Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis
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...
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Published in | Clinical and experimental allergy Vol. 51; no. 3; pp. 402 - 418 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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England
Wiley Subscription Services, Inc
01.03.2021
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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. |
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AbstractList | 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. 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; I 2 =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; I 2 =0%; moderate certainty; 2728 participants, 6 trials). Conclusion Regular emollients during infancy probably do not prevent eczema and probably increase local skin infections. 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. 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. Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to July 2020. 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. 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; I =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; I =0%; moderate certainty; 2728 participants, 6 trials). Regular emollients during infancy probably do not prevent eczema and probably increase local skin infections. ObjectiveEczema 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.DesignA 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 sourcesCochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to July 2020.Eligibility criteria for selected studiesIncluded 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.ResultsOf 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).ConclusionRegular emollients during infancy probably do not prevent eczema and probably increase local skin infections. |
Author | Lodrup Carlsen, Karin C. Duley, Lelia Axon, Emma Ohya, Yukihiro Simpson, Eric L. Tran, Lien Kelleher, Maeve M. Rehbinder, Eva Maria Schmitt, Jochen Cornelius, Victoria McClanahan, Danielle Morita, Kumiko Boyle, Robert J. Van Vogt, Eleanor Chalmers, Joanne R. Shimojo, Naoki Yonezawa, Kaori Weidinger, Stephan Williams, Hywel C. Dissanayake, Eishika Surber, Christian Cro, Suzie Lowe, Adrian Ove Skjerven, Håvard Askie, Lisa M. Cooke, Alison Yamamoto‐Hanada, Kiwako Cork, Michael |
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Keywords | atopic dermatitis food allergy prevention |
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Notes | Funding information 1 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 . ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 |
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The Journal of Allergy and Clinical Immunology publication-title: Practice contributor: fullname: Allen KJ – ident: e_1_2_9_5_1 doi: 10.1136/bmj.b2433 – volume: 1 start-page: CD001150 year: 2016 ident: e_1_2_9_29_1 article-title: Topical emollient for preventing infection in preterm infants publication-title: Cochrane Database Syst Rev contributor: fullname: Cleminson J – ident: e_1_2_9_20_1 – ident: e_1_2_9_28_1 doi: 10.1016/j.jaip.2019.06.034 – volume: 2 start-page: CD013534 year: 2021 ident: e_1_2_9_15_1 article-title: Skincare interventions in infants for preventing eczema and food allergy publication-title: Cochrane Database Syst Rev contributor: fullname: Kelleher MM – ident: e_1_2_9_16_1 – ident: e_1_2_9_3_1 doi: 10.1371/journal.pone.0178539 – ident: e_1_2_9_25_1 doi: 10.1111/cea.13577 – ident: e_1_2_9_21_1 – ident: e_1_2_9_2_1 doi: 10.1001/jama.2010.104 – ident: e_1_2_9_7_1 doi: 10.1016/j.jaci.2015.10.049 – ident: e_1_2_9_17_1 doi: 10.1111/j.1365-2133.1994.tb08530.x – ident: e_1_2_9_12_1 doi: 10.1016/j.clindermatol.2011.08.015 – ident: e_1_2_9_13_1 doi: 10.1111/j.1396-0296.2004.04S1006.x – ident: e_1_2_9_6_1 doi: 10.1111/cea.12406 – volume: 2 start-page: Cd012119 issue: 2 year: 2017 ident: e_1_2_9_11_1 article-title: Emollients and moisturisers for eczema publication-title: Cochrane Database Syst Rev contributor: fullname: Zuuren EJ – ident: e_1_2_9_27_1 doi: 10.1136/bmjopen-2018-024594 – ident: e_1_2_9_4_1 doi: 10.1038/ng1767 – ident: e_1_2_9_18_1 doi: 10.1034/j.1600-0625.2001.100102.x – ident: e_1_2_9_10_1 doi: 10.1016/j.jaci.2019.09.004 – ident: e_1_2_9_23_1 doi: 10.1016/S0140-6736(19)32983-6 – ident: e_1_2_9_26_1 doi: 10.1186/s13063-020-4150-5 |
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Eczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare... 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... Abstract Objective Eczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether... ObjectiveEczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare... OBJECTIVEEczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare... |
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SubjectTerms | atopic dermatitis Dermatitis, Atopic - prevention & control Eczema Emollients - therapeutic use Food allergies food allergy Food Hypersensitivity - prevention & control Food sources Humans Infant Infant, Newborn Infants Meta-analysis prevention Risk factors Sensitivity analysis Skin Skin Care Skin Diseases, Infectious - epidemiology Soaps Systematic review Water Softening |
Title | Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fcea.13847 https://www.ncbi.nlm.nih.gov/pubmed/33550675 https://www.proquest.com/docview/2497339768 https://search.proquest.com/docview/2487434795 |
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