Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta-analysis

Maeve M Kelleher¹, Suzie Cro², Eleanor Van Vogt², Victoria Cornelius², Karin C Lodrup Carlsen^{3

4}, Håvard Ove Skjerven³, Eva Maria Rehbinder^{4

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 Surber^{18

19}, Lisa M Askie²⁰, Lelia Duley²¹, Joanne R Chalmers¹⁷, Hywel C Williams¹⁷, Robert J Boyle^{1

17}

Affiliations

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.

PMID: 33550675
DOI: 10.1111/cea.13847

Meta-Analysis

Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta-analysis

Maeve M Kelleher et al. Clin Exp Allergy. 2021 Mar.

. 2021 Mar;51(3):402-418.

doi: 10.1111/cea.13847. Epub 2021 Feb 25.

Authors

Affiliations

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.

PMID: 33550675
DOI: 10.1111/cea.13847

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.

Keywords: atopic dermatitis; food allergy; prevention.

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References

REFERENCES

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Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta-analysis

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Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta-analysis

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