Cutaneous Sensitization |
1994190
|
Increased
airways responsiveness in mice depends on local challenge with antigen |
Saloga J, et al. |
First evidence to support that sensitization could
occur through skin |
Murine skin differs from human skin |
Murine model |
Mechanistic |
Level 5 |
Cutaneous Sensitization |
2003191
|
Avon
Longitudinal Study of Parents and Children (ALSPAC) |
Lack G, et al. |
Peanut allergy associated with topical use of peanut oil infants, but
not with maternal consumption |
|
UK, general population |
Population-based, longitudinal birth cohort |
Level 2 |
The Role of Filaggrin in AD
|
200693
|
Common loss-of-function variants of the epidermal barrier protein
filaggrin are a major predisposing factor for atopic dermatitis
|
Palmer CNA, et al.
|
AD was more common in homozygous or compound heterozygous for FLG null
alleles, and nearly absent in those without
|
Only 2 mutations had been identified and analyzed, both common in those
of European ancestry, but rare in other ethnicities
|
9 Irish families with icthyosis vulgaris and/or AD;
2 cohorts of Scottish children with and without asthma;
Danish children from the COPSAC study
|
Multiple cohorts
|
Level 2
|
The Role of Filaggrin in FA |
201166
|
Loss-of-function variants in the filaggrin gene are a significant
risk factor for peanut allergy |
Brown SJ, et al. |
FLG
loss-of-function mutations significantly increase the risk of peanut
allergy, suggesting a role for epithelial barrier dysfunction |
Different definitions of AD and criteria for diagnosing peanut allergy
were used in the different populations; difficult to distinguish the
role of AD from FLG status, and other variables affecting the
development of peanut allergy; the effect varied in different
populations despite all being predominantly white and of European
ancestry |
English, Dutch, and Irish subjects with peanut allergy and
controls; replicated in a white, Canadian case-control population |
Case-control study |
Level 3 |
Skin barrier Dysfunction and Transcutaneous Sensitization in FA |
201427
|
Peanut
allergy: Effect of environmental peanut exposure in children with
filaggrin loss-of-function mutations |
Brough HA, et al. |
Exposure to
peanut protein in household dust demonstrated a dose-response
relationship with measures of peanut sensitization and allergy at 8 and
11y in children with FLG mutations, when controlling for other factors;
no effect of exposure was seen in children with WT-FLG |
Peanut allergy
not challenge-proven in all subjects; overall small number of subjects
with peanut allergy, FLG gene status, and exposure history; excluded
non-Caucasians as the 6 FLG mutations studied were only defined in
Caucasians |
UK, high risk infants (family history of atopy) |
Observational study within randomized controlled study |
Level
3 |
Topical intervention for AD
|
2014192
|
Application of moisturizer to neonates prevents development of atopic
dermatitis
|
Horimoku K, et al.
|
Daily application of an emulsion-based moisturizer starting at 1week of
life prevented AD in 1/3 of infants at 8m
|
Control group could use petroleum jelly if desired, which may be
beneficial for SB, limiting the impact of the intervention
|
Japan,
high risk
|
RCT
|
Level 2
|
Oral Tolerance Induction
|
2015193 &
2016194
|
LEAP &
LEAP-On
|
du Toit, et al.
|
Early introduction and regular consumption of peanut in infants at high
risk for FA prevents peanut allergy, and likely induces durable, and
long-lasting tolerance
|
Excluded infants with peanut SPT>4mm at entry
|
UK, high risk cohort
|
Randomized, open-label, controlled trial
|
Level 2
|
Preventative Emollient Therapy for AD and FA
|
2018195
|
A randomised trial of a barrier lipid
replacement strategy for the prevention of atopic dermatitis and
allergic sensitisation: The PEBBLES Pilot Study
|
Lowe AJ, et al.
