There are no generally accepted strategies for the prevention of atopic dermatitis (AD) and other atopic diseases. Relevant to a primary goal of the NIH's mission, to prevent disease, the candidate's long-term goal is to develop into an independent clinician-scientist specializing in atopic disease prevention. Dr. Simpson's short term goal is to test the hypothesis that skin barrier protection from birth is a feasible approach to AD prevention. These feasibility data are required to proceed with larger controlled studies that will definitely test this novel AD prevention strategy. An international research consortium is currently in place awaiting direction from these proposed feasibility studies. The current proposal will not definitely answer whether skin barrier protection effectively prevents AD, but will provide the necessary preliminary data to proceed with larger scale international studies. Primary outcomes in the current proposal include compliance with the intervention and willingness to randomize. Basic mechanistic studies are included in this proposal to further investigate the physiologic effects emollients have on the skin barrier function of the infant. A better understanding of infant skin physiology will also be gained by studying barrier function in high-risk infants prior to AD development. Results from this line of work will likely lead to a change in the standard of care for infants at risk for the development of atopic diseases. Future work will focus on the effect skin barrier protection may have on reducing epicutaneous sensitization which could reduce the incidence of IgE-mediated allergic diseases such as food allergy and allergic asthma. The mentored career development plan consists of a three-tiered approach: a mentored clinical research experience, a didactic educational component, and a broad based experiential learning program. Dr. Simpson has recently completed both the Human Investigations Program at Oregon Health and Science University (OHSU) which is a two year K30 (NIH) conducted program and the Master of Clinical Research Program which provided him with the foundation for a career in clinical research. His current training and mentorship plan focuses on the implementation of these new skills in a """"""""real world"""""""" setting, on acquiring more specialized skills in statistics and study design pertinent to his research focus, and on learning to lead consortium-based research under direct supervision. His mentorship committee is composed of a PhD/MPH epidemiologist specializing in clinical trials in pregnant women, a Professor of Dermatology with over 30 years of clinical and basic science study experience in atopic dermatitis, a Professor and expert in biophysical skin analysis, and a PhD statistician. His off-site mentor is a PhD epidemiologist from the UK who leads an international atopic dermatitis research consortium. The Candidate's previous success in executing clinical studies, his mentoring committee and his career development plan will make him well- suited to achieve his short and long-term goals.
Skin barrier protection with emollients, although a cornerstone of atopic dermatitis therapy, has not been previously explored as a disease prevention strategy. An approach that even decreases atopic dermatitis severity or delays the onset would have large public health implications in this extremely common disease. This strategy would be a cost-effective, easy, and safe intervention that may also have benefits in preventing food allergy and asthma.
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