Contact allergens in moisturizers in preventative emollient therapy – A systematic review

Abstract

Background Results of preventative emollient therapy on atopic dermatitis and food allergy trials are inconsistent. In addition to the ingredients considered beneficial, the moisturizers may contain potentially harmful haptens. This study aimed to assess the prevalence of haptens in moisturizers used in studies to prevent atopic dermatitis or food allergy and assess their correlations to the trial results. Methods A systematic search of studies investigating the role of emollient usage in preventing atopic dermatitis or food allergy in infants was performed from inception to December 2020. Haptens were identified based on the nine common patch test series (European, American, and Australian). Results 12 clinical trial studies were included in the review. In total, 16 different emollients were applied as an intervention. The vast majority (75%) of preparations contained at least one hapten from which several substances pose high allergic or irritant potential. Quantitative data synthesis of the findings regarding food allergy and atopic dermatitis prevention was not possible due to the significant heterogeneity of preparations used. Conclusions Careful selection of emollient should consider the absence of potentially harmful ingredients, particularly when used in youngest children. Chronic skin exposure to haptens promotes the development of allergic contact dermatitis and moreover, via deterioration of the skin barrier and subclinical inflammation, may facilitate epicutaneous sensitization and promote atopic dermatitis; however further research is needed to validate our suppositions.

Prevention of atopic dermatitis in high‐risk neonates via different types of moisturizer application: A randomized, blinded, parallel, three‐group, phase II trial (PAF study)

“…Chronic skin exposure to haptens promotes the development of allergic contact dermatitis via the deterioration of the skin barrier and subclinical inflammation, which may facilitate epicutaneous sensitization and promote the development of AD. 31 Although rare, there have also been reports of contact dermatitis secondary to phenoxyethanol exposure. 32 More studies need to properly evaluate the ingredients in emollients.…”

“…A review of 12 AD prevention trials found that the majority (75%) of preparations contained at least one hapten from which several substances pose high allergic or irritant potential. Chronic skin exposure to haptens promotes the development of allergic contact dermatitis via the deterioration of the skin barrier and subclinical inflammation, which may facilitate epicutaneous sensitization and promote the development of AD 31 . Although rare, there have also been reports of contact dermatitis secondary to phenoxyethanol exposure 32 .…”

Skin care interventions and early complementary food introduction for the prevention of atopic dermatitis in infants

“…for the prevention of AD, there is a possibility that the use of moisturizing creams for the treatment of already existing AD could have influenced the data. In the opposite case, the path of percutaneous sensitization cannot be excluded, when microparticles of food or other allergens can get into the cream during the application of the emollient to the skin (Ryczaj et al, 2022).…”

A novel Ca2+ double cone vector system to treat compromised skin

“…A further issue of compromised skin is the risk of contact allergic dermatitis due to repeated exposure to skin sensitizers [11]. Compared to skin sensitizers commonly found in emollients, which include also lanolin despite its moisturizing quality [45], the risk of skin sensitivity is low when using the calcium vector. The composition of the vector per se, with natural phospholipids, ensures excellent biocompatibility and was well tolerated in the clinical study without any adverse effects.…”