Lactobacillus rhamnosus GG in the Primary Prevention of Eczema in Children: A Systematic Review and Meta-Analysis

Abstract

Current guidelines recommend the use of probiotics to reduce the risk of eczema. It remains unclear which strain(s) to use. We systematically evaluated data on the efficacy of Lactobacillus rhamnosus GG (LGG) supplementation prenatally and/or postnatally for the primary prevention of eczema. The Cochrane Library, MEDLINE, and EMBASE databases were searched up to August 2018, with no language restrictions, for systematic reviews of randomized controlled trials (RCTs) and RCTs published afterwards. The primary outcome was eczema. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). A random-effects model was used to pool data. Heterogeneity was explored using the I2 statistics. The GRADE criteria were used to assess the overall quality of evidence supporting the primary outcome. Seven publications reporting 5 RCTs (889 participants) were included. 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. It does not support the general recommendation to use probiotics for preventing eczema, unless specific strains would be indicated.

Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children – a 2019 update

“…Lastly, the use of a specific probiotic strain may not lead to reproducible results, as the manufacturing environment and processing of the product, as well as the matrix, may have an effect on the efficacy of the bacterial strain studied. Indeed, this may be the reason why one RCT has shown that L rhamnosus GG is efficacious in the primary prevention of allergy, while later studies were not able to replicate these results, including a study done in a different country with the exact same methodology …”

Microbial and Nutritional Programming—The Importance of the Microbiome and Early Exposure to Potential Food Allergens in the Development of Allergies

“…The authors emphasize that the recommendations are conditional and depend on the results of the further research. Recently, Szajewska and Horvath published a meta-analysis of randomized double blind placebo controlled studies, which presented that pre- and/or postnatal supplementation with Lactobacillus rhamnosus GG strain does not affect the occurrence of atopic dermatitis, and this strain should not be recommended in allergy prevention [ 61 ]. However, it is necessary to remember that probiotic effects are both strain- and population-specific.…”

<p>Randomized Clinical Trial Examining the Impact of <em>Lactobacillus rhamnosus</em> GG Probiotic Supplementation on Cognitive Functioning in Middle-aged and Older Adults</p>

“…These benefits emerged despite no difference in dropout rates between study arms, suggesting that Lactobacillus rhamnosus GG was well-tolerated and had no deleterious impact on health, consistent with past work. [87][88][89] Should these findings be replicated in larger and clinical samples including persons with diagnosed neurodegenerative and neuropsychiatric conditions, probiotic supplementation may ultimately prove to be a low-risk and cost-effective approach to promote cognitive health in older adults.…”