Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore.
Allergy. 2022 Jun;77(6):1685-1699. doi: 10.1111/all.15116. Epub 2021 Oct 12.
Several studies have evaluated prophylactic emollients as a preventive strategy against atopic dermatitis (AD) and food allergy (FA). We aimed to synthesize the evidence on efficacy and safety of prophylactic emollients started during the first 6 weeks of infancy for prevention of AD and FA.
MEDLINE, Embase, CINAHL, BIOSIS, and the Cochrane Library databases were searched systematically for randomized controlled trials published between January 2000 and July 2020, which assessed the effects of prophylactic emollients initiated within the first 6 weeks of life on the development of AD within 24 months of age, compared to no treatment. Risk of bias and certainty of evidence were assessed using the Cochrane Collaboration's tool and GRADE process, respectively.
Of the 1486 articles identified, 10 studies fulfilled inclusion criteria. In infants given emollients, there was no significant reduction on the development of AD (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.64, 1.10) compared to the control group. However, there was significant benefit of prophylactic emollients (RR 0.75, 95% CI 0.62-1.11) in the high-risk population (n = 8 studies). There was also significant benefit (RR 0.59, 95% CI 0.43, 0.81) in studies (n = 6) where emollients were used continuously to the point of AD assessment; but not when treatment was ceased for an interval before AD assessment. There were no protective effects on FA found.
The prophylactic application of emollients initiated in early infancy may prevent AD, especially in high-risk populations and when used continuously. We hypothesize that emollients may delay rather than prevent AD.
已有多项研究评估了预防性润肤剂作为预防特应性皮炎（AD）和食物过敏（FA）的策略。我们旨在综合评估婴儿期前 6 周开始使用预防性润肤剂预防 AD 和 FA 的疗效和安全性。
系统检索了 MEDLINE、Embase、CINAHL、BIOSIS 和 Cochrane 图书馆数据库，以获取 2000 年 1 月至 2020 年 7 月期间发表的随机对照试验，评估了在生命的前 6 周内开始使用预防性润肤剂与不治疗相比，对 24 个月龄内发生 AD 的影响。使用 Cochrane 协作工具评估偏倚风险，使用 GRADE 过程评估证据确定性。
在纳入的 1486 篇文章中，有 10 项研究符合纳入标准。与对照组相比，使用润肤剂的婴儿 AD 发生率无显著降低（风险比（RR）0.84，95%置信区间（CI）0.64，1.10）。然而，在高危人群（n=8 项研究）中，预防性润肤剂具有显著的益处（RR 0.75，95%CI 0.62-1.11）。在（n=6 项研究）中连续使用润肤剂直至 AD 评估点时，也具有显著的益处（RR 0.59，95%CI 0.43，0.81）；但在 AD 评估前间隔停止治疗时则无保护作用。未发现对 FA 的保护作用。
婴儿期早期开始预防性使用润肤剂可能预防 AD，尤其是在高危人群中，且当连续使用时。我们假设润肤剂可能延迟而不是预防 AD。
