Eczema and food allergies are common health problems that usually begin in early childhood and often occur together in the same person. They may be relate to damage to the skin barrier in early infancy. It is unclear whether trying to prevent or reverse a damage skin barrier shortly after birth is effective in preventing eczema or food allergies. Research purposes main purpose To assess the effect of skin care interventions, such as emollients. In the primary prevention of infantile eczema and food allergy. The secondary purpose Identifies study population characteristics, such as age, genetic risk, and adherence to interventions. That is associate with the greatest therapeutic benefit or harm in eczema and food allergy. Search strategy We search databases up to July 2020: Cochrane Skin Specialize Register, and Cochrane Central Register of Controlle Trials.
Skin Conditions Who Underwent Skin Care Interventions To Prevent Eczema
We search two trial registers and check reference lists of include studies and relevant systematic reviews Soothely Neck Massager for further relevant randomize control trials ( RCTs ). We contact field experts to identify plane trials and to seek information on unpublishe or incomplete trials. Inclusion and exclusion criteria We include RCTs of healthy full-term (37 weeks) infants (0 to 12 months) without eczema, food allergies, or other skin conditions who underwent skin care interventions that might enhance skin barrier function, reduce dryness, or reduce subclinical inflammation. The comparison was with local standard treatment or no treatment. Types of skin care interventions include moisturizers/emollients; bath products; advice on reducing soap exposure and frequency of bathing; and use of water softeners.
This is a prospective meta-analysis
No minimum follow-up was require. Data collection and analysis This is a prospective meta-analysis of individual participant data (IPD). We use standard Cochrane methodological procedures, with the primary analysis using the IPD dataset. The primary outcomes were the cumulative incidence of eczema and immunoglobulin (Ig) E-mediate food allergy over one to three years, both measure through the most recent two-year time point available. Secondary outcomes include adverse events during the intervention; eczema severity (clinician-assessment); parent-reports eczema severity; time to eczema flare-up; immediate parent-report food allergy; and sensitization to food or inhale allergens. main results This review identifies 33 RCTs enrolling 25,827 participants. Skin Care Interventions To Prevent Eczema.
Skincare Intervention
A total of 17 studies, randomizing 5823 participants, report information on one or more of the outcomes specific to this review. Eleven studies randomize 5217 participants, 10 of which provide IPD, and were include in one or more meta-analyses (each individual meta-analysis range from 2 to 9 studies). Most studies were conducte at children’s hospitals. All interventions were compare with no skincare intervention or local standard care. Of the 17 studies in which we report results, 13 assess emollients. All 25 studies providing data for the meta-analysis were include, randomizing newborns up to three weeks old to receive either a skincare intervention or standard infant skin care.
This Systematic Review
Eight of 11 meta-analyses recruit infants at high risk of developing eczema or food allergy, but the definition of high-risk varies across studies. Intervention and follow-up times range from 24 hours to two years. We assess most of the evidence in this systematic review as low quality or with some risk of bias concerns. Ratings for some questions were often due to a lack of blinding of outcome assessors or missing important data, which could have influence outcome measures but were considere unlikely to do so. Evidence for the outcome of primary food allergy was rate as a high risk of bias because only one trial was include and results vary when different assumptions were made about missing data.
Skincare Intervention
Skincare interventions in infancy probably did not change the risk of eczema at one to two years of age ( RR 1.03, 95% CI 0.81 to 1.31; moderate-quality evidence; 3075 participants, 7 trials) and time to eczema onset ( RR 0.86, 95% CI 0.65 to 1.14; moderate-quality evidence; 3349 participants, 9 trials). It is unclear whether a skincare intervention in infancy modifies the risk of IgE-mediate food allergy at 1 to 2 years of age (RR 2.53, 95% CI [0.99 to 6.47]; 996 participants, 1 trial) or Sensitivity to food allergens at 1 to 2 years of age ( RR 0.86, 95% CI 0.28 to 2.69; 1055 participants, 2 trials), as the certainty of the evidence for these outcomes was very low.
Skin Infection During The Intervention
Skincare interventions in infancy may slightly increase the risk of parents reporting immediate reactions to common food allergens within two years (RR 1.27, 95% CI 1.00 to 1.61; low-quality evidence; 1171 participants, 1 trial test). However, this was seen only with cow’s milk, and because of the severe overreporting of cow’s milk allergies in some infants, this may not be reliable. Skincare interventions in infancy may increase the risk of skin infection during the intervention ( RR 1.34, 95% CI 1.02 to 1.77; moderate-quality evidence; 2728 participants, 6 trials) and may increase the risk of slipping ( RR 1.42, 95% CI 0.67 to 2.99; low-quality evidence; 2538 participants, 4 trials) or stinging/allergic reaction to moisturizer ( RR 2.24, 95% CI [0.67 to 7.43]; low-certainty evidence; 343 participants, 4 trials).
