Emollients for the Prevention of Atopic Dermatitis: 5-year Findings From the BEEP Randomized Trial

To evaluate the association between daily use of emollients in the first year of life on the development of atopic dermatitis and allergic disease.

Study population included 1394 term-newborns with family history of atopy that were enrolled in the Barrier Enhancement for Eczema Prevention trial.

The Barrier Enhancement for Eczema Prevention trial was a randomized controlled trial, multicenter study where term-newborns between November 2014 through November 2016 were randomized 1:1 to either control or treatment groups. The treatment group involved daily emollient plus standard skin-care advice and the control group involved providing standard skin care advice without daily emollients. Emollient use in the treatment group was continued until the infants were 1 year old and adherence was measured by following up with parents about emollient use at 3, 6 and 12 months of age. The primary outcome included the development of atopic dermatitis in the prior year, which was measured at the 2-year mark and overtime at 3, 4 and 5 years from the study onset via questionnaires. Additional outcomes measured included the presence of wheezing and/or asthma, allergic rhinitis, or food allergy.

Overall, at 3 years, emollient use at least 3 times weekly was greater in the treatment group (31%) versus the control group (20%). The frequency of atopic dermatitis was higher in the treatment group versus the control group, however the differences between both groups were not clinically or statistically significant. Food reactions and food allergy diagnoses were reported to be more frequent in the emollient group when compared with the control group at 3 and 4 years; this difference resolved by 5 years, where outcomes of food allergies were similar in both groups. Wheezing was noted to be higher in the control group (28%) when compared with the emollient group (21%) at 3 years. This difference resolved by 5 years, where no difference between both groups was noted. Allergic rhinitis symptoms were similar in both groups at each year measured.

Authors found no difference between emollient use versus control on long-term risk for developing atopic dermatitis in the first 5 years of life. Food allergy was greater in the treatment group; however, no effect was seen in the cumulative frequency of diagnoses of food allergy at 5 years, thus, emollient use did not decrease the frequency of food allergies. Authors did not find a protective effect of emollients on developing wheezing, asthma, or allergic rhinitis.

There has been controversy regarding regular early emollient use on the development of atopic dermatitis and atopy. This is the first study to provide long-term follow up of patients with emollient therapy to assess for the development of atopic dermatitis and other atopic conditions. This particular study places emphasis on at-risk infants through a history of atopy in the family, thus, more studies looking at infants without preexisting risk factors are needed to further apply these findings to the general population. Additional research is needed to evaluate other preventive strategies to minimize risk for atopic dermatitis and atopy.