Atopic eczema in under 12s: diagnosis and management

Reason for the decision

We found 52 new studies through surveillance of this guideline: 24 in a search of systematic reviews and randomised controlled trials (between October 2013 and November 2015) and 27 identified by topic experts. A further study was identified through post-publication communications. None of the new evidence considered in surveillance of this guideline was thought to have an effect on current recommendations. These studies included new evidence on:

None of the new evidence considered in surveillance of this guideline was thought to have an effect on current recommendations.

We did not find any new evidence on:

We found new evidence related to the research recommendations on methods to measure severity of atopic eczema, house dust mite avoidance strategies, optimal feeding regimen in the first year of life, effects of improving the control of atopic eczema in the first year of life, treatment, and education and adherence to therapy. This new evidence was not considered to fully address these research recommendations or affect current recommendations. We did not find new evidence that would affect other research recommendations.

The majority of topic experts considered the guideline still relevant to clinical practice. One topic expert felt that there is a comprehensive body of new evidence to inform an update of the guideline. Topic experts highlighted that a topical corticosteroid (Elocon: mometasone furoate) is generic now and therefore cheaper. For topical corticosteroids, the current guideline already recommends the drug with the lowest acquisition cost taking into account potency tailoring to the severity of the child's atopic eczema, pack size and frequency of application. Topic experts also highlighted that children should be referred for allergy tests recognising that referral for allergy tests could have a cost impact. However, the current guideline does not recommend having allergy tests for most children (recommendation 1.4.1.5: 'Healthcare professionals should reassure children with mild atopic eczema and their parents or carers that most children with mild atopic eczema do not need to have tests for allergies'). Therefore, it was felt that an update of the guideline related to allergy tests and topical corticosteroids is not necessary at this time. Topic experts also mentioned the need to review the food allergy section of the guideline, particularly around allergy testing. They also felt there would be value in giving greater clarity about safety of pimecrolimus and tacrolimus in children. However, all these areas are already covered in other NICE guidance on food allergy in under 19s: assessment and diagnosis (2011) NICE guideline CG116 and tacrolimus and pimecrolimus for atopic eczema (2004) NICE technology appraisal guidance 84. Other areas for consideration highlighted by topic experts included prevention of eczema and the inclusion of adults. However, prevention of eczema and diagnosis and management for adults are out of scope of this guideline and outside the original remit from the Department of Health.