Application of moisturizer to neonates prevents development of atopic dermatitis - 02/10/14
Doi : 10.1016/j.jaci.2014.07.060
Kenta Horimukai, MD a, ∗, Kumiko Morita, MD a, ∗, Masami Narita, MD, PhD a, Mai Kondo, MD a, Hiroshi Kitazawa, MD, PhD a, Makoto Nozaki, MD b, Yukiko Shigematsu, MD b, Kazue Yoshida, MD, PhD b, Hironori Niizeki, MD, PhD b, Ken-ichiro Motomura, MD c, Haruhiko Sago, MD, PhD c, Tetsuya Takimoto, MD, PhD d, Eisuke Inoue, PhD d, Norio Kamemura, PhD e, Hiroshi Kido, MD, PhD e, Junzo Hisatsune, PhD f, Motoyuki Sugai, DDS, PhD f, Hiroyuki Murota, MD, PhD g, Ichiro Katayama, MD, PhD g, Takashi Sasaki, PhD h, Masayuki Amagai, MD, PhD h, Hideaki Morita, MD, PhD i, Akio Matsuda, PhD i, Kenji Matsumoto, MD, PhD i, Hirohisa Saito, MD, PhD i, ⁎ 
, Yukihiro Ohya, MD, PhD a, ⁎
, Yukihiro Ohya, MD, PhD a, ⁎ a Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
b Division of Dermatology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
c Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
d Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
e Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
f Department of Bacteriology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
g Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
h Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
i Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
∗Corresponding authors: Yukihiro Ohya, MD, PhD, Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.∗Hirohisa Saito, MD, PhD, Department of Allergy & Immunology, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.
Abstract |
Background |
Recent studies have suggested that epidermal barrier dysfunction contributes to the development of atopic dermatitis (AD) and other allergic diseases.
Objective |
We performed a prospective, randomized controlled trial to investigate whether protecting the skin barrier with a moisturizer during the neonatal period prevents development of AD and allergic sensitization.
Methods |
An emulsion-type moisturizer was applied daily during the first 32 weeks of life to 59 of 118 neonates at high risk for AD (based on having a parent or sibling with AD) who were enrolled in this study. The onset of AD (eczematous symptoms lasting >4 weeks) and eczema (lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. The primary outcome was the cumulative incidence of AD plus eczema (AD/eczema) at week 32 of life. A secondary outcome, allergic sensitization, was evaluated based on serum levels of allergen-specific IgE determined by using a high-sensitivity allergen microarray of diamond-like carbon–coated chips.
Results |
Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (P = .012, log-rank test). We did not show a statistically significant effect of emollient on allergic sensitization based on the level of IgE antibody against egg white at 0.34 kUA/L CAP-FEIA equivalents. However, the sensitization rate was significantly higher in infants who had AD/eczema than in those who did not (odds ratio, 2.86; 95% CI, 1.22-6.73).
Conclusion |
Daily application of moisturizer during the first 32 weeks of life reduces the risk of AD/eczema in infants. Allergic sensitization during this time period is associated with the presence of eczematous skin but not with moisturizer use.
Le texte complet de cet article est disponible en PDF.Key words : Atopic dermatitis, atopy, allergic sensitization, food allergy, IgE, randomized controlled trial
Abbreviations used : AD, DLC, FLG, IRB, NCCHD, OR, RCT, UMIN-CTR
Plan
| Supported in part by Health and Labour Sciences Research Grants for Research on Allergic Diseases and Immunology from the Ministry of Health, Labour and Welfare of Japan (H22-Men'eki-Ippan-002 to H.S. and H25-Nanchito-Ippan-001 to M.A. and H.S. as principal investigators), funding from the Japan Environment and Children's Study (JECS; to Y.O. and H.S.), and grants from the National Center for Child Health and Development (20S-1 to Y.O. and 23S-3 to H.S.). |
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| Disclosure of potential conflict of interest: K. Horimukai has received research support from the Ministry of Health, Labour and Welfare (the grant no. of MHLW is henceforth H22-Men'eki-Ippan-002 and H25-Nanchito-Ippan-001, unless otherwise specified); is employed by the National Center for Child Health and Development and the Jikei University Katsushika Medical Center; and has received payment for lectures from Maruho and GlaxoSmithKline K.K. K. Morita has received research support from the Ministry of Health, Labour and Welfare and Shiseido and is employed by the National Center for Child Health and Development. M. Narita is employed by the National Center for Child Health and Development and has received payment for lectures from GlaxoSmithKline K.K. M. Kondo, Y. Shigematsu, K. Motomura, and T. Takimoto have received research support from the Ministry of Health, Labour and Welfare and is employed by the National Center for Child Health and Development. H. Kitazawa is employed by the National Center for Child Health and Development and Miyagi Children's Hospital. M. Nozaki, K. Yoshida, and H. Morita have received research support from the Ministry of Health, Labour and Welfare. H. Niizeki has received research support from the Ministry of Health, Labour and Welfare; is employed by the National Center for Child Health and Development; has received payment for lectures from GlaxoSmithKline; and has received travel support from Kyowa Kirin. H. Sago has