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. KelleherEric l. Simpson, Stella T. Lartey, Susan Davies-Jones, Robert J. Boyle, Hywel C. Williams

Norwich Medical School

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

12 Citations (Scopus)

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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

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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, KS., 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{d379f88c011b4068a558e6eae9bbb6b6,

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.",

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 Kim S. Thomas and Hilary Allen and Cork, {Michael J.} and Kelleher, {Maeve M.} and Eric l. Simpson and Lartey, {Stella T.} and Susan Davies-Jones and Boyle, {Robert J.} and Williams, {Hywel C.}",

note = "Funding Information: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 12/67/12). Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Access to the data will be subject to review of a data sharing and use request (available from [email protected]) by a committee including the CI and sponsor, and will only be granted upon receipt of a data sharing and use agreement. Any data shared will be pseudoanonymised which may impact on the reproducibility of published analyses. The study protocol, statistical analysis plan and health economics analysis plan are available on the trial website: https://www.nottingham.ac.uk/research/groups/cebd/projects/1eczema/beep-maintrial.aspx.",

year = "2023",

month = apr,

doi = "10.1111/all.15555",

language = "English",

volume = "78",

pages = "995--1006",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley",

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, E, 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: 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: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 12/67/12). Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Access to the data will be subject to review of a data sharing and use request (available from [email protected]) by a committee including the CI and sponsor, and will only be granted upon receipt of a data sharing and use agreement. Any data shared will be pseudoanonymised which may impact on the reproducibility of published analyses. The study protocol, statistical analysis plan and health economics analysis plan are available on the trial website: https://www.nottingham.ac.uk/research/groups/cebd/projects/1eczema/beep-maintrial.aspx.

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.

U2 - 10.1111/all.15555

DO - 10.1111/all.15555

M3 - Article

VL - 78

SP - 995

EP - 1006

JO - Allergy

JF - Allergy

SN - 0105-4538

IS - 4

ER -