Prevention Of Atopic Dermatitis Research Articles

Probiotics and primary prevention of atopic dermatitis: a meta‐analysis of randomized controlled studies

Atopic Dermatitis (AD) has an increasing incidence and the real cause of the disease is not known yet. Probiotics may be involved in AD prevention, but their role is controversial. The purpose of our study was to evaluate the role of probiotics in AD occurrence. We carried out an extensive search on this topic in the international databases (Pubmed, Scopus,Web of knowledge, EBSCO, ARTO, Google Scholar, ClinicalTrials.gov.) selecting only those studies where the role of probiotics in AD occurrence was analysed. For the selected studies we calculated odds ratio (OR) and 95% confidence interval (CIs). Initially, we found 1513 articles, of which only 26 studies fulfilled our criteria. After exclusion of studies on the same populations, 16 studies were included in the final analysis. The meta-analysis of these studies revealed that probiotics administration confers protection against AD occurrence (OR = 0.64, P < 0.001). The subgroup meta-analysis, in general population and population at high risk for allergies, suggested that probiotics administration is protective for AD development in both subgroups (OR = 0.53, P = 0.005; OR = 0.66, P < 0.001). Additional subgroup analysis showed that probiotics prenatal administration followed by postnatal administration was protective (OR = 0.61, P < 0.001) unlike only administration in postnatal period (OR = 0.95, P < 0.82). Finally, the subgroup analysis based on the type of treatment suggested that both Lactobacillus alone and Lactobacillus with Bifidobacterium are protective against AD (OR = 0.70, P = 0.004; OR = 0.62, P < 0.001). Probiotics seem to have a protective role in AD prevention if there are administration in pre and postnatal period in both general and allergic risk population.

Probiotic lactic acid bacteria and their potential in the prevention and treatment of allergic diseases.

Allergy is one of the most important and very common health problems worldwide. To reduce the proportion of people suffering from allergy, alternative methods of prevention and treatment are sought. The aim of this paper is to present the possibilities of probiotics in the prevention and treatment of allergic diseases.Probiotics are live microorganisms belonging mainly to the lactic acid bacteria. They modify the microflora of the human digestive system, especially the intestinal microflora. Prophylactic administration of probiotics in the early stages of life (naturally in breast milk or milk substitute synthetic compounds) is very important because intestinal microflora plays a huge role in the development of the immune system. Prevention of allergies as early as in the prenatal and postnatal periods provides huge opportunities for inhibiting the growing problem of allergy in emerging and highly developed societies. Effects of probiotic therapy depend on many factors such as the species of the microorganism used, the dose size and characteristics of the bacteria such as viability and capacity of adhesion to the intestinal walls. Authors of several studies showed beneficial effects of probiotics in the perinatal period, infancy, and also in adults in the prevention of atopic dermatitis or allergic rhinitis.Probiotics, due to their immunomodulatory properties and safety of use are a good, natural alternative for the prevention and treatment of many diseases including allergies. It is therefore important to explore the knowledge about their use and to carry out further clinical trials.

New approaches to the prevention of childhood atopic dermatitis

There has been a steep rise in the burden of atopic dermatitis (AD), and up to 20% of children in developed countries now suffer of the disease. At present, treatment at best achieves symptom control rather than cure, and there is a strong need to identify new methods of disease prevention. While earlier approaches focused on allergen avoidance strategies, there has been a clear shift towards attempts to induce tolerance and enhancement of skin barrier function, as skin barrier breakdown plays an important role in AD development. This article reviews the latest developments in the prevention of AD.

20-O-β-d-glucopyranosyl-20(S)-protopanaxadiol-fortified ginseng extract attenuates the development of atopic dermatitis-like symptoms in NC/Nga mice

Ethnopharmacological relevanceGinseng and ginsenosides are frequently used in the treatment of chronic inflammatory diseases. Recently, 20-O-β-d-glucopyranosyl-20(S)-protopanaxadiol (GPD), the main metabolite of ginsenosides, was reported to have both anti-allergic and anti-pruritic effects. The immunomodulatory effects of GPD-fortified ginseng extract (GFGE) on atopic dermatitis (AD)-like symptoms in mice were investigated. This study was designed to investigate the preventive effect of GFGE on AD-like symptoms. Materials and methodsThe effects of orally administered GFGE on Dermatophagoides farinae body extract (DFE)-induced AD-like symptoms in NC/Nga mice were assessed by analyzing dermatitis score, ear thickness, scratching time, skin histological changes, and serum level of macrophage-derived chemokine (MDC). In addition, splenocytes were isolated from the mice and stimulated with anti-CD3 and anti-CD28 monoclonal antibodies to produce cytokines. ResultsOral administration of GFGE significantly attenuated DFE-induced increases in dermatitis score, ear thickness, scratching time, and severity of skin lesions in NC/Nga mice. GFGE treatment also reduced level of MDC in serum, infiltration of eosinophils and mast cells in skin, and production of cytokines in splenocytes. ConclusionsThese results suggest that GFGE might ameliorate DFE-induced AD-like symptoms and be an alternative therapeutic agent for the prevention of AD.

