Moisturizer therapy in prevention of atopic dermatitis and food allergy: To use or disuse?

Is colloidal oat an effective emollient ingredient for the prevention and treatment of atopic dermatitis in infants?

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by barrier dysfunction and immune dysregulation, often leading to increased allergen penetration, sensitization, and secondary infections. Colloidal oat emollients are widely used in adult AD management, but their role in pediatric AD treatment, prevention, and allergy modulation remains under investigation.

METHODS

A comprehensive literature review evaluated clinical and preclinical studies on colloidal oat-containing emollients in pediatric AD treatment and prevention. Studies assessing skin barrier function, immune modulation, AD prevention, food allergy risk, and healthcare utilization were included.

RESULTS

Colloidal oat emollients improved skin hydration, reduced transepidermal water loss (TEWL), and supported barrier repair, leading to fewer AD flares and reduced reliance on steroid treatments. Studies suggest that early, consistent use of advanced emollient formulations may lower AD incidence in high-risk infants and reduce food sensitization rates. Real-world data indicate that patients using colloidal oat emollients have fewer clinic visits and lower overall healthcare costs. Concerns about oat sensitization remain unsubstantiated in most studies.

CONCLUSION

Colloidal oat emollients are effective, well-tolerated, and cost-efficient for pediatric AD management. Their barrier-restorative and anti-inflammatory properties may reduce AD and allergy risk. Future research should focus on head-to-head emollient comparisons to optimize treatment strategies.

Synthesis and Characterization of Superhigh Moisturizing Carboxymethyl Tamarind Xyloglucan and Its Potential Application in Cosmetics

Carboxymethyl tamarind xyloglucan (CMTXG) was synthesized by xyloglucan with sodium chloroacetate in 50% ethanol. The effects of carboxymethylation on the structure and properties of xyloglucan were studied, and its application potential in cosmetics was evaluated. The results showed that carboxymethylation increased the molecular weight, enhanced water solubility and stability, decreased apparent viscosity, and promoted xyloglucan's application in cosmetics. The CMTXG with moderate substitution (CMT-M) exhibited superior hygroscopic and moisturizing effects, indicating that CMTXG does not need to pursue high degree of substitution. The moisturizing rate of CMT-M was 81.08% after 12 h, surpassing that of sodium hyaluronate (55.79%) and glycerin (59.52%). The CMT-M exhibited enhanced antioxidant and antibacterial activity after modification. Toxicity assessment indicated that CMT-M can improve the long-term tolerance of larvae zebrafish. Furthermore, the CMT-M cream demonstrated a long-term moisturizing effect compared to commercial creams. The research findings are expected to provide an effective bioactive moisturizer candidate for the daily chemical industry.

Carbon-Based Particles Inhibit Antigen Penetration Into the Skin by Adsorbing the Antigen

In most cases, atopic dermatitis (AD) is induced by allergic inflammation, with antigen penetration into the epithelial tissues of the skin being the first step in AD development. Accordingly, inhibiting the skin penetration of antigens is effective in preventing AD. We evaluated the ability of the following four types of particles to adsorb ovalbumin (OVA): titanium dioxide (TiO2), silicon dioxide (SiO2), carbon, and SiO2 coated with one-layer graphene (1LGCS). We found that metal oxide particles (TiO2 and SiO2) could adsorb OVA at pH 5.0, but their abilities decreased at pH 7.0 and 9.0. In contrast, the carbon-based particles (carbon and 1LGCS) adsorbed OVA regardless of pH changes. Epicutaneous treatment with OVA resulted in an increase in the proportion of OVA-positive Langerhans cells and dermal dendritic cells in the lymph nodes, along with elevated interleukin-4 mRNA expression, indicating that OVA penetrated the epidermis and underlying tissues. When OVA was applied together with the particles, these responses were significantly reduced by the carbon-based particles but were only partially or not inhibited by metal oxide particles. These findings indicated that antigen penetration was potently inhibited by the carbon-based particles. Additionally, when mice were epicutaneously sensitised and challenged with OVA in the presence of carbon, the increase in OVA-specific IgG1 and IgE levels was significantly inhibited. The efficiency of carbon-based particles may be attributed to their stable adsorption of proteins despite pH changes on the skin surface. These findings may lead to the development of new treatments for AD with fewer side effects.

