PURPOSE OF THE STUDY.
To evaluate the prevalence of allergen sensitization and development of allergic diseases in high-risk infants following prenatal and postnatal probiotic supplementation.
The study population included 191 pregnant women with atopic diseases determined by history, total immunoglobulin E (IgE) concentration >100 kU/L, and/or positive specific IgE concentration >0.7 kU/L for at least 1 of the following: Dermatophagoides pteronyssinus, cockroach, egg white, milk protein, shrimp, or peanut.
Pregnant mothers were assigned to receive Lactobacillus GG (LGG) or placebo, daily, from 24 weeks’ gestation until delivery. After delivery, breastfeeding mothers and non-breastfeeding infants received LGG for 6 months. Questionnaires regarding allergic symptoms, total IgE levels, and allergen-specific IgE levels were obtained in mothers at enrollment and delivery. Clinical assessments, total IgE levels, and allergen-specific IgE levels were obtained in children at 0 (cord blood), 6, 18, and 36 months of age. Primary outcome measures assessed point and cumulative prevalence for allergic symptoms and diseases in children with allergen sensitization and IgE-associated diseases at 6, 18, and 36 months. Paired studies of cytokine profiles before and after LGG administration were assessed for interleukin (IL)-10, IL-13, IL-12p70, interferon-γ, inducible protein-10, and transforming growth factor-β.
No significant effects of probiotic supplementation on allergic sensitization in children, development of allergic diseases in children, or maternal IgE levels were found. Maternal symptoms of allergic rhinitis improved in 60% of the LGG group and 34% of the placebo group. No symptomatic improvement of gastrointestinal allergy or eczema was demonstrated. Maternal allergic symptom improvement was most prominent in women with initial total IgE >100 kU/L. Symptom improvement was associated with increased IL-12p70 levels, irrespective of LGG or placebo administration.
Administration of LGG from 24 weeks’ gestation reduced severity of maternal atopy but did not prevent childhood sensitization or allergic disease. Increases in IL-12p70 levels in mothers with clinical improvement suggest that LGG improved maternal atopy by enhancing T helper 1 cell expression rather than decreasing IgE production.
Several recent studies have investigated prenatal and postnatal probiotic treatment of prevention of allergic diseases, with varying conclusions. Variable periods of probiotic administration, different probiotic supplements, different populations, and different methodologies complicate comparison. Further studies demonstrating both safety and efficacy are necessary before prenatal and postnatal probiotic supplementation can be recommended for prevention of childhood allergic diseases.
- Copyright © 2013 by the American Academy of Pediatrics