Atopic dermatitis and skin disease
Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials

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Background

Allergic diseases are considered a health burden because of their high and constantly increasing prevalence, high direct and indirect costs, and undesirable effects on quality of life. Probiotics have been suggested as an intervention to prevent allergic diseases.

Objective

We sought to synthesize the evidence supporting use of probiotics for the prevention of allergies and inform World Allergy Organization guidelines on probiotic use.

Methods

We performed a systematic review of randomized trials assessing the effects of any probiotic administered to pregnant women, breast-feeding mothers, and/or infants.

Results

Of 2403 articles published until December 2014 identified in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, 29 studies fulfilled a priori specified inclusion criteria for the analyses. Probiotics reduced the risk of eczema when used by women during the last trimester of pregnancy (relative risk [RR], 0.71; 95% CI, 0.60-0.84), when used by breast-feeding mothers (RR, 0.57; 95% CI, 0.47-0.69), or when given to infants (RR, 0.80; 95% CI, 0.68-0.94). Evidence did not support an effect on other allergies, nutrition status, or incidence of adverse effects. The certainty in the evidence according to the Grading of Recommendation Assessment Development and Evaluation approach is low or very low because of the risk of bias, inconsistency and imprecision of results, and indirectness of available research.

Conclusion

Probiotics used by pregnant women or breast-feeding mothers and/or given to infants reduced the risk of eczema in infants; however, the certainty in the evidence is low. No effect was observed for the prevention of other allergic conditions.

Section snippets

Types of studies

We included randomized controlled trials with a minimum follow-up of 4 weeks that compared any type of probiotic with placebo, irrespective of their language or publication status.

Types of participants

Studies must have included 1 or more of the following groups of participants: pregnant women, breast-feeding mothers, and infants and children. We included studies that assessed the use of probiotics in any age group, from newborn infants to preschool and school-age children (up to 9 years of age).

Types of interventions

We included studies

Results

Our search strategy identified 2403 unique bibliographic citations, of which 178 were selected for full-text assessment (Fig 1). We identified 29 randomized controlled trials comparing at least 1 probiotic with placebo18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46 and meeting the inclusion criteria. Fig 2 lists the included studies according to the different populations and periods when the probiotics were administered (eg,

Discussion

In this systematic review we found that supplementation with probiotics during pregnancy, in breast-feeding mothers, or in infants decreases the risk of eczema (including atopic eczema) in infants. However, the certainty in the evidence is very low because of the risk of bias across trials, indirectness of the evidence, inconsistency of results among studies, and imprecision of the pooled estimates. Currently available evidence suggests that supplementation of probiotics does not reduce the

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    Supported by the World Allergy Organization.

    Disclosure of potential conflict of interest: This study was supported by the World Allergy Organization (WAO). The institution of J. L. Brożek, A. Fiocchi, J. J. Yepes-Nuñez, L. Terracciano, S. Gandhi, C. A. Cuello-Garcia, Y. Zhang, and H. J. Schünemann, has received consultancy fees from the WAO, as well as support for travel to meetings and other study-related purposes and fees for participating in review activities. A. Fiocchi has received consultancy fees from GlaxoSmithKline, as well as payment for delivering lectures from Danone. R. Pawankar received royalties from Springer and is employed by the Nippon Medical School in Tokyo, Japan, which has received or has grants pending from the Japanese Ministry of Education. L. Terracciano has received consultancy fees from Heinz-Plada. The rest of the authors declare that they have no relevant conflicts of interest.

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