Association of frequent moisturizer use in early infancy with the development of food allergy

Abstract

Background: Food allergy is thought to develop through transcutaneous sensitization, especially in the presence of skin barrier impairment and inflammation. Regular moisturizer application to infant skin could potentially promote transcutaneous sensitization and the development of food allergy. Objectives: We tested this hypothesis in the Enquiring About Tolerance (EAT) study population. Methods: The EAT study was a population-based randomized clinical trial conducted from January 15, 2008, to August 31, 2015, and recruited 1303 exclusively breastfed 3-month-old infants and their families from England and Wales. At enrollment at 3 months, families completed a questionnaire that included questions about frequency and type of moisturizer applied, use of corticosteroid creams, and parental report of dry skin or eczema. Infants were examined for visible eczema at the enrollment visit. Results: A statistically significant dose-response relationship was observed between parent-reported moisturization frequency at 3 months of age and the subsequent development of food allergy. Each additional moisturization per week was associated with an adjusted odds ratio of 1.20 (95% CI, 1.13-1.27; P < .0005) for developing food allergy. For infants with no visible eczema at the enrollment visit, the corresponding adjusted odds ratio was 1.18 (95% CI, 1.07-1.30; P 5 .001) and for those with eczema at the enrollment visit, 1.20 (95% CI, 1.11-1.31; P < .0005). Moisturizer frequency showed similar dose-response relationships with the development of both food and aeroallergen sensitization at 36 months. Conclusions: These findings support the notion that regular application of moisturizers to the skin of young infants may promote the development of food allergy through transcutaneous sensitization.

Reply

“…We stated the concerns about the use of olive oil and other vegetable oils in our article 4 and their potential to impede the development of the lamellar lipid structures. As Leung et al state, 1 this potentially facilitates allergen penetration.…”

“…In reference to Leung et al, 1 among infants with eczema in the Enquiring about Tolerance (EAT) study at 3 months of age, there was indeed an association between the frequency with which these infants were moisturized and the severity of their eczema, as we reported in our article. 4 However, in our logistic models we adjusted for eczema severity (as well as for filaggrin mutation status and transepidermal water loss), and the association between moisturization frequency and subsequent food allergy development remained robust. Inaccurate recall was not likely in the EAT cohort because of the study's prospective nature and close follow-up of the participating families through monthly questionnaires, in addition to the face-to-face visits.…”

Primary Prevention of Food Allergy—Environmental Protection beyond Diet

“…However, as Perkin et al found, moisturizing infants' skin can also promote food allergy. The authors explained that moisturizers can make it easier for food allergens to break the skin barrier or damage the skin barrier and enable the penetration of the food allergen [50]. Beyond proper skin care, a second important aspect of dual-allergen exposure theory is the importance of introducing foods orally at the right time to stimulate tolerance.…”

Olive oil is for eating and not skin moisturization

“…In the March 2021 issue of the Journal of Allergy and Clinical Immunology, investigators reported an association of frequent moisturizer use in early infancy with the development of FA. 1 We want to highlight several important considerations regarding this study.…”