{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T05:15:38Z","timestamp":1784351738267,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["CDF\u20102014\u2010 07\u2010037"],"award-info":[{"award-number":["CDF\u20102014\u2010 07\u2010037"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Observational studies suggest an increased risk of eczema in children living in hard versus soft water areas, and there is, therefore, an interest in knowing whether softening water may prevent eczema. We evaluated the feasibility of a parallel\u2010group assessor\u2010blinded pilot randomized controlled trial to test whether installing a domestic ion\u2010exchange water softener before birth in hard water areas reduces the risk of eczema in infants with a family history of atopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pregnant women living in hard water areas (&gt;250\u00a0mg\/L calcium carbonate) in and around London UK, were randomized 1:1 antenatally to either have an ion\u2010exchange water softener installed in their home or not (ie to continue to receive usual domestic hard water). Infants were assessed at birth and followed up for 6\u00a0months. The main end\u2010points were around feasibility, the primary end\u2010point being the proportion of eligible families screened who were willing and able to be randomized. Clinical end\u2010points were evaluated including frequency of parent\u2010reported doctor\u2010diagnosed eczema and visible eczema on skin examination. Descriptive analyses were conducted, and no statistical testing was performed as this was a pilot study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred and forty\u2010nine families screened were eligible antenatally and 28% (41\/149) could not have a water softener installed due to technical reasons or lack of landlord approval. Eighty of 149 (54%) were randomized, the primary end\u2010point. Two participants withdrew immediately after randomization, leaving 39 participants in each arm (78 total). Attrition was 15% (12\/78) by 6\u00a0months postpartum. All respondents (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a069) to the study acceptability questionnaire reported that the study was acceptable. Fifty\u2010six of 708 (7.9%) water samples in the water softener arm were above the hard water threshold of 20\u00a0mg\/L CaCO\n                      <jats:sub>3<\/jats:sub>\n                      . At 6\u00a0months of age 27\/67 infants (40%) developed visible eczema, 12\/36 (33%) vs. 15\/31 (48%) in the water softener and control groups, respectively, difference \u221215% (95% CI \u221238, 8.3%), with most assessments (\u226596%) remaining blinded. Similarly, a lower proportion of infants in the water softener arm had parent\u2010reported, doctor\u2010diagnosed eczema by 6\u00a0months compared to the control arm, 6\/17 (35%) versus 9\/19 (47%), difference \u221212% (95% CI \u221244, 20%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A randomized controlled trial of water softeners for the prevention of atopic eczema in high\u2010risk infants is feasible and acceptable. Trial registration: NCT03270566 (clinicaltrials.gov)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.14071","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T02:01:16Z","timestamp":1638410476000},"page":"405-415","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Randomized controlled pilot trial with ion\u2010exchange water softeners to prevent eczema (SOFTER trial)"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4127-8263","authenticated-orcid":false,"given":"Z. K.","family":"Jabbar\u2010Lopez","sequence":"first","affiliation":[{"name":"Unit for Population\u2010Based Dermatology St John\u2019s Institute of Dermatology King\u2019s College London and Guy\u2019s and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3791-0297","authenticated-orcid":false,"given":"B.","family":"Ezzamouri","sequence":"additional","affiliation":[{"name":"Unit for Population\u2010Based Dermatology St John\u2019s Institute of Dermatology King\u2019s College London and Guy\u2019s and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Briley","sequence":"additional","affiliation":[{"name":"Women\u2019s Health King\u2019s College London and Guy\u2019s and St Thomas\u2019 NHS Foundation Trust  London UK"},{"name":"Caring Futures Institute Flinders University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Greenblatt","sequence":"additional","affiliation":[{"name":"Unit for Population\u2010Based Dermatology St John\u2019s Institute of Dermatology King\u2019s College London and Guy\u2019s and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Gurung","sequence":"additional","affiliation":[{"name":"Unit for Population\u2010Based Dermatology St John\u2019s Institute of Dermatology King\u2019s College London and Guy\u2019s and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. R.","family":"Chalmers","sequence":"additional","affiliation":[{"name":"Centre of Evidence\u2010Based Dermatology University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. S.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Centre of Evidence\u2010Based Dermatology University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Frost","sequence":"additional","affiliation":[{"name":"Aqua Focus Ltd.  Shrewsbury UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Kezic","sequence":"additional","affiliation":[{"name":"Academic Medical Center University of Amsterdam  Amsterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3280-7365","authenticated-orcid":false,"given":"J. E. A.","family":"Common","sequence":"additional","affiliation":[{"name":"Skin Research Institute of Singapore A*STAR  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-140X","authenticated-orcid":false,"given":"S.","family":"Danby","sequence":"additional","affiliation":[{"name":"Department of Infection Sheffield Dermatology Research Immunity &amp; Cardiovascular Diseases The University of Sheffield Medical School  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. J.","family":"Cork","sequence":"additional","affiliation":[{"name":"Department of Infection Sheffield Dermatology Research Immunity &amp; Cardiovascular Diseases The University of Sheffield Medical School  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0310-2518","authenticated-orcid":false,"given":"J. 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