Probiotic administration in early life, atopy, and asthma: a meta-analysis of clinical trials. Pediatrics 2013 Sep;132(3):e666-76
Date
08/21/2013Pubmed ID
23958764DOI
10.1542/peds.2013-0246Scopus ID
2-s2.0-84884562690 (requires institutional sign-in at Scopus site) 230 CitationsAbstract
BACKGROUND AND OBJECTIVE: Probiotics may reduce the risk of atopy and asthma in children. However, results from clinical trials have been conflicting, and several of them may have been underpowered. We performed a meta-analysis of randomized, placebo-controlled trials to assess the effects of probiotic supplementation on atopic sensitization and asthma/wheeze prevention in children.
METHODS: Random-effects models were used to calculate pooled risk estimates. Meta-regression was conducted to examine the effect of potential factors on probiotics efficacy.
RESULTS: Probiotics were effective in reducing total immunoglobulin E (IgE) (mean reduction: -7.59 U/mL [95% confidence interval (CI): -14.96 to -0.22]; P = .044). Meta-regression showed that the reduction in IgE was more pronounced with longer follow-up. Probiotics significantly reduced the risk of atopic sensitization when administered prenatally (relative risk: 0.88 [95% CI: 0.78 to 0.99]; P = .035 for positive result on the skin prick test and/or elevated specific IgE to common allergens) and postnatally (relative risk: 0.86 [95% CI: 0.75 to 0.98]; P = .027 for positive result on skin prick test). Administration of Lactobacillus acidophilus, compared with other strains, was associated with an increased risk of atopic sensitization (P = .002). Probiotics did not significantly reduce asthma/wheeze (relative risk: 0.96 [95% CI: 0.85 to 1.07]).
CONCLUSIONS: Prenatal and/or early-life probiotic administration reduces the risk of atopic sensitization and decreases the total IgE level in children but may not reduce the risk of asthma/wheeze. Follow-up duration and strain significantly modified these effects. Future trials for asthma prevention should carefully select probiotic strain and consider longer follow-up.
Author List
Elazab N, Mendy A, Gasana J, Vieira ER, Quizon A, Forno EAuthor
Janvier Gasana MD, MPH, PhD Adjunct Associate Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAsthma
Child
Child, Preschool
Dermatitis, Atopic
Double-Blind Method
Female
Follow-Up Studies
Humans
Immunoglobulin E
Infant
Infant, Newborn
Male
Pregnancy
Probiotics
Randomized Controlled Trials as Topic
Respiratory Hypersensitivity
Risk
Treatment Outcome