Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy

Yamamoto-Hanada, Kiwako; Kobayashi, Toshio; Mikami, Masashi; Williams, Hywel C; Saito, Hirohisa; Saito‐Abe, Mayako; Sato, Miori; Irahara, Makoto; Miyaji, Yoshiyuki; Ishikawa, Fumi; Tsuchiya, Kazuyoshi; Tamagawa‐Mineoka, Risa; Takaoka, Yuri; Takemura, Yutaka; Sato, Sakura; Wakiguchi, Hiroyuki; Hoshi, Miyuki; Natsume, Osamu; Yamaide, Fumiya; Seike, Miwako; Ohya, Yukihiro; Morita, Kumiko; Inoue, Eisuke; Fukuie, Tatsuki; Kabashima, Shigenori; Inuzuka, Yusuke; Nishimura, Koji; Toyokuni, Kenji; Ogita, Hiroya; Kiguchi, Tomoyuki; Yoshida, Kazue; Saito, Jumpei; Hosoi, Hajime; Katoh, Norito; Morimoto, Mariko; Masuda, Koji; Kameda, Makoto; Shigekawa, Amane; Yamaguchi, Koji; Nagai, Megumi; Ebisawa, Motohiro; Asaumi, Tomoyuki; Itonaga, Takaaki; Hasegawa, Shunji; Yasudo, Hiroki; Nagao, Mizuho; Fujisawa, Takao; Yasuoka, Ryuhei; Fujiyama, Toshiharu; Shimojo, Naoki; Nakano, Taiji; Kondo, Yasuto; Mori, Yoshihide; Kawaguchi, Takahiro; Futamura, Masaki; Sugiura, Katsuaki; Nagai, Akiko; Kaburagi, Sachiko; Kitazawa, Hiroshi; Kido, Hiroshi; Nakayama, Shoji F.

doi:10.1016/j.jaci.2023.03.008

Cited by 41 publications

(15 citation statements)

References 36 publications

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“…All patients showed good AD control (Investigator's Global Assessment of 0 or 1). These results highlighted the value of early AD intervention, and a randomized controlled clinical trial was recently completed to follow‐up on these findings 46–48 …”

Section: Studies In Atopic Dermatitis—early Interventionmentioning

confidence: 91%

“…It enrolled 650 infants aged 7–13 weeks with AD that developed an itchy rash meeting UK Working Party Criteria for AD within the previous 28 days and randomized them 1:1 to a modified proactive steroid maintenance utilizing twice weekly full‐body TCS use or conventional reactive topical steroid, without a proactive approach, treatment for 28 weeks 47,48 . The primary outcome was a diagnosis of hen's egg allergy by oral food challenge at 28 weeks, which was achieved; infants treated with proactive therapy had significantly lower hen's egg allergy at 28 weeks 47,48 . The proactive treatment group also had superior Eczema Area and Severity Index and Patient‐Oriented Eczema Measure Scores 48 .…”

Section: Studies In Atopic Dermatitis—early Interventionmentioning

confidence: 99%

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Early intervention and disease modification in atopic dermatitis—the current state of the field and barriers to progress

Jacobson,

Seshadri,

Morimoto

et al. 2023

Acad Dermatol Venereol

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Atopic dermatitis (AD) is a highly prevalent chronic inflammatory skin disease representing a major source of global disability burden. Disease‐modifying therapies are showing promise in chronic inflammatory disorders such as rheumatoid arthritis and Crohn's disease with method and timing of initial treatment impacting long‐term disease outcomes. Whether disease‐modifying therapies, specifically those used as an early interventional approach, impacts disease course and comorbidity development in AD is not well‐understood. We reviewed the progress in disease modification strategies, emphasizing early intervention approaches in common (or proto‐typical) inflammatory diseases. Although more common in other fields, disease modification approaches are becoming increasingly investigated in dermatology, though studies in AD are lacking. Despite significant limitations in ongoing and completed studies, early data are promising and suggest that both the choice and timing of early intervention approach can affect long‐term disease course and comorbidity development. To best improve AD patient outcomes, more research is needed to further explore the impact of early disease‐modifying therapies. Future studies should focus on identifying the most effective approaches and extend the early results to a more inclusive set of comorbidities and longer‐term outcomes.

