Grant Proposal Review |Julia Wisniewski, MD

February 12, 2016 by School of Medicine Webmaster

Date: Friday February 19, 2016
Time: 12:00 PM until 1:00 PM
Location: MR-4 Second Floor Conf Room

“Effects of Newborn Detergent Use on Allergic Diseases in Childhood”

photo of Julia Wisniewski, MD

Julia Wisniewski, MD

Assistant Professor of Pediatrics

Division of Allergy and Immunology

 

Moderator:

Peter W. Heymann, MD

Professor of Pediatrics

Section Head, Pediatric Allergy and Immunology

OBJECTIVES

  • To review our current understanding of risk and prevention of allergic diseases in childhood.
  • To review the physiology of newborn skin and our understanding of the effects of detergent.
  • To identify the knowledge gaps in our understanding of the relationship between Westernized newborn bathing practices and development of allergic disease.

 

RELEVANCE

Atopic dermatitis (AD) affects more than 40% of high-risk children and 20% of the general pediatric population in Westernized countries.  Skin barrier dysfunction is the hallmark of AD skin which contributes to cutaneous allergen sensitization associated with food allergy and asthma.  The Westernized practice of bathing infants with detergents has recently gained attention because of associations between detergent use and skin barrier disruption as well as its impact on commensal bacteria.  This study examines the relevant question to all newborn infants:  Do current bathing guidelines for infants influence their development of atopic dermatitis and allergies?  This pilot study is designed to begin to address this question and will provide new knowledge regarding whether avoiding exposure to detergents and applying skin-barrier enhancing emollients to skin during the newborn period can lower the incidence of atopic dermatitis and allergy in high risk infants.

 

SPECIFIC AIMS

AIM 1. Implementing skin-barrier enhancing practices at birth among high risk infants

Hypothesis: High risk newborns treated with skin-barrier enhancing oils, compared to detergent cleansers, will have a lower incidence of AD at 6 months.  To test the feasibility of implementing a skin-barrier enhancing intervention at birth, we will conduct a 6 month pilot trial (Fig. 1).  High risk infants born at UVA will be recruited prior to their first bath.  Subjects will be randomized to routine bathing or the intervention of detergent avoidance and emollient use.  The presence of AD will be determined by a pediatric dermatologist blinded to allocation at 6 months of life.  We expect the incidence of AD in the intervention group will be half that of controls.

AIM 2. Effect of skin-barrier enhancing practices on maturation of skin barrier properties

Hypothesis: High risk newborns treated with skin barrier-enhancing oils, compared to detergent cleansers, will exhibit lower TEWL at 48hours of life. Transepidermal water loss (TEWL) measurement is a validated measure of skin barrier integrity and is lower in AD compared to healthy skin.  TEWL will be measured on subjects’ skin at 48hrs, 2 and 6 months of life.  We expect TEWL to be significantly lower for the intervention group compared to controls, beginning at 48 hours of life, and for this difference to persist over the study period.

AIM 3. Effect of skin-barrier enhancing practices at birth on development of atopy

Hypothesis: High risk newborns treated with skin barrier-enhancing oils, compared to detergent cleansers, will exhibit lower rates of allergic sensitization. Early sensitization to foods is associated with AD and is a marker of risk for food allergy and asthma.  Allergic sensitization to egg, milk, and peanut will be measured by standard skin prick testing at 6 months of life. We expect that the non-intervention group will exhibit greater rates of sensitization to egg, milk, and peanut. ​


Contact cline@virginia.edu for more information