The Role of Food Allergy in Atopic Dermatitis

Atopic dermatitis (AD) and food allergies are 2 atopic conditions that tend to develop early in life. Their interrelationship has been a topic of controversy and many studies. The presence of atopic dermatitis in infancy and early childhood, particularly if severe, is a risk factor for the development of immunoglobulin E (IgE) -mediated food allergies. While it is common for children with AD to demonstrate extensive sensitization to foods, serum IgE testing is not always indicative of clinical allergy.

Skin Barrier in Atopic Dermatitis

A compromised permeability barrier is a hallmark of atopic dermatitis (AD). Localized to the outermost skin layer, the stratum corneum (SC) is critically dependent on terminal differentiation of epidermal keratinocytes, which transform into protein-rich corneocytes surrounded by extracellular lamellae of unique epidermal lipids, conferring permeability barrier function. These structures are disrupted in AD. A leaky barrier is prone to environmental insult, which in AD elicits type 2-dominant inflammation, in turn resulting in a vicious cycle further impairing the SC structure. Therapies directed at enforcing SC structure and anti-inflammatory strategies administered by topical and systemic route as well as UV therapy have differential effects on the permeability barrier. The expanding armamentarium of therapeutic modalities for AD treatment warrants optimization of their effects on permeability barrier function.

Risk of atopic dermatitis and the atopic march paradigm in children of mothers with atopic illnesses: A birth cohort study from the United Kingdom

BACKGROUND

Atopic dermatitis (AD) is thought to precede the onset of other allergic illness (OAI) in a temporal progression (ie, atopic march), yet the timing and progression has been questioned. It is also unclear how parental allergic illness impacts the development of these illnesses in offspring.

OBJECTIVE

(1) Explore risk of incident AD and (2) timing of allergic disease onset in children of mothers with AD compared with mothers without AD from the United Kingdom.

METHODS

We created a birth cohort of mother-child pairs using IQVIA Medical Research Data database and developed Cox proportional models to examine the above associations (hazard ratio, HR [95% confidence interval, CI]).

RESULTS

Among 1,224,243 child-mother pairs, mean child (standard deviation) follow-up time was 10.8 (8.3) years and 50.1% were males (N = 600,905). Children were 59% (HR = 1.59 [1.57, 1.60]) more likely to have AD if their mothers had AD compared with no AD with mean age of first AD diagnosis at 3.3 (4.8) years. Most children with any diagnosis of AD present with AD first (91.0%); however, in those with asthma, only 67.8% developed AD first.

CONCLUSION

Children born to mothers with AD are more prone to develop AD and some develop OAI first, suggesting that not all follow the same sequential pathway.

Transepidermal water loss in allergic diseases

Background: In recent years, the epithelial barrier hypothesis has been emphasized in the formation of allergic diseases. Transepidermal water loss (TEWL) occurs through diffusion and evaporation from the skin to the external environment. There are few studies on TEWL in allergic diseases. Objective: This study evaluated the relationship between patients with atopic diseases and healthy controls and hygiene habits in TEWL. Methods: The study was conducted on patients who were followed up for atopic disease (asthma, allergic rhinitis, immunoglobulin E mediated food allergy, and atopic dermatitis) and healthy children. TEWL measurement was in a room that was stable in terms of humidity and temperature by using a widely validated open room system. During the measurement, the participants reported their frequency of taking a shower and cleaning product use. Results: In the study group, TEWL was measured in 182 patients, and the median (min-max) TEWL was 21.3 g/hm² (7.8-101.3 g/hm²) in the disease group and 9.6 g/hm2 (3.9-30.3 g/hm²) in the control group (p < 0.001). The number of weekly baths was higher in the disease group (p < 0.001). The cutoff for atopic diseases was 13.2 g/hm² (sensitivity, 83.2%; specificity, 84.3%; p < 0.001). Conclusion: High TEWL in atopic diseases supports the epithelial barrier hypothesis associated with disease development. Further studies are necessary to determine the threshold between healthy controls and the patients in the disease group. The TEWL measurement can be an effective method to determine the risk groups. Moreover, further studies related to factors on TEWL and treatment methods to reduce this loss are necessary, too.

