Prevention of Atopic Eczema: A Dream Not So Far Away?

Williams, Hywel C

doi:10.1001/archderm.138.3.391

Cited by 11 publications

(5 citation statements)

References 11 publications

(7 reference statements)

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“…A significant proportion of cases of allergy related diseases occur in children who are otherwise considered not to be at “high risk” and therefore primary prevention strategies must also be assessed in general populations [ 30 ]. This long term follow-up of the ProPACT trial is an important addition to the literature concerning probiotics in the prevention of allergic disease as one of few studies to recruit participants from a general population [ 7 , 8 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial

et al. 2015

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BackgroundPerinatal probiotics supplementation has been shown to be effective in the primary prevention of atopic dermatitis (AD) in early childhood, although the long term effects of probiotics on AD and other allergic diseases is less certain. We have previously reported a significant reduction in the cumulative incidence of AD at 2 years after maternal probiotic supplementation. In this study we present the effects of perinatal probiotics given to women from a general population on allergy related diseases in their offspring at 6 years.MethodsFour hundred and fifteen pregnant women were randomised to receive probiotic or placebo milk in a double-blinded trial from 36 week gestation until 3 months postpartum. Probiotic milk contained Lactobacillus rhamnosos GG, L. acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12. At 6 years, children were re-assessed for AD, atopic sensitisation, asthma and allergic rhinoconjunctivitis (ARC).ResultsAt 6 years, 81 and 82 children were assessed for AD in the probiotic and placebo groups, respectively. In a multiple imputation analysis, there was as trend towards a lower cumulative incidence of AD in the probiotic group compared to the placebo group (OR 0.64, 95 % CI 0.39-1.07, p = 0.086; NNT = 10). This finding was statistically significantly in the complete case analysis (OR 0.48, 95 % CI 0.25-0.92, p = 0.027, NNT = 6). The prevalence of asthma and atopic sensitisation, and the cumulative incidence of ARC were not significantly affected by the probiotic regime at 6 years of age.ConclusionsMaternal probiotic ingestion alone may be sufficient for long term reduction in the cumulative incidence of AD, but not other allergy related diseases.Trial registrationClinicalTrials.gov identifier: NCT00159523Electronic supplementary materialThe online version of this article (doi:10.1186/s12895-015-0030-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial

et al. 2015

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“…The mechanisms for the possible preventive effects of probiotics are unclear 13 . Because of the lack of change in atopic sensitization in these studies, and because a large proportion of all cases of AD develops in ‘low‐risk’ groups, Williams pointed out the need for a study involving children both with and without a family history of atopy 14 . Furthermore, the increase in allergic diseases has been suggested to be greatest among those without a family history of atopy 15 .…”

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confidence: 99%

Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial

Dotterud

Storrø

Johnsen

et al. 2010

British Journal of Dermatology

251

258

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SummaryBackground Previous reports have suggested that certain probiotics given to mothers and children at risk of atopy halves the incidence of atopic dermatitis (AD) at 2 years of age. Objectives To examine if probiotics given to pregnant women in a nonselected population could prevent atopic sensitization or allergic diseases during the child's first 2 years. Methods In a randomized, double-blind trial of children from a nonselected maternal population (ClinicalTrials.gov identifier: NCT00159523), women received probiotic milk or placebo from 36 weeks of gestation to 3 months postnatally during breastfeeding. The probiotic milk contained Lactobacillus rhamnosus GG, L. acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12. Children with an itchy rash for more than 4 weeks were assessed for AD. At 2 years of age, all children were assessed for atopic sensitization, AD, asthma and allergic rhinoconjunctivitis. The intention-to-treat (ITT) analysis was enabled by multiple imputations. Results Four hundred and fifteen pregnant women were computer randomized. At 2 years, 138 and 140 children in the probiotic and the placebo groups, respectively, were assessed. In the ITT analysis, the odds ratio (OR) for the cumulative incidence of AD was 0AE51 in the probiotic group compared with the placebo [95% confidence interval (CI) 0AE30-0AE87; P = 0AE013]. There were no significant effects on asthma (OR 0AE68, 95% CI 0AE26-1AE80; P = 0AE437) or atopic sensitization (OR 1AE52, 95% CI 0AE74-3AE14; P = 0AE254). Conclusions Probiotics given to nonselected mothers reduced the cumulative incidence of AD, but had no effect on atopic sensitization.

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“…This protective effect was also seen at a four‐year follow‐up study (38). These are intriguing results but are tempered by several shortcomings of the study such as poor disease definitions, unclear randomization methods, and a glaring absence of an intent‐to‐treat analysis (39). Safety concerns have emerged, including reports of septicemia and liver abscesses primarily occurring in immunocompromised patients (40).…”

Section: Probioticsmentioning

confidence: 99%

“…The Health Technology Assessment of Atopic Dermatitis, an evidenced‐based review of atopic dermatitis treatments published in 2000, revealed that only 7% of controlled trials of atopic dermatitis treatment addressed disease prevention (1). The committee made an “urgent call” for more prevention research as part of its conclusions (1,2). Despite many years of research, primarily in the field of allergen avoidance, there remains no generally accepted primary prevention strategy for atopic dermatitis.…”

Section: Introductionmentioning

confidence: 99%

Atopic dermatitis prevention

Simpson

2006

Dermatol Ther

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A shift in focus from disease therapy toward disease prevention is occurring in many medical specialties, including dermatology. There are no generally accepted strategies for the prevention of atopic dermatitis. Most research has focused on allergen avoidance and has not produced consistently effective interventions. Immune cell modulation and skin barrier protection are examples of new approaches that hold promise for preventing, or modifying the course of, this common disease.

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Prevention of Atopic Eczema: A Dream Not So Far Away?

Cited by 11 publications

References 11 publications

Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial

Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial

Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial

Atopic dermatitis prevention

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