Is it possible to prevent the development of allergic march by application of moisturizer to neonates or early intervention to infantile atopic dermatitis?

Recent studies have suggested that atopic dermatitis (AD) and/or epidermal barrier dysfunction in infancy contribute to the development of allergic sensitization and other allergic diseases, so called “allergic march”. Is it possible to prevent the development of allergic march by application of moisturizer to neonates or early intervention to infantile atopic dermatitis?<BR>Retrospective chart survey was applied for all 26 infants under a year old admitted for treatment of severe atopic dermatitis to our hospital. Incidence of food allergy at 18 months of age in the early intervention group who was admitted before 5 months old was significantly lower than that of the late intervention group who was admitted at 5 months old or later (50% vs 100%, p<0.01). Another retrospective study of child patients with moderate to severe AD revealed that the serum total IgE level, egg white- and milk-specific total IgE level were significantly decreased in the patients with proactive therapy during the maintenance phase compared with the reactive treatment group. The short duration of skin barrier dysfunction in the early intervention group or the complete suppression of skin inflammation in the proactive treatment group might have preventive effect on the trans epidermal sensitization.<BR>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. 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/eczema (eczematous symptoms lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (p=0.012, log-rank test).<BR>Daily application of moisturizer to neonates and in early infancy reduces the risk of AD/eczema in infants and may prevent the development of allergic march.Skin Research, Suppl. 23: 19-22, 2015