Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy

The big idea:

Early-onset atopic dermatitis (AD) is a strong risk factor for food allergy, suggesting that early effective treatment may prevent transcutaneous sensitisation (the process where the immune system becomes allergic to an external substance after it penetrates the skin barrier).

What the study asked:

This study tested whether enhanced treatment of AD to clinically affected and unaffected skin is more effective in preventing hen’s egg allergy than reactive treatment to clinically affected skin only.

Explanation of key terms: 

• Enhanced early skin treatment is an intensive, proactive management strategy involving:

  • Early remission induction: 

    • Entailing processes such as twice daily application of topical corticosteroids for 14 days.

  • Maintenance therapy  

    • Following remission, proactive maintenance is used. This involves applying the same topical corticosteroids (TCSs) twice weekly to the entire face and body to prevent new flares.

  • Daily emollients:

    • Regular, daily application of emollients (moisturisers) is maintained alongside the medication to repair the skin barrier. 

• Reactive treatment involves immediately addressing active flares to control symptoms and repairing the skin barrier to prevent further allergic reactions.

• Corticosteroids:

  • Powerful anti-inflammatory and immunosuppressant medications that mimic cortisol, a natural hormone produced by the adrenal glands.

What the study did:

• The study involved a randomised control trial, which was: 

  • multicentre (multiple different hospitals and research centres)

  • parallel-group (participants are randomised into 2 or more groups: one receiving the treatment and the other a placebo)

  • open-label (both the researchers and the participants know which treatment the participant is receiving)

  • assessor-blind (the person evaluating the results is unaware of which treatment the participant received

• The study enrolled infants 7-13 weeks old with AD and randomly assigned them in a 1:1 ratio to enhanced early skin treatment or conventional reactive treatment using TCSs.

• The primary outcome was the proportion of immediate hen’s egg allergy confirmed by oral food challenge at 28 weeks of age. 

What the study found:

• This study enrolled 650 infants and analysed 640 infants.

• Enhanced treatment significantly reduced hen’s egg allergy compared with the conventional treatment (31.4% vs 41.9%), while it lowered body weight (mean difference: –422 g) and height (mean difference: –0.8 cm) at 28 weeks of age.

What this means for eczema:

• This study highlighted the potential of well-controlled atopic dermatitis management as a component of a hen’s egg allergy prevention strategy.

• However, the enhanced treatment protocol of this trial should be modified before it can be considered as an approach to prevent hen’s egg allergy in daily practice to avoid the adverse effects of TCSs. 

• After remission induction by TCSs, maintenance therapy with lower potency TCSs or other topical therapies might be considered as alternative proactive treatments to overcome the safety concerns of TCSs.

Link to study:

https://www.jaci-inpractice.org/article/S2213-2198(19)31018-9/fulltext