Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial

Lucy E. Bradshaw; Laura A. Wyatt; Sara J. Brown; Rachel H. Haines; Alan A. Montgomery; Michael R. Perkin; Sandra Lawton; Tracey H. Sach; Joanne R. Chalmers; Matthew J. Ridd; Carsten Flohr; Joanne Brooks; Richard Swinden; Eleanor J. Mitchell; Stella Tarr; Nicola Jay; Kim S. Thomas; Hilary Allen; Michael J. Cork; Maeve M. Kelleher; Eric L. Simpson; Stella T. Lartey; Susan Davies-Jones; Robert J. Boyle; Hywel C. Williams

doi:10.1111/all.15555

Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial

Lucy E. Bradshaw
, Laura A. Wyatt
, Sara J. Brown
, Rachel H. Haines
, Alan A. Montgomery
, Michael R. Perkin
, Sandra Lawton
, Tracey H. Sach
, Joanne R. Chalmers
, Matthew J. Ridd
, Carsten Flohr
, Joanne Brooks
, Richard Swinden
, Eleanor J. Mitchell
, Stella Tarr
, Nicola Jay
, Kim S. Thomas
, Hilary Allen
, Michael J. Cork
, Maeve M. Kelleher

Eric L. Simpson, Stella T. Lartey, Susan Davies-Jones, Robert J. Boyle, Hywel C. Williams (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

31 Citations (Scopus)

302 Downloads (Pure)

Abstract

Background: The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years.

Methods: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy.

Results: Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31%) in the emollient group and 178/631 (28%) in the control group (adjusted relative risk 1.10, 95% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15%] emollients and 87/632 [14%] controls, adjusted relative risk 1.11, 95% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever.

Conclusions: Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever.

Original language	English
Pages (from-to)	995-1006
Number of pages	12
Journal	Allergy
Volume	78
Issue number	4
Early online date	19 Oct 2022
DOIs	https://doi.org/10.1111/all.15555
Publication status	Published - Apr 2023

Keywords

asthma
atopic dermatitis
food allergy
prevention
rhinitis

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10.1111/all.15555Licence: CC BY

Final published versionFinal published version, 1.98 MBLicence: CC BY

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Bradshaw, L. E., Wyatt, L. A., Brown, S. J., Haines, R. H., Montgomery, A. A., Perkin, M. R., Lawton, S., Sach, T. H., Chalmers, J. R., Ridd, M. J., Flohr, C., Brooks, J., Swinden, R., Mitchell, E. J., Tarr, S., Jay, N., Thomas, K. S., Allen, H., Cork, M. J., ... Williams, H. C. (2023). Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial. Allergy, 78(4), 995-1006. https://doi.org/10.1111/all.15555

@article{3640b556387a47ed8dc15bef497fb610,

title = "Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial",

abstract = "Background: The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years.Methods: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy.Results: Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31\%) in the emollient group and 178/631 (28\%) in the control group (adjusted relative risk 1.10, 95\% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15\%] emollients and 87/632 [14\%] controls, adjusted relative risk 1.11, 95\% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever.Conclusions: Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever.",

keywords = "asthma, atopic dermatitis, food allergy, prevention, rhinitis",

author = "Bradshaw, \{Lucy E.\} and Wyatt, \{Laura A.\} and Brown, \{Sara J.\} and Haines, \{Rachel H.\} and Montgomery, \{Alan A.\} and Perkin, \{Michael R.\} and Sandra Lawton and Sach, \{Tracey H.\} and Chalmers, \{Joanne R.\} and Ridd, \{Matthew J.\} and Carsten Flohr and Joanne Brooks and Richard Swinden and Mitchell, \{Eleanor J.\} and Stella Tarr and Nicola Jay and Thomas, \{Kim S.\} and Hilary Allen and Cork, \{Michael J.\} and Kelleher, \{Maeve M.\} and Simpson, \{Eric L.\} and Lartey, \{Stella T.\} and Susan Davies-Jones and Boyle, \{Robert J.\} and Williams, \{Hywel C.\}",

note = "Funding Information: Health Technology Assessment (HTA) 12/67/12; National Institute for Health Research. Copyright: {\textcopyright} 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley \& Sons Ltd. ",

year = "2023",

month = apr,

doi = "10.1111/all.15555",

language = "English",

volume = "78",

pages = "995--1006",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley-Blackwell",

number = "4",

}

Bradshaw, LE, Wyatt, LA, Brown, SJ, Haines, RH, Montgomery, AA, Perkin, MR, Lawton, S, Sach, TH, Chalmers, JR, Ridd, MJ, Flohr, C, Brooks, J, Swinden, R, Mitchell, EJ, Tarr, S, Jay, N, Thomas, KS, Allen, H, Cork, MJ, Kelleher, MM, Simpson, EL, Lartey, ST, Davies-Jones, S, Boyle, RJ & Williams, HC 2023, 'Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial', Allergy, vol. 78, no. 4, pp. 995-1006. https://doi.org/10.1111/all.15555

TY - JOUR

T1 - Emollients for prevention of atopic dermatitis

T2 - 5-year findings from the BEEP randomized trial

AU - Bradshaw, Lucy E.

AU - Wyatt, Laura A.

AU - Brown, Sara J.

AU - Haines, Rachel H.

AU - Montgomery, Alan A.

AU - Perkin, Michael R.

AU - Lawton, Sandra

AU - Sach, Tracey H.

AU - Chalmers, Joanne R.

AU - Ridd, Matthew J.

AU - Flohr, Carsten

AU - Brooks, Joanne

AU - Swinden, Richard

AU - Mitchell, Eleanor J.

AU - Tarr, Stella

AU - Jay, Nicola

AU - Thomas, Kim S.

AU - Allen, Hilary

AU - Cork, Michael J.

AU - Kelleher, Maeve M.

AU - Simpson, Eric L.

AU - Lartey, Stella T.

AU - Davies-Jones, Susan

AU - Boyle, Robert J.

AU - Williams, Hywel C.

N1 - Funding Information: Health Technology Assessment (HTA) 12/67/12; National Institute for Health Research. Copyright: © 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

PY - 2023/4

Y1 - 2023/4

N2 - Background: The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years.Methods: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy.Results: Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31%) in the emollient group and 178/631 (28%) in the control group (adjusted relative risk 1.10, 95% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15%] emollients and 87/632 [14%] controls, adjusted relative risk 1.11, 95% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever.Conclusions: Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever.

AB - Background: The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years.Methods: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy.Results: Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31%) in the emollient group and 178/631 (28%) in the control group (adjusted relative risk 1.10, 95% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15%] emollients and 87/632 [14%] controls, adjusted relative risk 1.11, 95% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever.Conclusions: Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever.

KW - asthma

KW - atopic dermatitis

KW - food allergy

KW - prevention

KW - rhinitis

UR - https://www.scopus.com/pages/publications/85141436048

U2 - 10.1111/all.15555

DO - 10.1111/all.15555

M3 - Article

C2 - 36263451

SN - 0105-4538

VL - 78

SP - 995

EP - 1006

JO - Allergy

JF - Allergy

IS - 4

ER -

Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial

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Molecular Mechanisms in Atopic Skin (Senior Research Fellowship in Clinical Science)

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Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial

Abstract

Keywords

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Molecular Mechanisms in Atopic Skin (Senior Research Fellowship in Clinical Science)

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