The Risk Of Skin Infections
But confidence intervals for slipping and stinging/anaphylaxis were wide, including the possibility of no effect or reduce risk. Preplanne subgroup analyses show that intervention effects were independent of age, duration of intervention, genetic risk, FLG mutation, or type of intervention targeting eczema risk. We were unable to assess these effects on food allergy risk. There was insufficient evidence to show whether adherence to an intervention affects the relationship between skin care interventions and the risk of developing eczema or food allergy. Author’s conclusion Skin care interventions such as the use of emollients during the first year of life in healthy infants may not be effective in preventing eczema and may increase the risk of skin infections.
Different Skin Care Approaches
The effect of skin care interventions on food allergy risk is uncertain. Further work is need to understand whether different skin care approaches may promote or prevent eczema and to assess their impact on food allergy base on robust outcomes. Peaks Brief summary Available in English Deutsch Español Farsi French Malay Russian Thai language Simplifie Chinese Skincare interventions to prevent eczema and food allergies Can moisturizing a baby’s skin prevent eczema or food allergies? Key Information Skin care for babies, such as using moisturizers on the skin during the first year of life, may not prevent them from developing eczema and may increase the chance of skin infections.
How Skin Care Treatments Affect
We are uncertain how skin care treatments affect the development of food allergies. We need evidence from good studies to determine the effects of skin care products on food allergies in babies. What is an allergy? The immune response is the body’s way of recognizing and defending against substances that appear to be harmful. An allergy is the body’s immune system’s reaction to a specific food or substance (an allergen) that is usually harmless. Different allergies affect different parts of the body, and their effects can range from mild to severe. Food Allergies and Eczema Eczema is a common skin allergy that causes dry, itchy, cracke skin. Eczema is common in children and usually develops before their first birthday. It sometimes lasts for a long time, but it may get better or go away as the child gets older.
The Water With Moisturizer Or Moisturizing Oil
Food allergies can cause itchy mouth, itchy rashes, facial swelling, stomach symptoms, or trouble breathing. They usually occur within 2 hours of eating. People with food allergies often have other allergic conditions such as asthma, hay fever, and eczema. Why we did this Cochrane Review We want to understand how skin care affects a baby’s risk of eczema or food allergy. Skincare treatments include: applying moisturizer to baby’s skin; Bathing your baby in the water with moisturizer or moisturizing oil; advising parents to use less soap, or to bathe their children less; and Using a water softener. We also wonder if there were any adverse effects from these skin-care treatments.
Skin Care Studies In Healthy Infants
What did we do We search for different types of skin care studies in healthy infants (under one year old) who had no previous food allergies, eczema, or other skin conditions. Search date: We include evidence publishe up to July 2020. We are intereste in some studies reporting on How many children develop eczema or food allergies between the ages of 1 and 3. The Severity of eczema (assesse by investigator and parents); how long it takes for eczema to develop; Parental reports of immediate reactions (within two hours) to food allergens. How many children develop sensitivities to specific food allergens; and Any adverse reactions? We assess the strengths and weaknesses of each study to determine the reliability of the results.
Skincare Is Compare To No Skincare
We then combine the results of all relevant studies and look at the overall effect. what we found We found 33 studies involving 25,827 infants. These studies were conducte in Europe, Australia, Japan, and the United States, most commonly at children’s hospitals. Skincare is comparing to no skincare or care as usual (standard care). Treatment and follow-up times ranged from 24 hours to two years. Many studies (13) tested the use of moisturizers; others primarily tested the use and frequency of bath and cleansing products. We pooled results from 11 studies; eight had infants considered at high risk of developing eczema or food allergy.
More Skin Infections
What are the main findings of this systematic review? Compared to no skincare or standard care, moisturizer: probably did not change the risk of developing eczema in infants aged one to two years (evidence from 7 studies with 3075 infants) or the time it took for eczema to develop (9 studies; 3349 infants); Possibly a slight increase in immediate reaction to a common food allergen after two years, as reported by parents (1 study; 1171 infants); May result in more skin infections (6 studies; 2728 infants); Potentially increased adverse effects, such as tingling or allergic reactions to moisturizers (4 studies; 343 infants); and May increase the chance of infants slipping and falling (4 studies; 2538 infants).
