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 - 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
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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 and Experimental Allergy
JF - Clinical and Experimental Allergy
IS - 3
ER -