Lactobacillus bifermentans로 발효한 율피의 항아토피 효과

본 연구에서는 DNCB 도포를 통해 아토피 피부염을 유발시킨 NC/Nga mice에 율피 발효물을 각각 0.1%, 1%, 5%로 도포하고 항아토피 효능을 평가하였다. 율피 발효물의 유효성분은 HPLC 분석 결과, gallic acid와 ellagic acid가 각각 10.18 mg/g, 2.14 mg/g 함량을 나타내었다. 실험군 간의 유의적 체중 변화는 관찰되지 않았으며, 육안 평가를 통해 홍반, 가려움과 피부건조, 부종과 혈종, 짓무름 그리고 태선화와 같은 일반적인 아토피 피부염 증상의 심각도를 측정한 점수 결과에서는 DNCB 도포를 통해 아토피 피부염을 유발한 atopic dermatitis(AD)군(13.17±0.40)과 비교 시, 아토피 피부염 유발 후 5% 율피 발효물을 도포한 fermented Castanea crenata inner shell(FCS) 5군에서 7.50±0.43으로 나타나 아토피 피부염 증상이 빠르게 개선되는 것을 확인하였다(P<0.01). 피부 측정 기기인 MPA5 580을 이용하여 피부멜라닌지수, 피부홍반지수, 피부수분지수를 측정한 결과, AD군은 각각 296.61±8.11, 264.33±10.15, 3.15±0.54를 나타내었으며 FCS 5군은 각각 105.86±2.92, 199.56±4.22, 17.62±1.75로 개선효과가 유의적으로 나타났다(P<0.05). 각 실험군 mice의 면역반응을 확인하기 위해 비장 무게(mg)를 체중(g)으로 나누어 산출한 비장 수치의 경우, 아토피 피부염 유발로 인해 AD군에서 증가된 비장 수치(5.55±0.31)가 FCS 0.1군, FCS 1군, FCS 5군에서는 각각 4.53±0.24, 3.80±0.40, 3.32±0.24로 나타나 율피 발효물의 도포 농도에 의존적으로 감소되는 경향을 나타냈으며 특히 FCS 5군에서는 유의적으로 낮게 나타났다(P<0.05). 이는 율피 발효물이 아토피 피부염 상태에서 증가된 비장 내 T-림프구를 효과적으로 억제할 수 있음을 나타낸다. Quantitative real-time PCR을 통해 피부조직에서 IL-1β, TNF-α와 같은 염증 유전자의 발현 변화를 분석한 결과, 두 유전자 모두 정상군의 relative quantification값이 1일 때 AD군은 각각 1.30, 1.26으로 증가되었으며 FCS 5군에서는 1.11, 0.93으로 나타나 율피 발효물 도포에 의한 유의적인 감소(P<0.05)를 확인할 수 있었다. 아토피 피부염의 면역학적 지표인 혈청 내 IgE 함량을 분석한 결과에서는 각 실험군 간의 유의적 차이는 보이지 않았으나 AD군(1,628.71±202.59 ng/mL)과 비교 시, 율피 발효물을 도포한 FCS 0.1군, FCS 1군, FCS 5군에서 각각 1,530.15±198.70 ng/mL, 1,462.15±83.79 ng/mL, 1,187.47±140.09 ng/mL로 나타나 율피 발효물 도포에 의해 감소되는 경향을 확인할 수 있었다. 따라서 율피 발효물은 아토피 피부염 증상 개선을 위한 기능성 천연물의 소재로 활용될 수 있을 것이라 생각된다.

학령기 아동의 아토피 피부염 유병률과 교실 실내 환경 위험요인에 관한 연구 -통합창원시 지역을 중심으로-

The purpose of this study was to investigate the prevalence rate of atopic dermatitis (AD) and indoor risk factors of AD in school-aged children living in Changwon, which is one of the largest industrial cities in Korean. Data were collected from 2,118 children in 12 elementary schools in Changwon city. A cross-sectional questionnaire based on the Korean Version of the ISAAC (International Study of Allergy and Asthma in Childhood) was employed to survey the <TEX>$1^{st}$</TEX> and <TEX>$4^{th}$</TEX> year elementary students from the 12 elementary schools in Changwon. The life time and last 12-month prevalence of itchy eczema were 20.6%; 70.5% in the elementary children. The life time and last 12-month prevalence of AD diagnosis were 28.8%; 12.6% in the elementary children. There was only one elementary school that was abnormal in the levels of particulate matters (PM), and <TEX>$Co_2$</TEX>. Multivariate logistic regression analysis revealed that risk factors for AD were BMI, the levels of PM, <TEX>$Co_2$</TEX>, CO, <TEX>$No_2$</TEX>, <TEX>$O_3$</TEX>, Ethylebenzene, and Xylene. This study could be used to manage possible risk factors that are related to the prevalence of AD and develop the strategies for prevention of AD.

