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

Carlos A. Cuello-Garcia, Jan L. Brozek, Alessandro Fiocchi, Ruby Pawankar, Juan José Yepes-Nuñez, Luigi Terracciano, Shreyas Gandhi, Arnav Agarwal, Yuan Zhang, Holger J. Schünemann

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)952-961
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Volume136
Issue number4
DOIs
Publication statusPublished - Oct 1 2015

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Probiotics
Meta-Analysis
Hypersensitivity
Randomized Controlled Trials
Breast Feeding
Eczema
Mothers
Pregnant Women
Third Pregnancy Trimester
Nutritional Status
MEDLINE
Quality of Life
Guidelines
Costs and Cost Analysis
Pregnancy
Incidence
Health
Research

Keywords

  • Allergy
  • prevention
  • probiotics systematic reviews

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)

Cite this

Cuello-Garcia, C. A., Brozek, J. L., Fiocchi, A., Pawankar, R., Yepes-Nuñez, J. J., Terracciano, L., ... Schünemann, H. J. (2015). Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. Journal of Allergy and Clinical Immunology, 136(4), 952-961. https://doi.org/10.1016/j.jaci.2015.04.031

Probiotics for the prevention of allergy : A systematic review and meta-analysis of randomized controlled trials. / Cuello-Garcia, Carlos A.; Brozek, Jan L.; Fiocchi, Alessandro; Pawankar, Ruby; Yepes-Nuñez, Juan José; Terracciano, Luigi; Gandhi, Shreyas; Agarwal, Arnav; Zhang, Yuan; Schünemann, Holger J.

In: Journal of Allergy and Clinical Immunology, Vol. 136, No. 4, 01.10.2015, p. 952-961.

Research output: Contribution to journalArticle

Cuello-Garcia, CA, Brozek, JL, Fiocchi, A, Pawankar, R, Yepes-Nuñez, JJ, Terracciano, L, Gandhi, S, Agarwal, A, Zhang, Y & Schünemann, HJ 2015, 'Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials', Journal of Allergy and Clinical Immunology, vol. 136, no. 4, pp. 952-961. https://doi.org/10.1016/j.jaci.2015.04.031
Cuello-Garcia, Carlos A. ; Brozek, Jan L. ; Fiocchi, Alessandro ; Pawankar, Ruby ; Yepes-Nuñez, Juan José ; Terracciano, Luigi ; Gandhi, Shreyas ; Agarwal, Arnav ; Zhang, Yuan ; Schünemann, Holger J. / Probiotics for the prevention of allergy : A systematic review and meta-analysis of randomized controlled trials. In: Journal of Allergy and Clinical Immunology. 2015 ; Vol. 136, No. 4. pp. 952-961.
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abstract = "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.",
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AU - Yepes-Nuñez, Juan José

AU - Terracciano, Luigi

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N2 - 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.

AB - 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.

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