Application of Moisturizer to Neonates Prevents Development of Atopic Dermatitis

J Allergy Clin Immunol. 2014 Oct;134(4):824-830.e6. doi: 10.1016/j.jaci.2014.07.060.

Abstract

Background: Recent studies have suggested that epidermal barrier dysfunction contributes to the development of atopic dermatitis (AD) and other allergic diseases.

Objective: We performed a prospective, randomized controlled trial to investigate whether protecting the skin barrier with a moisturizer during the neonatal period prevents development of AD and allergic sensitization.

Methods: An emulsion-type moisturizer was applied daily during the first 32 weeks of life to 59 of 118 neonates at high risk for AD (based on having a parent or sibling with AD) who were enrolled in this study. The onset of AD (eczematous symptoms lasting >4 weeks) and eczema (lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. The primary outcome was the cumulative incidence of AD plus eczema (AD/eczema) at week 32 of life. A secondary outcome, allergic sensitization, was evaluated based on serum levels of allergen-specific IgE determined by using a high-sensitivity allergen microarray of diamond-like carbon-coated chips.

Results: Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (P = .012, log-rank test). We did not show a statistically significant effect of emollient on allergic sensitization based on the level of IgE antibody against egg white at 0.34 kUA/L CAP-FEIA equivalents. However, the sensitization rate was significantly higher in infants who had AD/eczema than in those who did not (odds ratio, 2.86; 95% CI, 1.22-6.73).

Conclusion: Daily application of moisturizer during the first 32 weeks of life reduces the risk of AD/eczema in infants. Allergic sensitization during this time period is associated with the presence of eczematous skin but not with moisturizer use.

Keywords: Atopic dermatitis; IgE; allergic sensitization; atopy; food allergy; randomized controlled trial.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Allergens / immunology
  • Dermatitis, Atopic / immunology
  • Dermatitis, Atopic / prevention & control*
  • Egg Hypersensitivity / immunology
  • Egg Hypersensitivity / prevention & control*
  • Egg Proteins / immunology
  • Emulsions / administration & dosage*
  • Emulsions / adverse effects
  • Epidermis / drug effects*
  • Epidermis / immunology
  • Epidermis / pathology
  • Female
  • Humans
  • Immunoglobulin E / blood
  • Infant, Newborn
  • Japan
  • Male
  • Microarray Analysis
  • Risk

Substances

  • Allergens
  • Egg Proteins
  • Emulsions
  • Immunoglobulin E