Observational study of pimecrolimus 1% cream for prevention of transcutaneous sensitization in children with atopic dermatitis during their first year of life

Abstract

IntroductionEpidermal barrier dysfunction in children with atopic dermatitis can cause transcutaneous sensitization to allergens and allergic diseases. We evaluated the effectiveness of an early-intervention algorithm for atopic dermatitis treatment, utilizing pimecrolimus for long-term maintenance therapy, in reducing transcutaneous sensitization in infants.MethodThis was a single-center cohort observational study that enrolled children aged 1-4 months with family history of allergic diseases, moderate-to-severe atopic dermatitis, and sensitization to ≥ 1 of the investigated allergens. Patients who sought medical attention at atopic dermatitis onset (within 10 days) were group 1 “baseline therapy with topical glucocorticoids with subsequent transition to pimecrolimus as maintenance therapy”; patients who sought medical attention later were group 2 “baseline and maintenance therapy with topical glucocorticoids, without subsequent use of pimecrolimus”. Sensitization class and level of allergen-specific immunoglobulin E were determined at baseline, and 6 and 12 months of age. Atopic dermatitis severity was evaluated using the Eczema Area and Severity Index score at baseline and 6, 9 and 12 months of age.ResultsFifty-six and 52 patients were enrolled in groups 1 and 2, respectively. Compared with group 2, group 1 demonstrated a lower level of sensitization to cow's milk protein, egg white and house dust mite allergen at 6 and 12 months of age, and a more pronounced decrease in atopic dermatitis severity at 6, 9 and 12 months of age. No adverse events occurred.DiscussionThe pimecrolimus-containing algorithm was effective in treating atopic dermatitis and prophylaxis of early forms of allergic diseases in infants.Trial registrationhttps://clinicaltrials.gov/NCT04900948, retrospectively registered, 25 May 2021.

Role of atopic dermatitis management in the prevention of food allergy

“…Another observational study found that infants aged 1-4 months who received active eczema treatment with topical glucocorticoids for 10 days followed first by maintenance therapy with pimecrolimus 1% cream twice daily for 3 months, and continued on pimecrolimus twice daily three times a week until age 1 year had a lower risk of food allergen sensitization compared with infants who received only reactive treatment with topical steroids during eczema flares. 54 A retrospective study by Miyaji at al. 6 also suggested that early enhanced proactive topical steroid therapy on both clinical and subclinical skin lesions of infants with atopic dermatitis might prevent the onset of food allergy.…”

Role of skin management in the prevention of atopic dermatitis and food allergy

“…The proactive group experienced significant reductions in AD severity, quality of life scores, and serum TARC levels compared with the reactive group. Another observational study found that infants aged 1–4 months who received active eczema treatment with topical glucocorticoids for 10 days followed first by maintenance therapy with pimecrolimus 1% cream twice daily for 3 months, and continued on pimecrolimus twice daily three times a week until age 1 year had a lower risk of food allergen sensitization compared with infants who received only reactive treatment with topical steroids during eczema flares 58 . A retrospective study by Miyaji et al 7 .…”