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Section: Studies In Atopic Dermatitis—early Interventionmentioning

confidence: 91%

Section: Studies In Atopic Dermatitis—early Interventionmentioning

confidence: 99%

Early intervention and disease modification in atopic dermatitis—the current state of the field and barriers to progress

Jacobson,

Seshadri,

Morimoto

et al. 2023

Acad Dermatol Venereol

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show abstract

“…mixed results and requires further investigation. [74][75][76] Early proactive treatment of moderate to severe eczema has been shown to prevent hen's egg allergy at 6 months of age by 10% in the PACI (Prevention of Allergy via Cutaneous Intervention) study 77 ; however, this also led to significant growth retardation. The PACI study included 14 days of twice daily whole body and face topical steroid application followed by 15-21 weeks of twice weekly, twice daily whole body and face topical steroid application (including non-affected areas).…”

Section: An Oun Ce Of Pre Venti On Is Worth a P Ound Of Curementioning

confidence: 99%

The future of food allergy: Challenging existing paradigms of clinical practice

Anagnostou

Lieberman

Greenhawt

et al. 2023

Allergy

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The field of food allergy has seen tremendous change over the past 5–10 years with seminal studies redefining our approach to prevention and management and novel testing modalities in the horizon. Early introduction of allergenic foods is now recommended, challenging the previous paradigm of restrictive avoidance. The management of food allergy has shifted from a passive avoidance approach to active interventions that aim to provide protection from accidental exposures, decrease allergic reaction severity and improve the quality of life of food‐allergic patients and their families. Additionally, novel diagnostic tools are making their way into clinical practice with the goal to reduce the need for food challenges and assist physicians in the—often complex—diagnostic process. With all the new developments and available choices for diagnosis, prevention and therapy, shared decision‐making has become a key part of medical consultation, enabling patients to make the right choice for them, based on their values and preferences. Communication with patients has also become more complex over time, as patients are seeking advice online and through social media, but the information found online may be outdated, incorrect, or lacking in context. The role of the allergist has evolved to embrace all the above exciting developments and provide patients with the optimal care that fits their needs. In this review, we discuss recent developments as well as the evolution of the field of food allergy in the next decade.

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“…Observational evidence assessing the environmental burden of peanut protein, the integrity of the skin barrier, 4,5,19,20 eczema severity 12,21 and cutaneous staphylococcal burden 22 supports the hypothesis that transcutaneous peanut allergen exposure drives the development of peanut allergy (PA) and offers potential intervention targets. A single randomised trial has demonstrated proof of principle that reducing eczematous inflammation by applying topical steroids regularly over both eczematous and non‐eczematous skin of infants with a history of eczema may reduce the prevalence of egg allergy 23 . Alternatively, regular consumption of peanut (via the ‘oral exposure route’) may induce tolerance either thereby preventing PA or increasing the threshold at which patients show signs of reacting.…”

Section: Introductionmentioning

confidence: 99%

Optimising the management of peanut allergy by targeting immune plasticity

Nguyen,

du Toit,

Lack

et al. 2024

Clin Experimental Allergy

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Randomised controlled trials investigating the efficacy of oral tolerance induction to peanut have enabled detailed comparison of their clinical and immunological success. They have demonstrated that the regular consumption of peanut for at least 2 years by babies who are not allergic enables protection from developing peanut allergy. The LEAP study intervention tested the impact of regular peanut consumption for 4 years and demonstrated a sustained protection against the development of peanut allergy even after 12 months of peanut avoidance from 5 to 6 years of age. The PreventADALL trial introduced multiple allergens into babies' diets from early infancy and reduced the prevalence of food allergy at 3 years, especially by protecting against peanut allergy. Immunological studies from the LEAP cohort demonstrated that regular peanut consumption was associated with a prompt induction of peanut‐specific IgG4 and reduced manufacture of peanut and Ara h 2‐specific IgE. Even after stopping peanut consumption for 5 years, there continued to be a significant fall in peanut‐specific Ara h 2 IgE in the consumption group from 5 to 6 years of age (p < .01). Children who developed peanut allergy by 5 years started to develop increasing sensitisation to linear sequential peanut epitopes from 2.5 years of age, suggesting that putative disease‐modifying interventions should commence before 3 years. Data comparing clinical outcomes between children undergoing peanut immunotherapy from infancy suggest that younger children can consume higher portions of peanut without reaction on challenge whilst taking immunotherapy, have fewer side effects and are more likely to enjoy remission of PA. Peanut oral immunotherapy modulates T‐cell populations in order to bring about hypo‐responsiveness of allergy effector cells. Studies are now needed to characterise and compare different states of immunological tolerance. This will accelerate the design of interventions which can promote primary, secondary and tertiary levels of PA prevention across a range of age groups.

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Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy

Cited by 41 publications

References 36 publications

Early intervention and disease modification in atopic dermatitis—the current state of the field and barriers to progress

Early intervention and disease modification in atopic dermatitis—the current state of the field and barriers to progress

The future of food allergy: Challenging existing paradigms of clinical practice

Optimising the management of peanut allergy by targeting immune plasticity

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