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Early proactive TCS for infant AD linked to lower food allergy rates at age 3Early eczema treatment in infants linked to lower food allergy risk at age three

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Key Takeaway
Consider that early proactive TCS for infant AD was associated with a modest reduction in food allergy at age 3.

This 3-year follow-up of a randomized controlled trial included 590 children who completed the PACI RCT. The study compared early enhanced (proactive) topical corticosteroid treatment for atopic dermatitis until 28 weeks of age against early conventional (reactive) treatment. The primary outcome was physician-diagnosed food allergy at age 3 years.

The main finding was a lower prevalence of any food allergy in the proactive treatment group (47.4%) compared to the reactive group (58.8%), with a p-value of 0.006. Raw egg allergy was also lower (30.4% vs 40.5%, p=0.013). Japanese cedar sensitization was lower at age 2 (6.1% vs 12.2%, p=0.026) but not at age 3. No between-group differences were observed for wheeze, asthma, or rhinitis at age 3, and AD control was well-maintained in both groups, with over 90% achieving mild or less disease.

Safety and tolerability data were not reported. Key limitations include that most observed differences were small, and the findings may reflect early diagnosis and good overall management in both groups rather than a specific treatment effect. The study supports early AD treatment as a potential strategy to modify allergic disease trajectories, but the clinical relevance of the modest reduction in food allergy prevalence requires careful interpretation.

Researchers wanted to know if treating eczema early and consistently in infants could change their chances of developing other allergies later on. They followed 590 children from a previous study. Half had received early, proactive eczema treatment until they were 28 weeks old, while the other half received standard, reactive treatment.

At age three, the group that got the early, proactive treatment had a lower rate of doctor-diagnosed food allergy. For example, about 47% of children in that group had any food allergy, compared to about 59% in the standard care group. The study also found a lower rate of egg allergy and one type of pollen sensitivity at age two, but not for other allergies like asthma or rhinitis.

The main reason to be careful is that the differences between the groups were small. The researchers note that the results might be due to both groups getting good overall eczema care and early diagnosis, not just the specific treatment plan. This study suggests that managing infant eczema well might be one part of a strategy to reduce later food allergies, but it is not a guarantee and more research is needed.

What this means for you:
Good early eczema care in infants may be linked to a modestly lower food allergy risk later, but it's not a sure prevention.

Study Details

Study typeRct
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: The Prevention of Allergy via Cutaneous Intervention (PACI) randomized controlled trial (RCT) demonstrated that early enhanced topical corticosteroid (TCS) therapy modestly reduced food allergy (FA) at 28 weeks of age. The present prospective follow-up study (PACI-ON) evaluated whether these effects persisted to age 3 years. METHODS: Participants were randomized in infancy to early enhanced (proactive) or early conventional (reactive) TCS treatment (1:1) for atopic dermatitis (AD) until 28 weeks. A total of 590 (91%) children who completed the PACI RCT were followed to age 3 years. During follow-up, no protocolized interventions were given; all participants received usual care. Main outcomes included physician-diagnosed FA, AD severity (EASI, POEM), sensitization profiles, allergic comorbidities, and growth parameters as safety outcomes. RESULTS: At age 3 years, the prevalence of any FA remained lower in the early enhanced group than in the conventional group (47.4% vs. 58.8%, p = 0.006), mainly driven by a reduced prevalence of raw egg allergy (30.4% vs. 40.5%, p = 0.013). No between-group differences were observed for wheeze, asthma, or rhinitis. Japanese cedar sensitization at age 2 was lower in the enhanced group (6.1% vs. 12.2%, p = 0.02 6) but not at age 3. AD control and quality of life were well maintained and similar across groups, with > 90% achieving mild or less disease. Early growth suppression at 1 year resolved by age 3. CONCLUSION: Early enhanced AD intervention was associated with a sustained modest reduction in its planned primary follow-up outcome of FA and safety (growth) up to age 3. Although most differences were small and may reflect early diagnosis and good overall management in both groups, the findings support early AD treatment as a potential strategy to modify allergic disease trajectories.
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