Skin Infections Were Of Moderate Quality
We are uncertain whether skin care treatments affect the odds of developing food allergy as assessed by the investigators (1 study; 996 infants) or the sensitivity to food allergens in infants aged 1 to 2 years (2 studies; 1055 infants ). confidence in the results Results from our study of eczema onset and time to onset was of moderate quality. These results may change if more evidence becomes available. We lack confidence in the findings of food allergy or sensitivity studies because they are based on small numbers of studies with widely varying results. These results may change when more evidence becomes available. Results from our study of skin infections were of moderate quality, but deficient quality for stinging, allergic reactions, and slipping.
Skin Care Interventions
Authors’ conclusions Implications for practice This review found that skin care interventions such as emollients probably do not influence the development or time to the onset of eczema in healthy term infants by age one to two years and probably increase the risk of skin infection (moderate‐certainty evidence). This suggests that regular application of emollients or other skin care interventions probably is not necessary for healthy infants unless there are other specific reasons for using such products. This information should be taken into account by guideline developers in this field. Given the probable increase in local skin infection risk, it may be important for carers to practice appropriate hygiene measures when applying emollients to the skin of infants.
Milk Allergy In Infants
This review could not draw conclusions about the impact of skin care interventions on IgE‐mediated food allergy by age one to two years (very low‐certainty evidence); only one study had food allergy diagnosed by oral food challenges, and in this study, only 29% of eligible participants attended for oral food challenge (OFC). Low‐certainty evidence from one trial suggests that skin care intervention may slightly increase parent reports of immediate food allergy (to a common allergen) at two years. However, this outcome was only detected in cow’s milk. Which may be unreliable as a measure due to the commercially influenced over‐reporting of cow’s milk allergy in infants.
Skin Care Interventions On Food Sensitization
Evidence was insufficient to detect the effects of skin care interventions on food sensitization at ages one to two years (very low‐certainty evidence). The gold standard for diagnosing a food allergy is an OFC; however, these are costly and time-consuming for participants and trialists. Alternative modes of diagnosis of food allergy, by standardized questionnaires and documented sensitization. Even more complex methods such as the basophil activation test, could be considered in further trials. Infant slippages and stinging/allergic reactions to moisturizers may increase with the use of skin care interventions during infancy (low‐certainty evidence).
The Relationship Between Skincare
Although confidence intervals for slippages and stinging/allergic reactions are wide and include the possibility of no effect or reduced risk. All results presented here are in comparison to standard care. Subgroup analysis showed that age, hereditary risk, FLG mutation, duration of intervention, and classification of intervention type did not have an impact on the risk of developing eczema. We could not evaluate these effects for food allergy risk. We do not know if adherence to treatment affects the relationship between skin care interventions and the risk of developing eczema or food allergy.
That Impact Skin Barrier Function
The common clinical practice of applying emollients to the skin of people who already have eczema is not directly affected by our findings. Implications for research In this review, the trials with eczema as an outcome were mainly emollient trials. Other methods of skin barrier intervention in this review had very short follow-ups and did not measure eczema as an outcome, so their impact on eczema remains unclear. Potential future studies on bathing practices should have longer follow-ups of clinical outcomes that use standard methods of eczema measurement. Trialists may wish to consider using novel interventions that impact skin barrier function. Rather than those that have already been evaluated in these trials.
Identify Whether Skincare
We were unable to identify whether skin care interventions such as emollients have an impact on the risk of developing food allergies. More research is needed to identify whether early skin care practices influence food allergy risk. Future trials should measure food allergy using a robust outcome assessment (Asai 2020), and researchers may wish to consider applying published algorithms to evaluate food allergy outcomes in participants who do not undergo oral food challenges (Kelleher 2020b). The lack of oral food challenge‐diagnosed food allergy outcomes in this meta‐analysis infers that oral food challenges are difficult to conduct and are infrequently attended in prevention studies.
Compliance With Interventions
We would suggest that future studies incorporate Core Outcome Measures for Food Allergy. An update of this review with food allergy outcomes from Skjerven 2020 and potentially the other ongoing trials with food allergy outcomes will be needed to fully address this. The hypothesis is that skin care interventions may impact the risk of food allergy. Conclusions on adherence to intervention could not be made. We would suggest that future studies carefully document adherence and compliance with interventions. Also, a collaboration between groups regarding future potential studies may allow for larger numbers with less imprecision.
Another Body Of Work Has Begun
This review focused on the primary prevention of eczema and food allergy, preventing American Beauty from the diagnosis of eczema and food allergy in infants. Given the strong links between early‐onset eczema and food allergy, another body of work has begun on the secondary prevention of food allergy among infants already diagnosed with eczema. These trials include infants younger than 13 weeks with diagnosed eczema and randomize them to active eczema management from onset with emollients and topical corticosteroids. Both studies have IgE‐mediated food allergy as a primary outcome and are ongoing.
