References
1. Eiwegger T, Hung L, San Diego KE, O’Mahony L, Upton J. Recent developments and highlights in food allergy. Allergy . 2019;74(12):2355-2367. doi:10.1111/all.14082
2. Brough HA, Nadeau KC, Sindher SB, et al. Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? Allergy . May 2020:all.14304. doi:10.1111/all.14304
3. Du Toit G, Roberts G, Sayre PH, et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N Engl J Med . 2015;372(9):803-813. doi:10.1056/NEJMoa1414850
4. Horimukai K, Morita K, Narita M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis. J Allergy Clin Immunol . 2014;134(4):824-830.e6. doi:10.1016/j.jaci.2014.07.060
5. Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol . 2014;134(4):818-823. doi:10.1016/j.jaci.2014.08.005
6. Chalmers JR, Haines RH, Bradshaw LE, et al. Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial.Lancet . 2020;395(10228):962-972. doi:10.1016/S0140-6736(19)32984-8
7. Skjerven HO, Rehbinder EM, Vettukattil R, et al. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial.Lancet . 2020;395(10228):951-961. doi:10.1016/S0140-6736(19)32983-6
8. Sindher S, Alkotob SS, Shojinaga MN, et al. Pilot study measuring transepidermal water loss (TEWL) in children suggests trilipid cream is more effective than a paraffin‐based emollient. Allergy . March 2020:all.14275. doi:10.1111/all.14275
9. Lack G, Fox D, Northstone K, Golding J. Factors Associated with the Development of Peanut Allergy in Childhood. N Engl J Med . 2003;348(11):977-985. doi:10.1056/NEJMoa013536
Figure 1. Environmental and genetic factors affecting skin barrier dysfunction and inflammation, leading to the development of the allergic disease complex. Epicutaneous allergen exposure happens due to the presence of food allergens in the environment. In the absence of oral ingestion this cutaneous exposure in patients with eczema is thought to promote allergic sensitization, resulting in a greater susceptibility to develop food allergy. It is unknown whether emollient usage may promote barrier integrity and affect the interplay between barrier impairment, skin inflammation, and ultimately prevent atopic dermatitis development.
Figure 2. Two prospective interventional trials assessed the preventive capacity of emollient usage on the development of atopic dermatitis at 24 months (BEEP) and at 12 months (PreventADALL). The BEEP study recommended a daily paraffin-based whole-body emollient vs. a standardized skin-care regimen within the first 12 months of life in 1394 high-risk infants and assessed the rate of AD at 24 months. The PreventADALL study studied 2397 population-based infants assessing the impact of petroleum-based emollient usage in the facial area in combination with bathing additives compared to an early food introduction protocol, a combination of both interventions, or best skin care practice. No superiority of any of these interventions over best skin practice regarding the prevention of AD was observed. AD: atopic dermatitis