Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial Early Probiotic Supplementation for Eczema and Asthma Prevention: A Randomized Controlled Trial A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. An Evaluation of the Ability of the Probiotic Strain Lactobacillus rhamnosus GG to Eliminate the Gastrointestinal Carrier State of Vancomycin-resistant Enterococci in Colonized Children Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial.
Perinatal administration of the probiotic Lactobacillus rhamnosus strain GG ( ATCC 53103 ) , reduces incidence of atopic eczema in at-risk children during the first 2 years of life ( infancy ) . We have therefore assessed persistence of the potential to prevent atopic eczema at 4 years . Atopic disease was diagnosed on the basis of a question naire and a clinical examination . 14 of 53 children receiving lactobacillus had developed atopic eczema , compared with 25 of 54 receiving placebo  ( relative risk 0.57 , 95 % CI 0.33 - 0.97 ) . Skin prick test reactivity was the same in both groups : ten of 50 children previously given lactobacillus compared with nine of 50 given placebo tested positive . Our results suggest that the preventive effect of lactobacillus GG on atopic eczema extends beyond infancy In this r and omized controlled trial , we examined the effect of early LGG infant supplementation in decreasing the risk of childhood eczema .  OBJECTIVES : To determine if probiotic administration during the first 6 months of life decreases  childhood asthma and eczema . METHODS : We conducted a r and omized , double-blind controlled trial of Lactobacillus rhamnosus GG ( LGG ) supplementation on the cumulative incidence of eczema ( primary end point ) and  asthma and rhinitis  ( secondary end points ) in high-risk infants . For the first 6 months of life , intervention infants ( n = 92 ) received a daily dose of 10 billion colony-forming units of LGG and 225 mg of inulin ( Amerifit Br and s , Cromwell , CT ) , and control infants ( n = 92 ) received 325 mg of inulin alone . We used survival analysis methods to estimate disease incidences in the presence or absence of LGG and to estimate the efficacy of LGG in delaying or preventing these diseases . RESULTS : Infants were accrued over a 6-year period ( median follow-up : 4.6 years ; 95 % retention rate at 2 years ) . At 2 years of age , the estimated cumulative incidence of eczema was 30.9 % ( 95 % confidence interval [ CI ] , 21.4%–40.4 % ) in the control arm and 28.7 % ( 95 % CI , 19.4%–38.0 % ) in the LGG arm , for a hazard ratio of 0.95 ( 95 % CI , 0.59–1.53 ) ( log-rank P = .83 ) . At 5 years of age , the cumulative incidence of asthma was 17.4 % ( 95 % CI , 7.6%–27.1 % ) in the control arm and 9.7 % ( 95 % CI , 2.7%–16.6 % ) in the LGG arm , for a hazard ratio of 0.88 ( 95 % CI , 0.41–1.87 ) ( log-rank P = .25 ) . CONCLUSIONS : For high-risk infants , early LGG supplementation for the first 6 months of life does not appear to prevent the development of eczema or asthma at 2 years of age BACKGROUND The role of probiotics in prevention of allergic disease is still not clearly established , although early reports suggested Lactobacillus GG halved the risk of eczema at 2 years . OBJECTIVE To determine whether probiotic supplementation in early life could prevent development of eczema and atopy at 2 years . METHODS Double-blind , r and omized placebo-controlled trial of infants at risk of allergic disease . Pregnant women were r and omized to take Lactobacillus rhamnosus HN001 ( L rhamnosus ) , Bifidobacterium animalis subsp lactis strain HN019 or placebo daily from 35 weeks gestation until 6 months if breast-feeding , and their infants were r and omized to receive the same treatment from birth to 2 years ( n = 474 ) . The infant 's cumulative prevalence of eczema and point prevalence of atopy , using skin prick tests to common allergens , was assessed at 2 years . RESULTS Infants receiving L rhamnosus had a significantly ( P = .01 ) reduced risk of eczema ( hazard ratio [ HR ] , 0.51 ; 95 % CI , 0.30 - 0.85 ) compared with placebo , but this was not the case for B animalis subsp lactis ( HR , 0.90 ; 95 % CI , 0.58 - 1.41 ) . There was no significant effect of L rhamnosus ( HR , 0.74 ; 95 % CI , 0.46 - 1.18 ) or B animalis subsp lactis ( HR , 0.82 ; 95 % CI , 0.52 - 1.28 ) on atopy . L rhamnosus ( 71.5 % ) was more likely than B animalis subsp lactis ( 22.6 % ) to be present in the feces at 3 months , although detection rates were similar by 24 months . CONCLUSION We found that supplementation with L rhamnosus , but not B animalis subsp lactis , substantially reduced the cumulative prevalence of eczema , but not atopy , by 2 years . Underst and ing how Lactobacilli act to prevent eczema requires further investigation BACKGROUND Reversal of the progressive increase in frequency of atopic disease would be an important breakthrough for health care and wellbeing in western societies . In the hygiene hypothesis this increase is attributed to reduced microbial exposure in early life . Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora . We assessed the effect on atopic disease of Lactobacillus GG ( which is safe at an early age and effective in treatment of allergic inflammation and food allergy ) . METHODS In a double-blind , r and omised placebo-controlled trial we gave Lactobacillus GG prenatally to mothers who had at least one first-degree relative ( or partner ) with atopic eczema , allergic rhinitis , or asthma , and postnatally for 6 months to their infants .  Chronic recurring atopic eczema , which is the main sign of atopic disease in the first years of life , was the primary endpoint . FINDINGS  Atopic eczema was diagnosed in 46 of 132 ( 35 % ) children aged 2 years . Asthma  was diagnosed in six of these children and allergic rhinitis in one . The frequency of atopic eczema in the probiotic group was half that of the placebo group ( 15/64 [ 23 % ] vs 31/68 [ 46 % ] ; relative risk 0.51 [ 95 % CI 0.32 - 0.84 ] ) . The number needed to treat was 4.5 ( 95 % CI 2.6 - 15.6 ) . INTERPRETATIONS Lactobacillus GG was effective in prevention of  early atopic disease in children at high risk . Thus , gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics , for prevention of atopic disease BACKGROUND Probiotics have shown promising potential in reducing the risk of eczema in infants . Optimal probiotic intervention regimen remains to be determined . OBJECTIVE We investigated whether maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of developing eczema in high-risk infants . METHODS This was a parallel , double-blind placebo-controlled trial of 241 mother-infant pairs . Mothers with allergic disease and atopic sensitization were r and omly assigned to receive ( 1 ) Lactobacillus rhamnosus LPR and Bifidobacterium longum BL999 ( LPR+BL999 ) , ( 2 ) L paracasei ST11 and B longum BL999 ( ST11+BL999 ) , or ( 3 ) placebo , beginning 2 months before delivery and during the first 2 months of breast-feeding . The infants were followed until the age of 24 months . Skin prick tests were performed at the ages of 6 , 12 , and 24 months . RESULTS Altogether 205 infants completed the follow-up and were included in the analyses . The risk of developing eczema during the first 24 months of life was significantly reduced in infants of mothers receiving LPR+BL999 ( odds ratio [ OR ] , 0.17 ; 95 % CI , 0.08 - 0.35 ; P < .001 ) and ST11+BL999 ( OR , 0.16 ; 95 % CI , 0.08 - 0.35 ; P < .001 ) . The respective ORs for chronically persistent eczema were 0.30 ( 95 % CI , 0.12 - 0.80 ; P = .016 ) and 0.17 ( 95 % CI , 0.05 - 0.56 ; P = .003 ) . Probiotics had no effect on the risk of atopic sensitization in the infants . No adverse effects were related to the use of probiotics . CONCLUSION Prevention regimen with specific probiotics administered to the pregnant and breast-feeding mother , that is , prenatally and postnatally , is safe and effective in reducing the risk of eczema in infants with allergic mothers positive for skin prick test Goals : To evaluate the efficacy of Lactobacillus rhamnosus GG ( LGG ) supplementation in eliminating the gastrointestinal carrier state of vancomycin-resistant enterococci ( VRE ) in colonized children , and to evaluate the affect of the probiotic on Lactobacillus spp . counts in the gastrointestinal tract . Study : A r and omized , single-blind , placebo-controlled study . Children ( 0 to 18 y old ) hospitalized at the wards of the children ’s hospital who were diagnosed with gastrointestinal carrier state of VRE were r and omized to group receiving 3 billion colony forming unit of  LGG/day or placebo for 21 consecutive days . A total of 61 children completed the study ( 32 in the treatment group and 29 in the control group ) . Rectal swabs for VRE and Lactobacillus spp . were collected at baseline , during supplementation at weekly intervals and 1 month after supplementation . Antibiotic supply was controlled throughout the duration of the analysis . Results : A significant difference in the number of children colonized with VRE between the groups was observed at 3 weeks ( P=0.002 ) . The VRE carrier state was lost by 20 of 32 participants in the treatment group and 7 of 29 in the control group . We also observed increased gastrointestinal counts of Lactobacillus spp . in children receiving LGG . A statistically significant difference in the occurrence of bacteria was observed from week 1 onwards , whereas in the aspect of growth intensity from week 2 onwards . Conclusions : LGG supplementation temporarily eliminates the VRE carrier state and increases gastrointestinal counts of Lactobacillus spp . in children versus placebo Controversy exists regarding the preventive effect of probiotics on the development of  eczema or atopic dermatitis .  