Probiotics for allergy prevention

Probiotics, given either as a supplement or in infant foods, have been evaluated in randomised controlled trials for allergy prevention. Here, the aim is to give an overview of the results from these primary prevention studies and to discuss current strategies. In most studies, single strains or a mixture of strains of lactic acid bacteria and bifidobacteria have been used – prenatally, postnatally or perinatally. Several meta-analyses have reported a moderate benefit of probiotics for eczema prevention, and the most consistent effect has been observed with a combined perinatal intervention in infants at high risk of allergic disease due to familial predisposition. In a recent meta-analysis, the use of multi-strain probiotics appeared to be most effective for eczema prevention. No preventive effect has been shown for other allergic manifestations. As long-term follow-up data on later onset allergic conditions (asthma and allergic rhinitis) are available only from a few of the initiated studies, reports from ongoing follow-up studies that are adequately powered to examine long-term outcomes are anticipated to provide more insight. Arguably, the differences in many aspects of study design and the use of different probiotic strains and combinations have made direct comparison difficult. To date, expert bodies do not generally recommend probiotics for allergy prevention, although the World Allergy Organization (WAO) in their recently developed guidelines suggests considering using probiotics in pregnant women, during breastfeeding and/or to the infant if at high risk of developing allergic disease (based on heredity). However, in concordance with other expert bodies, the WAO guideline panel stressed the low level of evidence and the need for adequately powered randomised controlled trials and a more standardised approach before clinical recommendations on specific strains, dosages and timing can be given.