Probiotics for allergy prevention
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Probiotics, given either as a supplement or in infant foods, have been evaluated in randomised controlled trials for allergy prevention. Here, the aim is to give an overview of the results from these primary prevention studies and to discuss current strategies. In most studies, single strains or a mixture of strains of lactic acid bacteria and bifidobacteria have been used – prenatally, postnatally or perinatally. Several meta-analyses have reported a moderate benefit of probiotics for eczema prevention, and the most consistent effect has been observed with a combined perinatal intervention in infants at high risk of allergic disease due to familial predisposition. In a recent meta-analysis, the use of multi-strain probiotics appeared to be most effective for eczema prevention. No preventive effect has been shown for other allergic manifestations. As long-term follow-up data on later onset allergic conditions (asthma and allergic rhinitis) are available only from a few of the initiated studies, reports from ongoing follow-up studies that are adequately powered to examine long-term outcomes are anticipated to provide more insight. Arguably, the differences in many aspects of study design and the use of different probiotic strains and combinations have made direct comparison difficult. To date, expert bodies do not generally recommend probiotics for allergy prevention, although the World Allergy Organization (WAO) in their recently developed guidelines suggests considering using probiotics in pregnant women, during breastfeeding and/or to the infant if at high risk of developing allergic disease (based on heredity). However, in concordance with other expert bodies, the WAO guideline panel stressed the low level of evidence and the need for adequately powered randomised controlled trials and a more standardised approach before clinical recommendations on specific strains, dosages and timing can be given.
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Simpson, M.R., Dotterud, C.K., Storro, O., Johnsen, R. and Oien, T., 2015. Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial. BMC Dermatology 15: 13.
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Soh, S.E., Aw, M., Gerez, I., Chong, Y.S., Rauff, M., Ng, Y.P., Wong, H.B., Pai, N., Lee, B.W. and Shek, L.P., 2009. Probiotic supplementation in the first 6 months of life in at risk Asian infants – effects on eczema and atopic sensitization at the age of 1 year. Clinical and Experimental Allergy 39: 571-578.
'Probiotic supplementation in the first 6 months of life in at risk Asian infants – effects on eczema and atopic sensitization at the age of 1 year ' () 39 Clinical and Experimental Allergy : 571 -578.
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Sudo, N., Sawamura, S., Tanaka, K., Aiba, Y., Kubo, C. and Koga, Y., 1997. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. Journal of Immunology 159: 1739-1745.
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Szajewska, H., Shamir, R., Turck, D., van Goudoever, J.B., Mihatsch, W.A. and Fewtrell, M., in press. Recommendations on probiotics in allergy prevention should not be based on pooling data from different strains. Journal of Allergy and Clinical Immunology.
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Taylor, A.L., Dunstan, J.A. and Prescott, S.L., 2007. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. Journal of Allergy and Clinical Immunology 119: 184-191.
'Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial ' () 119 Journal of Allergy and Clinical Immunology : 184 -191.
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Walker, J., Dieleman, L., Mah, D., Park, K., Meddings, J. and Vethanayagam, D., 2014. High prevalence of abnormal gastrointestinal permeability in moderate-severe asthma. Clinical and Investigative Medicine 37: E53-E57.
'High prevalence of abnormal gastrointestinal permeability in moderate-severe asthma ' () 37 Clinical and Investigative Medicine : E53 -E57.
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West, C.E. and Prescott, S.L., 2015c. Prebiotics and probiotics for prevention of allergic disease. UptoDate 20 October 2015. Available at: http://tinyurl.com/grmwzb7.
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West, C.E., Hammarström, M.L. and Hernell, O., 2009. Probiotics during weaning reduce the incidence of eczema. Pediatric Allergy and Immunology 20: 430-437.
'Probiotics during weaning reduce the incidence of eczema ' () 20 Pediatric Allergy and Immunology : 430 -437.
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West, C.E., Hammarström, M.L. and Hernell, O., 2013. Probiotics in primary prevention of allergic disease – follow-up at 8-9 years of age. Allergy 68: 1015-1020.
'Probiotics in primary prevention of allergic disease – follow-up at 8-9 years of age ' () 68 Allergy : 1015 -1020.
