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Enhanced compared to reactive treatment in atopic eczema reduces hen egg allergy

Enhanced and early treatment of infants diagnosed with atopic eczema reduces hen’s egg allergy compared to a conventional treatment approach

A team of UK and Japanese researchers have found that among infants with atopic eczema, an enhanced approach, i.e., applying treatment to both clinically affected and unaffected skin, is more effective at preventing hen’s egg allergy, compared to the usual or conventional strategy of only treating clinically affected areas.

There appears to be an increase in the prevalence of food allergy in some areas of the world, thus highlighting the need for better strategies for prevention, diagnosis and therapy. For example, one study of Japanese children found a caregiver-reported immediate food allergy prevalence of 7.6% in children aged 1, with hen egg allergy being the most common at 5.4%. The presence of atopic eczema is associated with the development of food allergies, with a suggestion that infants with early eczema onset (within the first 1 – 4 months after birth) have an increased risk of developing food allergy at 3 years of age. As there is clearly a relationship between atopic eczema and food allergies, researchers wondered if early treatment of the disease could reduce the subsequent development of allergies. One retrospective analysis showed that early aggressive use of topical corticosteroids to shorten the duration of atopic eczema in infants, was associated with decreased development of food allergy by 24 months of age.

Based on the findings of this retrospective analysis, in the current study, researchers conducted a randomised controlled trial. Infants aged 7-13 weeks with atopic eczema were treated with topical steroids and randomised 1:1 to enhanced early skin treatment or conventional reactive treatment, i.e., applying topical corticosteroids only to areas of clinically affected skin. The team set the primary outcome as the proportion of immediate hen’s egg allergy confirmed by oral food challenge at 28 weeks of age.

Enhanced early treatment and the development of hen’s egg allergy

A total of 640 children were included, 318 of whom were assigned to enhanced early treatment. Two-thirds (66%) of children in the enhanced group were aged 7 to 10 weeks at enrolment.

Enhanced treatment significantly reduced hen’s egg allergy compared with the conventional treatment (31.4% vs. 41.9%, p = 0.0028). However, a higher proportion of infants in the enhanced group experienced serious adverse events (5.3% vs 1.9%). In addition, the intervention reduced mean body weight and height when assessed at week 28.

The authors concluded that while enhanced control of atopic eczema appeared to reduce hen’s egg allergy, the treatment protocol of this trial should be modified in order to avoid the adverse effects of topical corticosteroids.

Yamamoto-Hanada K et al. Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy. J Allergy Clin Immunol 2023

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