received research support from the Ministry of Health, Labour and Welfare and the Japan Society for Promotion of Science; is employed by the National Center for Child Health and Development; and has received payment for lectures from GE Healthcare, Gene Tech, Johnson & Johnson, Kissei Pharmaceutical, Eisai, Bayer Health Care, and ASKA Pharmaceutical. E. Inoue has received research support from the Ministry of Health, Labour and Welfare; has consultant arrangements with Tokyo Women's Medical University and Stagen; is employed by the National Center for Child Health and Development; and has received payment for lectures from Takeda Pharmaceutical, Chugai Pharmaceutical, and the Japan Clinical Cancer Research Organization. N. Kamemura has received research support from the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology and is employed by the University of Tokushima. H. Kido has received research support from the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology; is employed by the University of Tokushima; and has received payment for lectures from Taisho Toyama Pharmaceutical and Teijin. J. Hisatsune has received research support from the Ministry of Health, Labour and Welfare and is employed by Hiroshima University. M. Sugai has received research support from the Ministry of Health, Labour and Welfare; is employed by Hiroshima University; has received payment for lectures from Saiseikai Kure Hospital and Hiroshima CDC; and has received payment for education presentations and travel support from Kochi University, Tokushima University, Nagasaki University, and Ehime University. H. Murota has received research support from the Ministry of Education, Culture, Sports, Science and Technology. T. Sasaki has received research support from the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology and is employed by KOSE Endowed Program for Skincare and Allergy Preventive Medicine. M. Amagai has received research support from the Ministry of Health, Labour and Welfare, MSD K.K., and Maruho and has consultant arrangements with Daiichi Sankyo, Novartis Pharma K.K., and GlaxoSmithKline K.K.. A. Matsuda has received research support from the Ministry of Health, Labour and Welfare, is employed by the National Center for Child Health and Development; has received payment for lectures from Japan Muliplex bio-Analysis Consortium, Benesis, Japan Blood Products Organization, and Affymetrix Japan; and has received payment for education presentations from Tokyo University of Science. K. Matsumoto has received research support from the Ministry of Health, Labour and Welfare and the National Institute for Biomedical Innovation (NiBio ID10-43); is employed by National Research Institute for Child Health and Development; has received payment for lectures from Merck Sharp and Dohme K.K., Ono Pharmaceutical, GlaxoSmithKline K.K., Kyorin Pharmaceutical, Ohtsuka Pharmaceutical K.K., Mitsubishi Tanabe Pharma, AstraZeneca K.K., Siemens Healthcare, Abbott Japan, and Sumitomo Dainippon Pharma; has received payment for manuscript preparation from Maruho; and has received payment for educational presentations from Gifu Pharmaceutical University. H. Saito has received research support and travel support from the Ministry of Health, Labour and Welfare; is employed by the National Center for Child Health and Development; has received research support from the Japan Society for the Promotion of Science (21390303 & 23390262); has received payment for lectures from Teijin Pharma, Shiseido, Merck Sharp and Dohme K.K., Taiho Pharmaceutical, Nippon Boehringer-Ingelheim, Ono Pharmaceutical, GlaxoSmithKline K.K., Pfizer Japan, Novartis Pharma K.K., Kyowa Hakko Kirin, Kyorin Pharmaceutical, and Daiichi Sankyo; has received payment for manuscript preparation from Taiho Pharmaceutical; has received payment for educational presentations from Shimane University and Toho University; and has received travel support from the Shimane University Japanese Society of Allergology and the Japanese Society of Pediatric Allergy & Clinical Immunology; and Pfizer Japan. Y. Ohya has received research support and travel support from the Ministry of Health, Labor, and Welfare; is employed by the National Center for Child Health and Development; has received research support from the Ministry of Health, Labour and Welfare, the National Center for Child Health & Development (23S-3), the Environmental Restoration & Conservation Agency, Shiseido, Maruho, and the National Institute for Environmental Studies; has received payment for lectures from Merck Sharp and Dohme K.K., GlaxoSmithKline K.K., Malho, Teijin Pharma, Shiseido, Abbott Japan, Sanofi K.K., Siemens AG, Kyowa Hakko Kirin, Ltd., and Nikkei Radio broadcasting; has received payment for manuscript preparation from the University of Tokyo Press, Tokyo Igakusha, and the Asahi Shinbun; has received payment for educational presentations from Japan Allergy Foundation, Japan Pharmacists Education Center, NHK Educational, and the Korean Pediatric Society; and has received travel support from the Japanese Society of Child Health, Japanese Society of Pediatric Dermatology, Tokyo Metropolitan Government, National Institute for Environmental Studies, Ministry of the Environment, and the Cabinet Office. I. Katayama declares no relevant conflicts of interest. |
© 2014
The Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 134 - N° 4
P. 824 - octobre 2014 Retour au numéro
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