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West, C.E., Hernell, O., Andersson, Y., Sjöstedt, M. and Hammarström, M.L., 2012. Probiotic effects on T-cell maturation in infants during weaning. Clinical and Experimental Allergy 42: 540-549.
'Probiotic effects on T-cell maturation in infants during weaning ' () 42 Clinical and Experimental Allergy : 540 -549.
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West, C.E., Jenmalm, M.C. and Prescott, S.L., 2015a. The gut microbiota and its role in the development of allergic disease: a wider perspective. Clinical and Experimental Allergy 45: 43-53.
'The gut microbiota and its role in the development of allergic disease: a wider perspective ' () 45 Clinical and Experimental Allergy : 43 -53.
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West, C.E., Renz, H., Jenmalm, M.C., Kozyrskyj, A.L., Allen, K.J., Vuillermin, P., Prescott, S.L., in, F.M.I.G. and in, F.M.I.G., 2015b. The gut microbiota and inflammatory noncommunicable diseases: associations and potentials for gut microbiota therapies. Journal of Allergy and Clinical Immunology 135: 3-13.
'The gut microbiota and inflammatory noncommunicable diseases: associations and potentials for gut microbiota therapies ' () 135 Journal of Allergy and Clinical Immunology : 3 -13.
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Wickens, K., Black, P.N., Stanley, T.V., Mitchell, E., Fitzharris, P., Tannock, G.W., Purdie, G. and Crane, J., 2008. A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. Journal of Allergy and Clinical Immunology 122: 788-794.
'A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial ' () 122 Journal of Allergy and Clinical Immunology : 788 -794.
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Wickens, K., Black, P.N., Stanley, T.V., Mitchell, E., Barthow, C., Fitzharris, P., Purdie, G. and Crane, J., 2012. A protective effect of Lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years. Clinical and Experimental Allergy 42: 1071-1079.
'A protective effect of Lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years ' () 42 Clinical and Experimental Allergy : 1071 -1079.
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Wickens, K., Stanley, T.V., Mitchell, E.A., Barthow, C., Fitzharris, P., Purdie, G., Siebers, R., Black, P.N. and Crane, J., 2013. Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years: does it also reduce atopic sensitization? Clinical and Experimental Allergy 43: 1048-1057.
'Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years: does it also reduce atopic sensitization? ' () 43 Clinical and Experimental Allergy : 1048 -1057.
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Zuccotti, G., Meneghin, F., Aceti, A., Barone, G., Callegari, M.L., Di Mauro, A., Fantini, M.P., Gori, D., Indrio, F., Maggio, L., Morelli, L., Corvaglia, L. and the Italian Society of Neonatology, 2015. Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy 70: 1356-1371.
'Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis ' () 70 Allergy : 1356 -1371.
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Probiotics for allergy prevention
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Probiotics, given either as a supplement or in infant foods, have been evaluated in randomised controlled trials for allergy prevention. Here, the aim is to give an overview of the results from these primary prevention studies and to discuss current strategies. In most studies, single strains or a mixture of strains of lactic acid bacteria and bifidobacteria have been used – prenatally, postnatally or perinatally. Several meta-analyses have reported a moderate benefit of probiotics for eczema prevention, and the most consistent effect has been observed with a combined perinatal intervention in infants at high risk of allergic disease due to familial predisposition. In a recent meta-analysis, the use of multi-strain probiotics appeared to be most effective for eczema prevention. No preventive effect has been shown for other allergic manifestations. As long-term follow-up data on later onset allergic conditions (asthma and allergic rhinitis) are available only from a few of the initiated studies, reports from ongoing follow-up studies that are adequately powered to examine long-term outcomes are anticipated to provide more insight. Arguably, the differences in many aspects of study design and the use of different probiotic strains and combinations have made direct comparison difficult. To date, expert bodies do not generally recommend probiotics for allergy prevention, although the World Allergy Organization (WAO) in their recently developed guidelines suggests considering using probiotics in pregnant women, during breastfeeding and/or to the infant if at high risk of developing allergic disease (based on heredity). However, in concordance with other expert bodies, the WAO guideline panel stressed the low level of evidence and the need for adequately powered randomised controlled trials and a more standardised approach before clinical recommendations on specific strains, dosages and timing can be given.
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