Targeting Skin Barrier Function in Atopic Dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the general population. Skin barrier dysfunction is the central abnormality leading to AD. The cause of skin barrier dysfunction is complex and rooted in genetic mutations, interactions between the immune pathway activation and epithelial cells, altered host defense mechanisms, as well as environmental influences that cause epithelial cell activation and release of alarmins (such as thymic stromal lymphopoietin) that can activate the type 2 immune pathway, including generation of interleukins 4 and 13, which induces defects in the skin barrier and increased allergic inflammation. These inflammatory pathways are further influenced by environmental factors including the microbiome (especially Staphylococcus aureus), air pollution, stress, and other factors. As such, AD is a syndrome involving multiple phenotypes, all of which have in common skin barrier dysfunction as a key contributing factor. Understanding mechanisms leading to skin barrier dysfunction in AD is pointing to the development of new topical and systemic treatments in AD that helps keep skin borders secure and effectively treat the disease.

Epicutaneous Sensitization and Food Allergy: Preventive Strategies Targeting Skin Barrier Repair-Facts and Challenges

Food allergy represents a growing public health and socio-economic problem with an increasing prevalence over the last two decades. Despite its substantial impact on the quality of life, current treatment options for food allergy are limited to strict allergen avoidance and emergency management, creating an urgent need for effective preventive strategies. Advances in the understanding of the food allergy pathogenesis allow to develop more precise approaches targeting specific pathophysiological pathways. Recently, the skin has become an important target for food allergy prevention strategies, as it has been hypothesized that allergen exposure through the impaired skin barrier might induce an immune response resulting in subsequent development of food allergy. This review aims to discuss current evidence supporting this complex interplay between the skin barrier dysfunction and food allergy by highlighting the crucial role of epicutaneous sensitization in the causality pathway leading to food allergen sensitization and progression to clinical food allergy. We also summarize recently studied prophylactic and therapeutic interventions targeting the skin barrier repair as an emerging food allergy prevention strategy and discuss current evidence controversies and future challenges. Further studies are needed before these promising strategies can be routinely implemented as prevention advice for the general population.

Relationship Between Atopic Dermatitis and Food Allergy in Children

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by a compromised skin barrier due to a variety of reasons, such as hereditary predisposition, immunological overactivity, and skin microbiome disruption. There is strong evidence linking food allergies (FA) with AD in some children, and many children with AD develop asymptomatic food sensitivity. FA and AD are two frequent childhood illnesses that are closely related. Food allergies affect 30% of kids suffering from moderate and severe eczema and can cause a variety of symptoms, including dry, cracked skin, rash, itchiness, oozing, and crusted skin. While preteens and teens with AD are commonly sensitive to environmental allergens including house dust mites, mold, pollen, or dander of animals, younger kids with AD typically exhibit sensitivity to food items like peanuts, milk, or eggs. A food challenge test (FC) should be used to confirm allergies before recommending a stringent diet that could be hazardous to the patient. While elimination diets continue to be the cornerstone of the management of FA, they should only be carried out under the guidance of a specialist. Topical treatments are crucial for all individuals with AD. Early skin care with emollients, topical steroid treatment, and early introduction of highly allergenic foods are promising methods of alleviating symptoms of AD.