A randomized trial of a barrier lipid replacement strategy for the prevention of atopic dermatitis and allergic sensitization: the PEBBLES pilot study

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M.L.K.T. and S.C.D. are equal senior authors.

Funding sources: this trial was supported by the Financial Markets Foundation for Children, and the Asthma Foundation of Victoria. Additional support was obtained via an NHMRC equipment grant to purchase instruments used to measure biophysical aspects of skin. PuraCap provided EpiCeram™, the study intervention, at no cost to the study. PuraCap had no role in the study design or decision to publish the results presented in this paper. A.J.L., S.C.D., K.J.A. and M.C.M. are supported by NHMRC fellowships.

Conflicts of interest: none declared.

Dear Editor, It is hypothesized that the impaired skin barrier in atopic dermatitis (AD) allows the immune system to be exposed to environmental allergens, resulting in sensitization and allergic disease.1 Two small trials recently found that routine use of emollients reduced the incidence of AD during the active treatment period by approximately half.2,3 It remains unknown whether prophylactic use of emollients can prevent the development of AD beyond the treatment period (as opposed simply to delaying its onset) or whether this reduction in AD leads to a reduced risk of allergic sensitization.