on skincare in infants. Publisher Copyright: © 2021 John Wiley & Sons Ltd
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - atopic dermatitis
KW - food allergy
KW - prevention
UR - http://www.scopus.com/inward/record.url?scp=85101531645&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101531645&partnerID=8YFLogxK
U2 - 10.1111/cea.13847
DO - 10.1111/cea.13847
M3 - Review article
C2 - 33550675
AN - SCOPUS:85101531645
SN - 0954-7894
VL - 51
SP - 402
EP - 418
JO - Clinical Allergy
JF - Clinical Allergy
IS - 3
ER -