What's new in atopic eczema? An analysis of systematic reviews published in 2007 and 2008. Part 2. Disease prevention and treatment.
This review summarizes clinically important findings from systematic reviews indexed in bibliographical databases between August 2007 and August 2008 that dealt with disease prevention (six reviews) and treatment of atopic eczema (seven reviews). Regarding disease prevention, two independent systematic reviews found some clinical trial evidence that ingestion of probiotics by mothers during pregnancy might reduce the incidence of subsequent eczema. Another review failed to find any clear benefit of prebiotics in eczema prevention. Although furry pets are often cited as causing allergic disease, a systematic review of observational studies found no evidence that exposure to cats or dogs at birth increases eczema risk. One very large review of studies of breastfeeding found some evidence of a protective effect on eczema risk, although all the studies were limited by their observational nature. A German group has attempted an overview of eczema prevention studies with a view to informing national guidelines. In terms of eczema treatment, two systematic reviews have confirmed the efficacy of topical tacrolimus ointment. Another review of 31 trials confirms the efficacy of topical pimecrolimus, although many of those trials were vehicle controlled, which limits their clinical utility. A review of 23 studies of desensitization therapy for allergic diseases found some evidence of benefit for eczema, which needs to be explored further. Despite the popularity of antistaphylococcal therapies for eczema, a Cochrane Review of 21 trials failed to show any clear benefit for any of the therapies for infected or clinically noninfected eczema. Another Cochrane Review dealt with dietary exclusions for people with eczema and found little evidence to support any dietary exclusion, apart from avoidance of eggs in infants with suspected egg allergy supported by evidence of sensitization. A review of 13 studies of probiotics for treating established eczema did not show convincing evidence of a clinically worthwhile benefit, an observation that has been substantiated in a subsequent Cochrane Review.
Williams
H C
HC
NHS Evidence-Skin Disorders, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK. hywel.williams@nottingham.ac.uk
Grindlay
D J C
DJ
D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D002415:Cats; D003876:Dermatitis, Atopic / Q000517:prevention & control / Q000628:therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D003888:Desensitization, Immunologic / Q000379:methods*; D004032:Diet; D004285:Dogs; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D057805:Pets; D056692:Prebiotics; D019936:Probiotics; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016559:Tacrolimus / Q000031:analogs & derivatives / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D056692:Prebiotics; C117268:pimecrolimus; D016559:Tacrolimus