- Skin Care from Birth for Allergy Prevention - Results today
ZÜRICH, June 8, 2020 /PRNewswire/ -- The 'Skin care from birth and allergy prevention: results today' session at the EAACI digital Congress 2020 looked at the increasing body of evidence assessing whether primary prevention of atopic dermatitis (AD) is effective in the prevention of food allergy (FA) and other allergic diseases.
Atopic Dermatitis has a strong and dose dependent association with food sensitization and food allergy. Atopic Dermatitis has also been shown to double the risk of asthma and allergic rhinitis. Given that AD precedes the development of food sensitization and FA, this has important implications for the prevention and treatment of FA. Detergent and environmental allergens (especially peanut) have also been shown to predispose towards worsening skin barrier function and allergy respectively.
Recent evidence has shown that early introduction of allergenic foods is an effective strategy to prevent the development of FA. It is, however, difficult to introduce the large number of allergenic foods in sufficient doses to induce oral tolerance in young infants. Targeting the skin before the onset of food sensitization would therefore provide a simple method to prevent all FA, averting the need for multiple early food introductions.
In the last ten years there has been an increasing body of evidence outlining the importance of the skin barrier in the development of allergic disease. The discovery of the filaggrin gene, and loss-of-function mutations of this gene leading to AD and FA supported the outside-inside concept; that barrier disruption precedes skin inflammation leading to AD and FA. This also encouraged many researchers from all over the world to evaluate whether applying skin barrier creams from birth could prevent the onset of AD and FA.
Initial pilot studies of petrolatum-based skin barrier creams applied within the first few weeks of life were very encouraging, resulting in a 33-50% reduction in AD. However, since then large randomised controlled studies using petrolatum based skin barrier creams have shown this strategy not to be effective in the primary prevention of AD or FA. There are many potential reasons for these unexpected negative results. For example, the BEEP study (Barrier Enhancement for Eczema Prevention) showed that application of petrolatum-based skin barrier creams increased the risk of skin infections, and it has been shown that Staph. Aureus colonisation increases the risk of developing FA, and prevents the resolution of FA.
Other researchers are using different types of skin barrier creams, such as trilipids which have been shown to have significantly greater beneficial effects on transepidermal water loss (an important marker of skin barrier function) in children with AD than petrolatum based skin barrier creams. Additionally, petrolatum based skin barrier creams have little impact on the inflammatory processes commonly found in AD, whereas topical steroids do, and there is some preliminary evidence that pro-active steroid cream may prevent the development of food allergy.
"Looking at the future, the optimum initiation and duration of intervention is important. So is the degree of adherence to intervention, and we know this was very low in the BEEP and preventADALL study. The different emollient properties are clear as we have highlighted in the comparison between petrolatum and trlipid creams. The role of environmental food exposure needs to be determined in these studies, and also the role of Staph aureus. We must also think that primary and secondary prevention may be different: a child that has a normal skin with a normal skin pH and a normal skin microbiome may be adversely affected by using certain types of moisturisers on the skin, whereas in secondary prevention the skin is already abnormal and therefore it may be beneficial to use such moisturisers on the skin. The very important role of topical anti-inflammatory agents also will need to be further explored," says Helen Brough, Consultant in Pediatric Allergy Evelina London, Guy's and St. Thomas' Hospital, Adjunct Senior Lecturer King's College London and EAACI 2020 Digital Congress Co-Chair and EAACI Pediatric Section Chair.
The European Academy of Allergy and Clinical Immunology (EAACI) is an association of clinicians, researchers and allied health professionals founded in 1956. EAACI is dedicated to improving the health of people affected by allergic diseases. With more 12 000 members from 124 countries and over 75 National Allergy Societies, EAACI is the primary source of expertise in Europe and worldwide for all aspects of allergy.
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