|
Twice daily application of emollient rich in ceramides to infants in the
first 3weeks of life through 6m demonstrated a trend towards less AD and
food sensitization at 12month; infants who had emollient applier BID for
at least 5/7 day per week did have a significant reduction in food
sensitization
|
Food sensitization only assessed at 1y, not later in life and not
challenge-proven; Small n=80), pilot study.
|
Australia, high risk infants (parental history of atopy)
|
Pilot randomized, parallel, single-blind, controlled trial
|
Level 3
|
Assessing Skin Barrier Dysfunction |
2019196
|
The
nonlesional skin surface distinguishes atopic dermatitis with food
allergy as a unique endotype |
Leung DYM, et al. |
Using a non-invasive,
well-tolerated skin tape stripping method, identifies unique immature
skin barrier characteristics in the stratum corneum that distinguish
between children with AD and FA (AD+FA+) from those with AD but without
FA (AD+FA-) |
Results require validation in larger, diverse populations
with challenge-proven allergy to a variety of foods, not just peanut |
62 US children classified as AD+FA+, AD+FA- or controls |
Blinded,
prospective mechanistic study |
Level 3 |
Proactive Early AD Treatment and the Prevention of FA |
2019197
|
Prevention
of Allergy via Cutaneous Intervention (PACI) pilot |
Miyaji Y, et al. |
Earlier aggressive treatment of AD shortened its duration in infants,
and resulted in fewer food allergies at 2 years of life |
Smaller,
retrospective pilot study; cohorts had significant differences in
baseline characteristics |
Japan |
Retrospective cohort |
Level
4 |
Preventative Emollient Therapy for AD and FA |
2020198
|
Barrier
Enhancement for Eczema Prevention (BEEP) |
Chalmers JR, et al. |
No
evidence for prevention of AD at 2y with daily emollient use, but
possible slight increase in infection risk, and nonsignificant increase
in FA (largely to egg) in the intervention group |
Choice of emollient;
limited FA assessment; median time to initiation of skin care at 11 days
of life |
UK, high risk |
Pragmatic, parallel group RCT |
Level
2 |
Oral Tolerance Induction |
2020199
|
Preventing
food allergy in infancy and childhood |
de Silva D, et al. |
Early
introduction of cooked egg (not raw or pasteurized egg) likely helps
prevent egg allergy; avoiding supplementation with cow’s milk-based
formula in the first week of life may slightly reduce milk allergy;
nearly every other dietary intervention reviewed has little to no effect |
Many are small studies of lower certainty of evidence, findings need
to be validated in large, heterogeneous populations |
n/a |
Systematic
review with meta-analysis |
Level 2 |
Preventative Emollient Therapy for AD and FA |
2020200
|
Preventing
Atopic Dermatitis and ALLergies in Children (PreventADALL) |
Skjerven
HO, et al. |
Found no decrease in AD or FA at 12m with skin emollient
use, early complementary feeding or both |
Skin intervention started at
2 weeks of life using a bath oil and cream; early food introduction
began with peanut butter at 3m; overall poor adherence in the
intervention groups; low statistical power to assess FA (results for FA
at 3y forthcoming) |
Scandinavian standard risk birth cohort |
Prospective interventional, cluster-randomized controlled trial |
Level
2 |
Link between Emollient use and Food Allergy
|
2021171
|
Association of frequent moisturizer use in early infancy with the
development of food allergy
|
Perkin M, et al.
|
Observed an increased risk of food allergy with the application of
moisturizer more frequent than once daily
|
All but 1 case of FA developed in children with at least 1 atopic
parent; AD assessed at 3m enrolment visit only; the cohort
frequently used oils for baby massage, which may prevent formation of an
intact skin barrier; unable to control for some potential confounding
factors
|
UK, exclusively breastfed standard risk cohort enrolled in the EAT study
and randomized to standard vs early introduction of 6 foods with poor
protocol adherence
|
Retrospective analysis of questionnaire data
|
Level 3/4
|