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Do skincare interventions stop infants from developing eczema and allergies?
Do skincare interventions stop infants from developing eczema and allergies?
PEARLS No.
671
Clinical question
How effective are skincare interventions, such as emollients, for primary prevention of eczema and food allergy in infants?
Bottom line
This review found that skincare interventions, such as emollients, probably do not influence the development or time to onset of eczema in healthy term infants by age 1 to 2 years.
However, there is evidence to suggest they may increase the risk of skin infection (moderate‐certainty evidence), with 50/1000 infants developing skin infections with standard care compared with 67/1000 developing skin infections in the intervention group. This suggests that regular application of emollients or other skincare interventions probably is not necessary for healthy infants unless there are other specific reasons for using such products.
The review could not draw conclusions about the impact of skincare interventions on immunoglobulin E‐mediated food allergy by age 1 to 2 years (very-low‐certainty evidence) as only 1 study had food allergy diagnosed by oral food challenges. In this study, only 29% of eligible participants underwent the oral food challenges.
Caveat
Although 33 studies were identified by this review, only 17 reported relevant outcomes. Of these 17 studies, only 8 reported the primary outcome of cumulative incidence of eczema by 1 to 3 years. However, 2 of the largest studies included the outcomes specified in this review and provided individual participant data, along with another 5 included studies, allowing for assessment of both study factors and individual participant factors that may have influenced results. This approach strengthened the evidence presented.
Context
Eczema and food allergy are common health conditions that usually begin in early childhood and often occur together. Genetic variations that damage skin barrier function are associated with both eczema and food allergy.
It is unclear whether interventions designed to improve the skin barrier in infants are effective in preventing eczema or food allergy. These skincare interventions work either by enhancement or promotion of the barrier through hydration via directly applied topical products, such as emollients or moisturisers, or through reduction of potential damage to the skin barrier and consequent dryness via various means, such as avoiding soaps or reducing water hardness.
Refer to “From the lab”, New Zealand Doctor, 9 December 2020 for more on eczema and food allergy in infants.
Cochrane Systematic Review
Kelleher MM, et al. Skin care interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev 2021, Issue 2. Art. No.: CD013534. DOI: 10.1002/14651858.CD013534.pub2. This review contains 33 trials with a total of 25,827 participants.
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