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A review of preventive measures for atopic dermatitis (AD) offers a tool to help clinicians understand this disorder and properly employ interventions.

Reviewers grouped AD preventive measures into several broad categories, including early skin interventions, probiotics and prebiotics, maternal and infant dietary changes, and dust mite avoidance among infants.

The review is part of a theme issue of the that focuses on preventive strategies for allergic diseases including food allergies and asthma as well as AD. It was undertaken by a team of Canadian and Australian investigators. The following study excerpts have been edited for length and clarity.

What prompted this review?

The pathogenesis of allergies may not always conform to a traditional sequential progression model. Whether preventing AD definitively prevents other allergic diseases remains a hypothesis with strong biologic plausibility. However, there have been insufficient supporting clinical outcome data.

This review therefore focused on preventing AD, rather than on preventing progression to other allergic diseases. It examined whether intervention is more likely to prevent mild AD or moderate to severe AD. The goal was to provide a framework for considering presented summaries of the evidence for various prevention strategies.

What were the key findings?

Of the numerous interventions covered in the review, probiotic and vitamin D supplementation among pregnant mothers and/or infants, and avoiding unnecessary antibiotic exposure, may modestly reduce the risk of childhood AD. However, uncertain effects combined and concerns about feasibility and burdens (practical and financial) might leave the decision to use supplements sensitive to preference.

The potential for optimizing the skin barrier to prevent AD using emollients and moisturizers requires further investigation, researchers concluded.

Two randomized controlled studies included in the review indicated that early life bacillus Calmette-Guerin (BCG) vaccination could have a small preventative effect for AD. Nevertheless, there are numerous uncertainties -- including accessibility and acceptability in non-tuberculosis endemic areas -- about BCG vaccination.

The authors highlight the complexity of factors that influence AD development, including skin barrier dysfunction, immune dysregulation, and the microbiome. They add, however, that those concerned about developing AD should be reassured that multiple safe and effective therapies are available that align with patient values and preferences.