FCAAIA Notes: The best data on probiotics and allergic disease probably apply to atopic dermatitis and food allergy in infancy.  Unfortunately, while there are some studies indicating some benefits, none have been so conclusive that it is a recommendation we routinely make. Some good news is that probiotics and prebiotics are unlikely to be harmful to mother, fetus, or infant (as far as we know!).  Furthermore, not all studies use the same probiotics, so we cannot recommend a particular species.

I think the data on probiotic use to prevent allergic disease is nicely summarized by the authors and appears at the end of this article: “If probiotics are used in infants, it is not clear when they should be started and how long they should be used,” I would add that the right probiotic and what dose to use are also still unknown.

(Source:   February 5, 2015. Adapted from World Allergy Organ J. 2015;doi:10.1186/s40413-015-0055-2.)

The World Allergy Organization has released conditional guidelines for the use of probiotics during pregnancy, breast-feeding and infancy to prevent allergic diseases.

International clinicians and researchers gathered to develop recommendations about the use of probiotics in the prevention of allergy, and they issued the suggestions after reviewing randomized controlled trials of probiotics.

Bambino Gesù in Rome, and colleagues issued three conditional recommendations for using probiotics:

  • in pregnant women at high risk for allergy in their children;
  • in women who breast-feed infants at high risk for developing allergy; and
  • in infants at high risk for developing allergies.

While the panel did not find sufficient evidence to indicate probiotic supplements reduced the risk for developing allergy in children, the panel wrote that there is a likely benefit from using probiotics in the prevention of eczema.

Question 1

In determining if probiotics should be used by pregnant women, the researchers analyzed eight reviews and 21 randomized controlled trials (RCTs). Fifteen of the studies measured and reported development of eczema in children. The risk for eczema was reduced in children whose mothers received probiotic during pregnancy compared with placebo (RR = 0.72; 95% CI, 0.61-0.85).

Development of asthma or wheezing was reported in eight studies and did not vary between the probiotic and placebo (RR = 0.93; 95% CI, 0.76-1.15).

The panel acknowledged the use of probiotics during pregnancy will most likely be determined by women’s preferences. “We agreed that the values and preferences of women regarding the use of probiotics during pregnancy are likely to depend on cultural and socioeconomic background,” the panel wrote.

The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines states there is no evidence to suggest women modify their diet or take supplements during pregnancy to prevent the development of food allergy.

Question 2

The panel asked if women who breast-feed should or should not use probiotics. Thirteen RCTs were analyzed to determine a conditional recommendation to use probiotics if the child is at great risk for developing allergy. The use of probiotics during breast-feeding reduced the rate of eczema in infants when compared with placebo (RR = 0.61; 95% CI, 0.5-0.64). But, there is some uncertainty because the analyzed research also included studies where the mothers took probiotics during pregnancy and the infants also were actively taking probiotics.

The EAACI Food Allergy and Anaphylaxis Guidelines indicate there is no evidence to suggest women who breast-feed should take any supplements to prevent food allergy in their children.

Question 3

The panel asked if probiotics should be administered to healthy infants. The panel analyzed five reviews and 23 RCTs and suggested using probiotics in infants at risk for allergy.

When given to infants, probiotics decreased the risk for developing eczema compared with placebo (RR = 0.81; 95% CI, 0.7-0.94). However, there was no indication probiotics affected the development of allergic rhinitis in children (RR = 0.83; 95% CI, 0.39-1.79). Although the panel suggested the use of probiotics during infancy, there was some uncertainty as to when they should be initiated.

“If probiotics are used in infants, it is not clear when they should be started and how long they should be used,” the panel wrote

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