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Trials. 2017 Jul 21;18(1):343. doi: 10.1186/s13063-017-2031-3.

Effectiveness and cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children (The BEEP trial): protocol for a randomised controlled trial.

Author information

Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
Skin Research Group, School of Medicine, University of Dundee, Dundee, UK.
Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
The Rotherham NHS Foundation Trust, Moorgate Road, Rotherham, UK.
Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
Department of Infection and Immunity, Sheffield, UK.
Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
Section of Paediatrics, Imperial College London, Wright Fleming Building, London, UK.



Atopic eczema (AE) is a common skin problem that impairs quality of life and is associated with the development of other atopic diseases including asthma, food allergy and allergic rhinitis. AE treatment is a significant cost burden for health care providers. The purpose of the trial is to investigate whether daily application of emollients for the first year of life can prevent AE developing in high-risk infants (first-degree relative with asthma, AE or allergic rhinitis).


This is a protocol for a pragmatic, two-arm, randomised controlled, multicentre trial. Up to 1400 term infants at high risk of developing AE will be recruited through the community, primary and secondary care in England. Participating families will be randomised in a 1:1 ratio to receive general infant skin-care advice, or general skin-care advice plus emollients with advice to apply daily to the infant for the first year of life. Families will not be blinded to treatment allocation. The primary outcome will be a blinded assessment of AE at 24 months of age using the UK Working Party Diagnostic Criteria for Atopic Eczema. Secondary outcomes are other definitions of AE, time to AE onset, severity of AE (EASI and POEM), presence of other allergic diseases including food allergy, asthma and hay fever, allergic sensitisation, quality of life, cost-effectiveness and safety of the emollients. Subgroup analyses are planned for the primary outcome according to filaggrin genotype and the number of first-degree relatives with AE and other atopic diseases. Families will be followed up by online and postal questionnaire at 3, 6, 12 and 18 months with a face-to-face visit at 24 months. Long-term follow-up until 60 months will be via annual questionnaires.


This trial will demonstrate whether skin-barrier enhancement through daily emollient for the first year of life can prevent AE from developing in high-risk infants. If effective, this simple and cheap intervention has the potential to result in significant cost savings for health care providers throughout the world by preventing AE and possibly other associated allergic diseases.


ISRCTN registry; ID: ISRCTN21528841 . Registered on 25 July 2014.


Atopic dermatitis; Barrier enhancement; Core outcomes; Eczema; Emollient; Filaggrin; Prevention; Protocol; Randomised controlled trial

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