Soh SE, Aw M, Gerez I, et al. Clin Exp Allergy. 2009;39(4):571–578
PURPOSE OF THE STUDY. To determine the effect of probiotic supplementation from birth to 6 months of age on eczema and allergic sensitization at 1 year of age in Asian infants at risk of allergic disease.
STUDY POPULATION. A total of 253 infants with a family history of allergic disease, defined as having a first-degree relative with doctor-diagnosed asthma, allergic rhinitis, or eczema, and positive skin-prick test result to dust mite, were voluntarily recruited prenatally at the clinics at the National University Hospital, Singapore, between May 2004 and June 2006.
METHODS. The subjects were randomly assigned to receive ≥60 mL/day of commercially available cow's milk–based formula either with or without probiotic supplementation from birth to the age of 6 months. The probiotics used were Bifidobacterium longum (107 colony-forming units per g) and Lactobacillus rhamnosus (2 × 108 colony-forming units per g). The primary outcome was eczema (pruritic rash with chronic relapsing course), and the secondary outcome was allergen sensitization. Questionnaires and pediatrician evaluations were performed at 1, 3, 6, and 12 months. The scoring atopic dermatitis index was used to objectively define the severity of atopic dermatitis. Skin-prick tests (to soy, milk, egg yolk, egg white, and 2 locally prevalent dust mites) were performed at the 12-month visit. The 2 outcomes were compared by using χ2 tests, and logistic regression was used to calculate the odds ratio and to adjust for potential confounders (gender, birth order, prenatal smoking exposure, and feeding history).
RESULTS. The incidence of eczema in the probiotic group (22%) was similar to that in the placebo group (25%) (odds ratio: 0.8 [95% confidence interval: 0.4–1.5]). Severity among those with eczema according to the scoring atopic dermatitis index was not significantly different (P = .17). The rate of sensitization at 1 year showed no difference between the 2 groups (24% [probiotic group] vs 19% [placebo]).
CONCLUSIONS. The results of this study do not support the role of early-life probiotic supplementation as a modality for primary eczema prevention.
REVIEWERS COMMENTS. Studies examining the effect of probiotics on atopy prevention or treatment have shown results ranging from negative (increased wheeze and allergic sensitization with probiotics) to neutral and to positive. Differences between these various studies include characteristics of the study population, probiotic strains and doses used and treatment length, and use of prenatal probiotic supplementation. Attention to these details will be required to draw conclusions about the efficacy of probiotics for prevention/treatment of atopic disease. For now, it seems that the jury is still out. It should be noted that this study used a standard whole-protein cow's milk formula, rather than a hydrolyzed type that would be recommended for atopy prevention in nonbreastfeeding infants at high risk.
- Copyright © 2009 by the American Academy of Pediatrics