Evidence supports probiotic use for prevention of eczema in infants; although uncertainty remains high
The use of probiotics during pregnancy, in breast-feeding women and directly in infants slightly reduced the risk for eczema in infants, however researcher uncertainty is significantly high, according to study results.
“Our confidence that one would observe effects in real life is low to very low,” Carlos A. Cuello-Garcia, MD, of the department of clinical epidemiology and biostatistics and medicine at McMaster University in Canada, and colleagues wrote. “This is a result of the relative paucity of direct evidence in any of the three groups in whom probiotics could be used, the high likelihood of bias in primary studies, and the serious imprecisions of the estimated pooled effects.”
Cuello-Garcia and colleagues conducted a systematic review of randomized trials from the Cochrane Central Register of Controlled Trials, Medline and Embase and identified 29 relevant randomized controlled trials to assess evidence supporting the use of probiotics for the prevention of allergies and inform World Allergy Organization guidelines on probiotic use.
Results from direct and indirect evidence indicated probiotic use during pregnancy reduced the risk for eczema in infants (n = 3,509; RR = 0.72; 95% CI, 0.61-0.85).
The use of probiotics in women during breast-feeding also reduced the risk for eczema in infants (n = 1,595; RR = 0.61; 95% CI, 0.5-0.74). However, the confidence in the estimate is low. One trial indicated probiotics taken by breast-feeding women showed a slight effect on the development of eczema (n = 88; RR = 0.57; 95% CI, 0.29-1.11).
The use of probiotics in infants reduced the risk for eczema in children as well (n = 3,447; RR = 0.81; 95% CI, 0.7-0.94).
The researchers stressed the need for more well-designed and executed randomized trials to reduce the risk for bias by properly measuring and reporting the effects of probiotics in the prevention of all allergic diseases, as well as potential adverse effects.
“It might be beneficial if future trials focused on the most common probiotics and perhaps also directly compares the effects of probiotics used in different populations, such as pregnant women versus breast-feeding mothers, as well as different dosages and specific probiotic strains,” the researchers wrote. – by Ryan McDonald
Disclosure: Cuello-Garcia reports receiving consultancy fees from the World Allergy Organization, as well as support for travel to meetings and other study-related purposes and fees from participating in review activities.