Skip to main content

Probiotic Supplementation for Prevention of Atopic Dermatitis in Infants and Children: A Systematic Review and Meta-analysis

American Journal of Clinical Dermatology volume 20, pages 367–377 (2019)Cite this article

Abstract

Background

Probiotic supplementation in early life may be effective in preventing atopic dermatitis (AD); however, results regarding efficacy have been controversial.

Objective

The aim of our study was to investigate the effect of probiotic supplementation on the risk of AD.

Methods

We systematically searched PubMed, EBSCO, Embase and Web of Science databases up to 8 March 2018 for potentially relevant studies regarding probiotic supplementation and AD. Included infants and children were those with probiotic exposure in utero and/or after birth who were not previously diagnosed with AD. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) and used the Jadad and Newcastle–Ottawa scales to assess methodologic quality.

Results

A total of 28 studies met the inclusion criteria. Compared with controls, probiotic treatment was associated with a reduced risk of AD (OR 0.69; 95% CI 0.58–0.82, P < 0.0001). The use of probiotics during both the prenatal and the postnatal period significantly reduced the incidence of AD (OR 0.67; 95% CI 0.54–0.82); however, analysis of studies of probiotics given prenatally only or postnatally only did not reach statistical significance.

Conclusions

Our meta-analysis showed that probiotic supplementation during both the prenatal and the postnatal period reduced the incidence of AD in infants and children. Our findings suggest that starting probiotic treatment during gestation and continuing through the first 6 months of the infant’s life may be of benefit in the prevention of AD.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

49,54 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Legatzki A, Roler B, von Mutius ME. Microbiome diversity and asthma and allergy risk. Curr Allergy Asthma Rep. 2014;14:466.

    Article  CAS  PubMed  Google Scholar 

  2. Leung DY, Bieber T. Atopic dermatitis. Lancet. 2003;361:151–60.

    Article  PubMed  Google Scholar 

  3. Ege MJ, Bieli C, Frei R, van Strien RT, Riedler J, Ublagger E, et al. Prenatal farm exposure is related to the expression of receptors of the innate immunity and to atopic sensitization in school-age children. J Allergy Clin Immunol. 2006;117:817–23.

    Article  PubMed  Google Scholar 

  4. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357:1076–9.

    Article  CAS  PubMed  Google Scholar 

  5. Abrahamsson TR, Jakobsson T, Bottcher MF, et al. Probiotics in prevention of IgE-associated eczema: a doubleblind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119:1174–80.

    Article  CAS  PubMed  Google Scholar 

  6. Kuitunen M, Kukkonen K, Juntunen-Backman K, Korpela R, Poussa T, Tuure T, et al. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. J Allergy Clin Immunol. 2009;123:335–41.

    Article  PubMed  Google Scholar 

  7. Huurre A, Laitinen K, Rautava S, Korkeamaki M, Isolauri E. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double blind placebo-controlled study. Clin Exp Allergy. 2008;38:1342–8.

    Article  CAS  PubMed  Google Scholar 

  8. Isolauri E, Arvola T, Sütas Y, Moilanen E, Salminen S. Probiotics in the management of atopic eczema. Clin Exp Allergy. 2000;30:1604–10.

    Article  CAS  PubMed  Google Scholar 

  9. Cabana MD, McKean M, Caughey AB, Fong L, Lynch S, Wong A, et al. Early probiotic supplementation for eczema and asthma prevention: a randomized controlled trial. Pediatrics. 2017;140(3):e20163000.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Allen SJ, Jordan S, Storey M, Thornton CA, Gravenor MB, Garaiova I, et al. Probiotics in the prevention of eczema: a randomised controlled trial. Arch Dis Child. 2014;99(11):1014–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mansfield JA, Bergin SW, Cooper JR, Olsen CH. Comparative probiotic strain efficacy in the prevention of eczema in infants and children: a systematic review and meta-analysis. Mil Med. 2014;179(6):580–92.

    Article  PubMed  Google Scholar 

  12. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  13. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting-Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    Article  CAS  PubMed  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clin Res Ed). 2003;327:557–60.

    Article  Google Scholar 

  15. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–48.

