A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age

Abstract

Background: Oligosaccharides may alter postnatal immune development by influencing the constitution of gastrointestinal bacterial flora. Aims: To investigate the effect of a prebiotic mixture of galacto-and long chain fructo-oligosaccharides on the incidence of atopic dermatitis (AD) during the first six months of life in formula fed infants at high risk of atopy. Methods: Prospective, double-blind, randomised, placebo controlled trial; 259 infants at risk for atopy were enrolled. A total of 102 infants in the prebiotic group and 104 infants in the placebo group completed the study. If bottle feeding was started, the infant was randomly assigned to one of two hydrolysed protein formula groups (0.8 g/100 ml prebiotics or maltodextrine as placebo). All infants were examined for clinical evidence of atopic dermatitis. In a subgroup of 98 infants, faecal flora was analysed. Results: Ten infants (9.8%; 95 CI 5.4-17.1%) in the intervention group and 24 infants (23.1%; 95 CI 16.0-32.1%) in the control group developed AD. The severity of the dermatitis was not affected by diet. Prebiotic supplements were associated with a significantly higher number of faecal bifidobacteria compared with controls but there was no significant difference in lactobacilli counts. Conclusion: Results show for the first time a beneficial effect of prebiotics on the development of atopic dermatitis in a high risk population of infants. Although the mechanism of this effect requires further investigation, it appears likely that oligosaccharides modulate postnatal immune development by altering bowel flora and have a potential role in primary allergy prevention during infancy.

Prebiotic‐supplemented partially hydrolysed cow's milk formula for the prevention of eczema in high‐risk infants: a randomized controlled trial

“…These findings contrast with some previous studies suggesting that hydrolysed formula or prebiotics alone may reduce eczema risk in formula‐fed infants 4, 5, 6, 7. We also found no effect on total or specific IgE levels, or a range of other immune markers at 6 months.…”

“…Consistent with the negative study, our data failed to demonstrate a protective effect of partially hydrolysed prebiotic‐supplemented infant formula against eczema incidence. Two previous trials evaluated an oligosaccharide mixture for eczema prevention, one comparing a standard cow's milk formula with or without the same prebiotics as our study, but in a low risk cohort 4, one comparing an extensively hydrolysed formula with or without prebiotics in a high‐risk population. The two studies found similar reductions in eczema incidence over the first year of life in the prebiotic‐supplemented groups 4, 5, 6.…”

“…Observational studies suggest that specific variations in early diet may be associated with allergic outcomes 3. Intervention trials in formula‐fed infants have found reduced eczema risk when formula is supplemented with a specific oligosaccharide mix 4, 5, 6. There is inconsistent evidence that partially hydrolysed formula reduces eczema risk compared with intact cow's milk formula in high‐risk infants 7, 8, 9.…”

Do prebiotics reduce the number of fever episodes in healthy children in their first year of life: a randomised controlled trial

“…Studies have suggested a role of prebiotics in the prevention of atopic dermatitis (17,20,28) (http://www.cdc.gov/asthma).…”

Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics

“…Similarly, utilization of prebiotics might also reduce blood ammonia levels and improve psychometric tests in patients with hepatic encephalopathy 65 , presum ably through the formation of relevant bacterial metabo lites. Study findings suggest that prebiotics can reduce the development or severity of atopic dermatitis and eczema in children, presumably mediated by alterations to bac terial growth and interactions with the developing immune system, beginning in the gut 66,67 . The ability to increase water retention on the skin and reduce erythema formation is an emerging attribute of GOS ingestion, as reported in mouse studies 68 .…”