Probiotics for prevention of atopic diseases in infants: systematic review and meta‐analysis

Allergy
Nov 2015
Citations:248
Influential Citations:9
Systematic Reviews / Meta-Analyses
82
S2 IconPDF Icon

Enhanced Details

Methods
Randomized, double-blind, placebo-controlled trials; participants included pregnant/nursing mothers and infants ≤3 months old; infants at high risk for atopy (family history of eczema/asthma) or general population.
Intervention
Oral probiotic supplementation during pregnancy and/or infancy (infants ≤3 months). Regimens used single strains (e.g., Lactobacillus rhamnosus GG, HN001; Lactobacillus reuteri ATCC 55730; Lactobacillus paracasei ST11; Lactobacillus acidophilus LAVRI-A1; Lactobacillus acidophilus AD031; Lactobacillus lactis W58) and multi-strain mixtures of Lactobacilli and Bifidobacteria. Start during pregnancy in most studies; start within 48 hours of birth in a subset; dosing and duration varied across trials.
Results
Probiotic supplementation during pregnancy/infancy reduced infant eczema risk (RR 0.78; 95% CI 0.69–0.89; P=0.0003), especially with multi-strain mixtures (RR 0.54; 95% CI 0.43–0.68; P<0.00001). No significant effects on asthma (RR 0.99; 95% CI 0.77–1.27), wheeze (RR 1.02; 95% CI 0.89–1.17) or rhinoconjunctivitis (RR 0.91; 95% CI 0.67–1.23). Number needed to treat to prevent one eczema case: 13. Conclusion: Prenatal/early-life probiotic use may prevent infantile eczema and could be a new indication; mixtures appear more effective than single strains; evidence for other atopic diseases remains inconclusive.
Limitations
Heterogeneity in probiotic strains and regimens (single strains vs mixtures), timing (pregnancy vs infancy), and duration; moderate microbiological quality across many trials; variable follow-up durations; results mainly reflect eczema outcomes with weaker data on asthma, wheeze, and rhinoconjunctivitis; generalizability may be limited.

Abstract

Growing evidence underlines the pivotal role of infant gut colonization in the development of the immune system. The possibility to modify gut colonization through probiotic supplementation in childhood might prevent atopic diseases. The aim of the p...