Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy.

Female Animals Egg Hypersensitivity / prevention & control Dermatitis, Atopic / therapy Chickens Food Hypersensitivity / therapy Risk Factors Dermatologic Agents

Atopic dermatitis food allergy prevention proactive therapy randomized controlled trial

Journal

The Journal of allergy and clinical immunology

ISSN: 1097-6825

Titre abrégé: J Allergy Clin Immunol

Pays: United States

ID NLM: 1275002

Informations de publication

Date de publication:
Jul 2023

Historique:

received: 17 11 2022

revised: 20 02 2023

accepted: 07 03 2023

medline: 10 7 2023

pubmed: 25 3 2023

entrez: 24 3 2023

Statut: ppublish

Résumé

Early-onset atopic dermatitis is a strong risk factor for food allergy, suggesting that early effective treatment may prevent transcutaneous sensitization. This study tested whether enhanced treatment of atopic dermatitis to clinically affected and unaffected skin is more effective in preventing hen's egg allergy than reactive treatment to clinically affected skin only. This was a multicenter, parallel-group, open-label, assessor-blind, randomized controlled trial (PACI [Prevention of Allergy via Cutaneous Intervention] study). This study enrolled infants 7-13 weeks old with atopic dermatitis and randomly assigned infants in a 1:1 ratio to enhanced early skin treatment or conventional reactive treatment using topical corticosteroids (TCSs). The primary outcome was the proportion of immediate hen's egg allergy confirmed by oral food challenge at 28 weeks of age. This study enrolled 650 infants and analyzed 640 infants (enhanced [n = 318] or conventional [n = 322] treatment). Enhanced treatment significantly reduced hen's egg allergy compared with the conventional treatment (31.4% vs 41.9%, P = .0028; risk difference: -10.5%, upper bound of a 1-sided CI: -3.0%), while it lowered body weight (mean difference: -422 g, 95% CI: -553 to -292 g) and height (mean difference: -0.8 cm, 95% CI: -1.22 to -0.33 cm) at 28 weeks of age. This study highlighted the potential of well-controlled atopic dermatitis management as a component of a hen's egg allergy prevention strategy. The enhanced treatment protocol of this trial should be modified before it can be considered as an approach to prevent hen's egg allergy in daily practice to avoid the adverse effects of TCSs. After remission induction by TCSs, maintenance therapy with lower potency TCSs or other topical therapies might be considered as alternative proactive treatments to overcome the safety concerns of TCSs.

Sections du résumé

BACKGROUND BACKGROUND

Early-onset atopic dermatitis is a strong risk factor for food allergy, suggesting that early effective treatment may prevent transcutaneous sensitization.

OBJECTIVES OBJECTIVE

This study tested whether enhanced treatment of atopic dermatitis to clinically affected and unaffected skin is more effective in preventing hen's egg allergy than reactive treatment to clinically affected skin only.

METHODS METHODS

This was a multicenter, parallel-group, open-label, assessor-blind, randomized controlled trial (PACI [Prevention of Allergy via Cutaneous Intervention] study). This study enrolled infants 7-13 weeks old with atopic dermatitis and randomly assigned infants in a 1:1 ratio to enhanced early skin treatment or conventional reactive treatment using topical corticosteroids (TCSs). The primary outcome was the proportion of immediate hen's egg allergy confirmed by oral food challenge at 28 weeks of age.

RESULTS RESULTS

This study enrolled 650 infants and analyzed 640 infants (enhanced [n = 318] or conventional [n = 322] treatment). Enhanced treatment significantly reduced hen's egg allergy compared with the conventional treatment (31.4% vs 41.9%, P = .0028; risk difference: -10.5%, upper bound of a 1-sided CI: -3.0%), while it lowered body weight (mean difference: -422 g, 95% CI: -553 to -292 g) and height (mean difference: -0.8 cm, 95% CI: -1.22 to -0.33 cm) at 28 weeks of age.

CONCLUSIONS CONCLUSIONS

This study highlighted the potential of well-controlled atopic dermatitis management as a component of a hen's egg allergy prevention strategy. The enhanced treatment protocol of this trial should be modified before it can be considered as an approach to prevent hen's egg allergy in daily practice to avoid the adverse effects of TCSs. After remission induction by TCSs, maintenance therapy with lower potency TCSs or other topical therapies might be considered as alternative proactive treatments to overcome the safety concerns of TCSs.

Identifiants

DOI: 10.1016/j.jaci.2023.03.008 PMID: 36963619

pubmed: 36963619

pii: S0091-6749(23)00331-7

doi: 10.1016/j.jaci.2023.03.008

pii:

doi:

Substances chimiques

Dermatologic Agents 0

Types de publication

Randomized Controlled Trial Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

126-135

Investigateurs

Kumiko Morita (K)

Eisuke Inoue (E)

Tatsuki Fukuie (T)

Shigenori Kabashima (S)

Yusuke Inuzuka (Y)

Koji Nishimura (K)

Kenji Toyokuni (K)

Hiroya Ogita (H)

Tomoyuki Kiguchi (T)

Kazue Yoshida (K)

Jumpei Saito (J)

Hajime Hosoi (H)

Norito Katoh (N)

Mariko Morimoto (M)

Koji Masuda (K)

Makoto Kameda (M)

Amane Shigekawa (A)

Koji Yamasaki (K)

Megumi Nagai (M)

Motohiro Ebisawa (M)

Tomoyuki Asaumi (T)

Takaaki Itonaga (T)

Shunji Hasegawa (S)

Hiroki Yasudo (H)

Mizuho Nagao (M)

Takao Fujisawa (T)

Ryuhei Yasuoka (R)

Toshiharu Fujiyama (T)

Naoki Shimojo (N)

Taiji Nakano (T)

Yasuto Kondo (Y)

Yuji Mori (Y)

Takahiro Kawaguchi (T)

Masaki Futamura (M)

Kazumitsu Sugiura (K)

Akiyo Nagai (A)

Sachiko Kaburagi (S)

Hiroshi Kitazawa (H)

Hiroshi Kido (H)

Shoji F Nakayama (SF)