We investigated whether supplementation of probiotics prevents the development of  eczema in infants at high risk . In a r and omized , double-blind , placebo-controlled trial , 112 pregnant women with a family history of allergic diseases received a once-daily supplement , either a mixture of Bifidobacterium bifidum BGN4 , B. lactis AD011 , and Lactobacillus acidophilus AD031 , or placebo , starting at 4 - 8 wks before delivery and continuing until 6 months after delivery . Infants were exclusively breast-fed during the first 3 months , and were subsequently fed with breastmilk or cow 's milk formula from 4 to 6 months of age . Clinical symptoms of the infants were monitored until 1 yr of age , when the total and specific IgE against common food allergens were measured . A total of 68 infants completed the study . The prevalence of eczema at 1 yr in the probiotic group was significantly lower than in the placebo group ( 18.2 % vs. 40.0 % , p=0.048 ) . The cumulative incidence of eczema during the first 12 months was reduced significantly in probiotic group ( 36.4 % vs. 62.9 % , p=0.029 ) ; however , there was no difference in serum total IgE level or the sensitization against food allergens between the two groups . Prenatal and postnatal supplementation with a mixture of B. bifidum BGN4 , B. lactis AD011 , and L. acidophilus AD031 is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life BACKGROUND Although recent reports suggest that supplementation with probiotics may enhance intestinal function in premature infants , the mechanisms are unclear , and questions remain regarding the safety and efficacy of probiotics in extremely low-birth-weight infants . OBJECTIVE The objective was to evaluate the efficacy of probiotics on the digestive tolerance to enteral feeding in preterm infants born with a very low or extremely low birth weight . DESIGN In a bicentric , double-blind , r and omized controlled clinical trial that was stratified for center and birth weight , 45 infants received enteral probiotics ( Bifidobacterium longum BB536 and Lactobacillus rhamnosus GG ; BB536-LGG )  and 49 received placebo .  The primary endpoint was the percentage of infants receiving > 50 % of their nutritional needs via enteral feeding on the 14th day of life . A triangular test was used to perform sequential analysis . RESULTS The trial was discontinued after the fourth sequential analysis concluded a lack of effect . The primary endpoint was not significantly different between the probiotic ( 57.8 % ) and placebo ( 57.1 % ) groups ( P = 0.95 ) . However , in infants who weighed > 1000 g , probiotic supplementation was associated with a shortening in the time to reach full enteral feeding ( P = 0.04 ) . Other than colonization by the probiotic strains , no alteration in the composition of intestinal microbiota or changes in the fecal excretion of calprotectin was observed . No colonization by probiotic strains was detected in infants who weighed < or = 1000 g , presumably because of more frequent suspensions of enteral feeding , more courses of antibiotic treatment , or both . CONCLUSIONS Supplementation with BB536-LGG may not improve the gastrointestinal tolerance to enteral feeding in very-low-birth-weight infants but may improve gastrointestinal tolerance in infants weighing > 1000 g. This trial was registered at clinical trials.gov as NCT 00290576
High to moderate certainty in the body of evidence suggests that LGG supplementation ( regardless of the timing of administration ) did not reduce the risk of eczema .
There was also no consistent effect on other allergic outcomes .
This meta- analysis shows that LGG was ineffective in reducing eczema .
Current guidelines recommend the use of probiotics to reduce the risk of  eczema .
It remains unclear which strain(s ) to use .
We systematic ally evaluated data on the efficacy of Lactobacillus rhamnosus GG ( LGG ) supplementation prenatally and /or postnatally for the primary prevention of eczema .