Skin care interventions in infants for preventing eczema and food allergy

BackgroundEczema and food allergy are common health conditions that usually begin in early childhood and often occur together in the same people. They can be associated with an impaired skin barrier in early infancy. It is unclear whether trying to prevent or reverse an impaired skin barrier soon after birth is effective in preventing eczema or food allergy.ObjectivesPrimary objectiveTo assess effects of skin care interventions, such as emollients, for primary prevention of eczema and food allergy in infantsSecondary objectiveTo identify features of study populations such as age, hereditary risk, and adherence to interventions that are associated withthe greatest treatment benefit or harm for both eczema and food allergy.Search methodsWe searched the following databases up to July 2020: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two trials registers and checked reference lists of included studies and relevant systematic reviews for further references to relevant randomised controlled trials (RCTs). We contacted field experts to identify planned trials and to seek information about unpublished or incomplete trials.Selection criteriaRCTs of skin care interventions that could potentially enhance skin barrier function, reduce dryness, or reduce subclinical inflammation in healthy term (> 37 weeks) infants (0 to 12 months) without pre‐existing diagnosis of eczema, food allergy, or other skin condition were included. Comparison was standard care in the locality or no treatment. Types of skin care interventions included moisturisers/emollients; bathing products; advice regarding reducing soap exposure and bathing frequency; and use of water softeners. No minimum follow‐up was required.Data collection and analysisThis is a prospective individual participant data (IPD) meta‐analysis. We used standard Cochrane methodological procedures, and primary analyses used the IPD dataset. Primary outcomes were cumulative incidence of eczema and cumulative incidence of immunoglobulin (Ig)E‐mediated food allergy by one to three years, both measured by the closest available time point to two years. Secondary outcomes included adverse events during the intervention period; eczema severity (clinician‐assessed); parent report of eczema severity; time to onset of eczema; parent report of immediate food allergy; and allergic sensitisation to food or inhalant allergen.Main resultsThis review identified 33 RCTs, comprising 25,827 participants. A total of 17 studies, randomising 5823 participants, reported information on one or more outcomes specified in this review. Eleven studies randomising 5217 participants, with 10 of these studies providing IPD, were included in one or more meta‐analysis (range 2 to 9 studies per individual meta‐analysis).Most studies were conducted at children's hospitals. All interventions were compared against no skin care intervention or local standard care. Of the 17 studies that reported our outcomes, 13 assessed emollients. Twenty‐five studies, including all those contributing data to meta‐analyses, randomised newborns up to age three weeks to receive a skin care intervention or standard infant skin care. Eight of the 11 studies contributing to meta‐analyses recruited infants at high risk of developing eczema or food allergy, although definition of high risk varied between studies. Durations of intervention and follow‐up ranged from 24 hours to two years.We assessed most of this review's evidence as low certainty or had some concerns of risk of bias. A rating of some concerns was most often due to lack of blinding of outcome assessors or significant missing data, which could have impacted outcome measurement but was judged unlikely to have done so. Evidence for the primary food allergy outcome was rated as high risk of bias due to inclusion of only one trial where findings varied when different assumptions were made about missing data.Skin care interventions during infancy probably do not change risk of eczema by one to two years of age (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.81 to 1.31; moderate‐certainty evidence; 3075 participants, 7 trials) nor time to onset of eczema (hazard ratio 0.86, 95% CI 0.65 to 1.14; moderate‐certainty evidence; 3349 participants, 9 trials). It is unclear whether skin care interventions during infancy change risk of IgE‐mediated food allergy by one to two years of age (RR 2.53, 95% CI 0.99 to 6.47; 996 participants, 1 trial) or allergic sensitisation to a food allergen at age one to two years (RR 0.86, 95% CI 0.28 to 2.69; 1055 participants, 2 trials) due to very low‐certainty evidence for these outcomes. Skin care interventions during infancy may slightly increase risk of parent report of immediate reaction to a common food allergen at two years (RR 1.27, 95% CI 1.00 to 1.61; low‐certainty evidence; 1171 participants, 1 trial). However, this was only seen for cow’s milk, and may be unreliable due to significant over‐reporting of cow’s milk allergy in infants. Skin care interventions during infancy probably increase risk of skin infection over the intervention period (RR 1.34, 95% CI 1.02 to 1.77; moderate‐certainty evidence; 2728 participants, 6 trials) and may increase risk of infant slippage over the intervention period (RR 1.42, 95% CI 0.67 to 2.99; low‐certainty evidence; 2538 participants, 4 trials) or stinging/allergic reactions to moisturisers (RR 2.24, 95% 0.67 to 7.43; low‐certainty evidence; 343 participants, 4 trials), although confidence intervals for slippages and stinging/allergic reactions are wide and include the possibility of no effect or reduced risk.Preplanned subgroup analyses show that effects of interventions were not influenced by age, duration of intervention, hereditary risk, FLG mutation, or classification of intervention type for risk of developing eczema. We could not evaluate these effects on risk of food allergy. Evidence was insufficient to show whether adherence to interventions influenced the relationship between skin care interventions and risk of developing eczema or food allergy.Authors' conclusionsSkin care interventions such as emollients during the first year of life in healthy infants are probably not effective for preventing eczema, and probably increase risk of skin infection. Effects of skin care interventions on risk of food allergy are uncertain.Further work is needed to understand whether different approaches to infant skin care might promote or prevent eczema and to evaluate effects on food allergy based on robust outcome assessments

