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Probiotic administration in early life, atopy, and asthma: a meta-analysis of clinical trials. Pediatrics 2013 Sep;132(3):e666-76

Date

08/21/2013

Pubmed ID

23958764

DOI

10.1542/peds.2013-0246

Scopus ID

2-s2.0-84884562690 (requires institutional sign-in at Scopus site)   230 Citations

Abstract

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 E

Author

Janvier Gasana MD, MPH, PhD Adjunct Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Asthma
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