    CAS  PubMed  Google Scholar 

  16. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  17. Munafo MR, Clark TG, Flint J. Assessing publication bias in genetic association studies: evidence from a recent meta-analysis. Psychiatry Res. 2004;129:39–44. https://doi.org/10.1016/j.psychres.2004.06.011.

    Article  PubMed  Google Scholar 

  18. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

    Article  CAS  PubMed  Google Scholar 

  19. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Enomoto T, Sowa M, Nishimori K, Shimazu S, Yoshida A, Yamada K, et al. Effects of bifidobacterial supplementation to pregnant women and infants in the prevention of allergy development in infants and on fecal microbiota. Allergol Int. 2014;63(4):575–85.

    Article  CAS  PubMed  Google Scholar 

  21. Loo EX, Llanora GV, Lu Q, Aw MM, Lee BW, Shek LP. Supplementation with probiotics in the first 6 months of life did not protect against eczema and allergy in at-risk Asian infants: a 5-year follow-up. Int Arch Allergy Immunol. 2014;163(1):25–8.

    Article  PubMed  Google Scholar 

  22. Abrahamsson TR, Jakobsson T, Björkstén B, Oldaeus G, Jenmalm MC. No effect of probiotics on respiratory allergies: a seven-year follow-up of a randomized controlled trial in infancy. Pediatr Allergy Immunol. 2013;24(6):556–61.

    Article  PubMed  Google Scholar 

  23. West CE, Hammarström ML, Hernell O. Probiotics in primary prevention of allergic disease—follow-up at 8–9 years of age. Allergy. 2013;68(8):1015–20.

    Article  CAS  PubMed  Google Scholar 

  24. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. J Allergy Clin Immunol. 2012;130(6):1355–60.

    Article  CAS  PubMed  Google Scholar 

  25. Jensen MP, Meldrum S, Taylor AL, Dunstan JA, Prescott SL. Early probiotic supplementation for allergy prevention: long-term outcomes. J Allergy Clin Immunol. 2012;130(5):1209–11.

    Article  PubMed  Google Scholar 

  26. Wickens K, Black P, Stanley TV, Mitchell E, Barthow C, Fitzharris P, et al. A protective effect of Lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years. Clin Exp Allergy. 2012;42(7):1071–9.

    Article  CAS  PubMed  Google Scholar 

  27. Boyle RJ, Ismail IH, Kivivuori S, Licciardi PV, Robins-Browne RM, Mah LJ, et al. Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial. Allergy. 2011;66(4):509–16.

    Article  CAS  PubMed  Google Scholar 

  28. Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010;21:e386–93.

    Article  PubMed  Google Scholar 

  29. Niers L, Martín R, Rijkers G, Sengers F, Timmerman H, van Uden N, et al. The effects of selected probiotic strains on the development of eczema (the PandA study). Allergy. 2009;64(9):1349–58.

    Article  CAS  PubMed  Google Scholar 

  30. West CE, Hammarström ML, Hernell O. Probiotics during weaning reduce the incidence of eczema. Pediatr Allergy Immunol. 2009;20(5):430–7.

    Article  PubMed  Google Scholar 

  31. Soh SE, Aw M, Gerez I, Chong YS, Rauff M, Ng YP, et al. Probiotic supplementation in the first 6 months of life in at risk Asian infants—effects on eczema and atopic sensitization at the age of 1 year. Clin Exp Allergy. 2009;39(4):571–8.

    Article  CAS  PubMed  Google Scholar 

  32. Wickens K, Black PN, Stanley TV, Mitchell E, Fitzharris P, Tannock GW, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2008;122(4):788–94.

    Article  PubMed  Google Scholar 

  33. Kalliomäki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(4):1019–21.

    Article  PubMed  Google Scholar 

  34. Kukkonen K, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(1):192–8.

    Article  CAS  PubMed  Google Scholar 

  35. Dotterud CK, Storro O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. Br J Dermatol. 2010;163:616–23.

    Article  CAS  PubMed  Google Scholar 

  36. Kopp MV, Hennemuth I, Heinzmann A, Urbanek R. Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention: no clinical effects of Lactobacillus GG supplementation. Pediatrics. 2008;121:e850–6.