Photoelectron Imaging of Molecular and Cluster Anions

Femtosecond negative-ion photoelectron imaging spectroscopy allows the probing of dynamics resulting from solvation and photodissociation in both the time-resolved and solvent domains. First, the basic premise of photoelectron imaging shall be presented, followed by a discussion of qualitative approaches for interpreting photoelectron angular distributions as illustrated by application to the photoelectron images of S₂⁻ and CS₂⁻. The photoelectron images of CS₂⁻ serve as a reference for interpreting the results for homogeneous and heterogeneous solvation in CO₂ and OCS cluster anions. The effects of solvation upon the photoelectron angular distribution and the photoelectron energy spectrum are discussed in relation to (OCS)n⁻, OCS⁻·H₂O, (CO2)n⁻, and (CO₂)n(H₂O)m⁻. The (OCS)₂⁻ cluster anion images show evidence of competition of excited state decay pathways and coexistence of isomers. The evolution of photoelectron images, resulting from I₂Br⁻ dissociation shows the evolving electronic structure of the I⁻ channel as the anion dissociates

Effect of Concentration and Degree of Saturation of Topical Fluocinonide Formulations on In Vitro Membrane Transport and In Vivo Availability on Human Skin

Purpose. The thermodynamic acitvity of drugs in topical vehicles is considered to significantly influence topical delivery. In vitro diffusion across a synthetic membrane was shown to be correlated to the degree of saturation of the drug in the applied vehicle and therefore offers a potential for increased topical drug delivery. Fluocinonide a topical corticosteroid, was chosen as a model compound to investigate in vitro and in vivo availability from formulations with different degrees of saturation. Methods. Sub-, as well as, supersaturated drug solutions were prepared using PVP as an antinucleant agent. In vitro membrane diffusion experiments across silicone membrane and in vivo pharmacodynamic activity assessments, using the human skin blanching assay, were carried out. Results. Over the concentration range studied, the in vitro membrane transport of fluocinonide was proportional to the degree of saturation of the respective formulations. The in vivo pharmacodynamic response in the human skin blanching assay was related to the concentration of the drug in the vehicle irrespective of the degree of saturation. Conclusions. From the membrane permeation experiment it can be concluded, that the drug flux might be increased supra-proportionally with increasing donor concentration, drug (super-)saturation (proportional), beyond what would be anticipated based on ideal donor concentration and partition coefficient considerations only. These findings could not be confirmed in the in vivo investigation, probably due to additional vehicle effects (e.g., enhancement, irritation, drug binding) which have to be expected and could have altered the integrity of the stratum corneum and therewith topical bioavailability of the dru

SURFACES AND INTERFACES OF HIGH EXPLOSIVES PROBED BY NONLINEAR OPTICAL SPECTROSCOPY

Author Institution: SCHOOL OF CHEMICAL SCIENCES, UNIVERSITY OF ILLINOIS URBANA CHAMPAIGN, 600 S MATTHEWS, URBANA, IL 61801The surfaces and interfaces of plastic explosives (PBX 9501) were studied using vibrational sum-frequency generation spectroscopy (SFG). SFG is a surface and interface selective nonlinear optical spectroscopy technique with which we study the interfaces within plastic explosive. We are interested in the explosive crystal to plastic binder interface and also the explosive crystal to explosive crystal interface. We initially studied the surfaces of the components of plastic explosives i.e. HMX crystals and a plastic binder, Estane. Our initial results showed that solution grown $\beta$-HMX crystals has small deposits of the $\delta$-HMX isomorphs on its surface. We also found that rapid evaporation from droplets of HMX solution produces nanocrystals of only $\delta$-HMX; presumably because the polar boat conformation of $\delta$-HMX is stabilize by polar solvents. A detail study of the surface vibrational modes of $\beta$-HMX was also carried out on a cleaved HMX crystal