Abstract
Allergic diseases have been linked to genetic and/or environmental factors, such as antibiotic use, westernized high fat and low fiber diet, which lead to early intestinal dysbiosis, and account for the rise in allergy prevalence, especially in western countries. Allergic diseases have shown reduced microbial diversity, including fewer lactobacilli and bifidobacteria, within the neonatal microbiota, before the onset of atopic diseases. Raised interest in microbiota manipulating strategies to restore the microbial balance for atopic disease prevention, through prebiotics, probiotics, or synbiotics supplementation, has been reported. We reviewed and discussed the role of prebiotics and/or probiotics supplementation for allergy prevention in infants. We searched PubMed and the Cochrane Database using keywords relating to “allergy” OR “allergic disorders,” “prevention” AND “prebiotics” OR “probiotics” OR “synbiotics.” We limited our evaluation to papers of English language including children aged 0–2 years old. Different products or strains used, different period of intervention, duration of supplementation, has hampered the draw of definitive conclusions on the clinical impact of probiotics and/or prebiotics for prevention of allergic diseases in infants, except for atopic dermatitis in infants at high-risk. This preventive effect on eczema in high-risk infants is supported by clear evidence for probiotics but only moderate evidence for prebiotic supplementation. However, the optimal prebiotic or strain of probiotic, dose, duration, and timing of intervention remains uncertain. Particularly, a combined pre- and post-natal intervention appeared of stronger benefit, although the definition of the optimal intervention starting time during gestation, the timing, and duration in the post-natal period, as well as the best target population, are still an unmet need.
Highlights
Allergic diseases represent a medical challenge and a worldwide burden, in particular in the most developed countries, where the frequency of affected subjects overcome 30% and is still growing [1, 2]
Mothers: during breast-feeding Infants: from 6 to 18 months of age Consumption of probiotic milk in pregnancy 36 months was associated with a slightly reduced risk [(adjusted recurrent wheeze or asthma (RR)] of atopic eczema at 6 months aRR=0.94 and of rhinoconjuctivitis between 18 and 36 months, aRR=0.87; the adjusted relative risk of rhinoconjunctivitis was aRR=0.80 when both mother and infant had consumed probiotic milk
Reviews, and meta-analyses, and several guidelines are available on this topic, the overall preventive effect of prebiotic/probiotic supplementation on allergic diseases remains unclear
Summary
Allergic diseases represent a medical challenge and a worldwide burden, in particular in the most developed countries, where the frequency of affected subjects overcome 30% and is still growing [1, 2]. In a longitudinal cohort study enrolling 259 high-risk infants, Moro et al [80] found that a hydrolyzed protein cow’s milk-based formula supplemented with 90% scGOS−10% lcFOS, (8g/L) significantly reduced AD at the age of 6 months [intervention group: 9.8 vs 23.1% placebo group (P < 0.05)] and increased the number of fecal bifidobacteria.
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