    Article  PubMed  Google Scholar 

  37. Allen SJ, Jordan S, Storey M, et al. Probiotics and atopic ECZEMA: a double-blind randomised controlled trial. Arch Dis Child. 2012;97:A2.

    Google Scholar 

  38. Rozé JC, Barbarot S, Butel MJ, Kapel N, Waligora-Dupriet AJ, De Montgolfier I, et al. An (alpha)-lactalbuminenriched and symbiotic-supplemented v a standard infant formula: a multicentre, double-blind, randomised trial. Br J Nutr. 2012;107:1616–22.

    Article  CAS  PubMed  Google Scholar 

  39. Kukkonen AK, Kuitunen M, Savilahti E, Pelkonen A, Malmberg P, Mäkelä M. Airway inflammation in probiotic-treated children at 5 years. Pediatr Allergy Immunol. 2011;22:249–51.

    Article  PubMed  Google Scholar 

  40. Ou CY, Kuo HC, Wang L, Hsu TY, Chuang H, Liu CA, et al. Prenatal and postnatal probiotics reduces maternal but not childhood allergic diseases: a randomized, double-blind, placebo-controlled trial. Clin Exp Allergy. 2012;42:1386–96.

    Article  PubMed  Google Scholar 

  41. Rautava S, Arvilommi H, Isolauri E. Specific probiotics in enhancing maturation of IgA responses in formula-fed infants. Pediatr Res. 2006;60(2):221–4.

    Article  PubMed  Google Scholar 

  42. Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party’s diagnostic criteria for atopic dermatitis III Independent hospital validation. Br J Dermatol. 1994;131:406–16.

    Article  CAS  PubMed  Google Scholar 

  43. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venerol (Stockh). 1980;92:44–7.

    Google Scholar 

  44. Novak N, Yu CF, Bussmann C, Maintz L, Peng WM, Hart J, et al. Putative association of a TLR9 promoter polymorphism with atopic eczema. Allergy. 2007;62:766–72.

    Article  CAS  PubMed  Google Scholar 

  45. He F, Ouwehand AC, Isolauri E, Hashimoto H, Benno Y, Salminen S. Comparison of mucosal adhesion and species identification of Bifidobacteria isolated from healthy and allergic infants. FEMS Immunol Med Microbiol. 2001;30:43–7.

    Article  CAS  PubMed  Google Scholar 

  46. Prescott SL, Wickens K, Westcott L, Jung W, Currie H, Black PN, et al. Supplementation with Lactobacillus rhamnosus or Bifidobacterium lactis probiotics in pregnancy increases cord blood interferon-gamma and breast milk transforming growth factor-beta and immunoglobin A detection. Clin Exp Allergy. 2008;38:1606–14.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the authors of the studies that made up the database for this meta-analysis.

Author information

Affiliations

  1. Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People’s Republic of China

    Lin Li, Zhen Han, Xiaoping Niu, Guozheng Zhang, Yuliang Jia, Shunguo Zhang & Chiyi He

Authors
  1. Lin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhen Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoping Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guozheng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuliang Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shunguo Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chiyi He
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Lin Li conceived and designed the paper. Lin Li, Zhen Han and Xiaoping Niu extracted the data. Yuliang Jia analyzed the data. Guozheng Zhang and Shunguo Zhang contributed materials/analysis tools. Lin Li and Zhen Han contributed to the writing of the manuscript. Chiyi He proofread the manuscript.

Corresponding author

Correspondence to Chiyi He.

Ethics declarations

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Dr. Lin Li, Dr. Zhen Han, Dr. Xiaoping Niu, Dr. Guozheng Zhang, Dr. Yuliang Jia, Dr. Shunguo Zhang and Dr. Chiyi He have no conflicts of interest that are directly relevant to the content of this article.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, L., Han, Z., Niu, X. et al. Probiotic Supplementation for Prevention of Atopic Dermatitis in Infants and Children: A Systematic Review and Meta-analysis. Am J Clin Dermatol 20, 367–377 (2019). https://doi.org/10.1007/s40257-018-0404-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-018-0404-3