Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial

Lucy E Bradshaw, Laura A Wyatt, Sara J Brown, Rachel H Haines, Alan A Montgomery, Michael R Perkin, Sandra Lawton, Tracey H Sach, Joanne R Chalmers, Matthew J Ridd, Carsten Flohr, Joanne Brooks, Richard Swinden, Eleanor J Mitchell, Stella Tarr, Nicola Jay, Kim S Thomas, Hilary Allen, Michael J Cork, Maeve M Kelleher, Eric L Simpson, Stella T Lartey, Susan Davies-Jones, Robert J Boyle, Hywel C Williams, Lucy E Bradshaw, Laura A Wyatt, Sara J Brown, Rachel H Haines, Alan A Montgomery, Michael R Perkin, Sandra Lawton, Tracey H Sach, Joanne R Chalmers, Matthew J Ridd, Carsten Flohr, Joanne Brooks, Richard Swinden, Eleanor J Mitchell, Stella Tarr, Nicola Jay, Kim S Thomas, Hilary Allen, Michael J Cork, Maeve M Kelleher, Eric L Simpson, Stella T Lartey, Susan Davies-Jones, Robert J Boyle, Hywel C Williams

Abstract

Background: The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years.

Methods: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy.

Results: Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31%) in the emollient group and 178/631 (28%) in the control group (adjusted relative risk 1.10, 95% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15%] emollients and 87/632 [14%] controls, adjusted relative risk 1.11, 95% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever.

Conclusions: Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever.

Keywords: asthma; atopic dermatitis; food allergy; prevention; rhinitis.

© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

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Source: PubMed

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