EFFICACY AND FINANCIAL VIABILITY OF PRIMARY PREVENTION OF ATOPIC DERMATITIS: PROTEIN-HYDROLYSATE-BASED FORMULAE

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Mechanisms underlying immune effects of dietary oligosaccharides

The WHO refers to human milk as the nutritional gold standard for term infants. Human milk contains many immunomodulatory compounds, including oligosaccharides. Human-milk oligosaccharides can serve as prebiotics because the nondigestible oligosaccharides present in human milk show a clear bifidogenic effect on the gut microbiota. Dietary oligosaccharide structures that have prebiotic effects similar to human-milk oligosaccharides include galacto-oligosaccharides, fructo-oligosaccharides, and pectin-derived acidic oligosaccharides. Both animal studies and human clinical trials showed that dietary intervention with these dietary oligosaccharides in early life could lead to the prevention of atopic dermatitis, food allergy, and allergic asthma. The immune-modulating effects of these oligosaccharides are likely assisted via alteration of the intestinal microbiota or in a microbiota-independent manner by direct interaction on immune cells or both. In this review, an overview of the prebiotic role of dietary oligosaccharides on the microbiota and the microbiota-independent immune modulation by these prebiotics is provided. In addition, recent publications that report on the pathways by which the oligosaccharides might exert their direct immunomodulatory effect are summarized.

Establishment of the intestinal microbiota and its role for atopic dermatitis in early childhood

Perturbations in the intestinal microbiota may disrupt mechanisms involved in the development of immunologic tolerance. The present study aimed to examine the establishment of the infant microbiota and its association to the development of atopic dermatitis (AD). Within a randomized, placebo-controlled trial on the prevention of AD by oral supplementation of a bacterial lysate between week 5 and the end of month 7, feces was collected at the ages of 5 weeks (n = 571), 13 weeks (n = 332), and 31 weeks (n = 499) and subjected to quantitative PCRs to detect bifidobacteria, bacteroides, lactobacilli, Escherichia coli, Clostridium difficile, and Clostridium cluster I. Birth mode, breast-feeding but also birth order had a strong effect on the microbiota composition. With increasing number of older siblings the colonization rates at age 5 weeks of lactobacilli (P < .001) and bacteroides (P = .02) increased, whereas rates of clostridia decreased (P < .001). Colonization with clostridia, at the age of 5 and 13 weeks was also associated with an increased risk of developing AD in the subsequent 6 months of life (odds ratioadjusted = 2.35; 95% CI, 1.36-3.94 and 2.51; 1.30-4.86, respectively). Mediation analyses demonstrated that there was a statistically significant indirect effect via Clostridium cluster I colonization for both birth mode and birth order in association to AD. The results of this study are supportive for a role of the microbiota in the development of AD. Moreover, the "beneficial" influence of older siblings on the microbiota composition suggests that this microbiota may be one of the biological mechanisms underlying the sibling effect.

Cost-effectiveness analysis, prevention of atopic dermatitis by oral application of bacterial lysate in newborns/small children

The aim of this analysis was to determine the cost-effectiveness compared to placebo of prophylactic treatment with sterile bacterial lysate (Escherichia coli and Enterococcus faecalis) (verum) of newborns/small children with heredity for atopy [atopic dermatitis (AD)]. Infants were followed from the age of 5 weeks until 3 years of age. During this time, the number of children with AD who were treated with verum or placebo was observed at eight visits. Cost-effectiveness analyses were performed at different time points. A randomized, double-blind placebo-controlled clinical trial performed in Germany included 606 newborns. After randomization, n = 303 patients were classified in the placebo group and n = 303 in the verum group. A total of 119 participants left the study, so data from n = 250 patients of the placebo group and n = 237 patients of the verum group were available for analysis. At the beginning of the study, newborns were treated prophylactically with bacterial lysate or placebo for 26 weeks. After this, children were observed until the age of 3 years. A systematic literature research was done to evaluate treatment costs of atopic eczema in newborn/small children. Finally, 17 publications were included and checked for searched treatment costs of AD. A study was then initiated to evaluate the direct costs to statutory health insurance. Based on the described clinical trial, a decision tree model was developed. Using the evaluated direct costs and prevalence according to the clinical trial, the developed model can be used in cost-effectiveness analyses. The focus of the analyses was on the subgroup "single heredity for atopy" in clinical trials. Cost-effectiveness analysis showed an advantage for bacterial lysate after 3 years. To further support this result a model extension was executed; the model was expanded from 3 to 6 years. Cost-effectiveness of bacterial lysate was also proven after 6 years. Prophylactic treatment with bacterial lysate of infants with single heredity for atopy for 26 weeks in the 1st year of life is cost-effective at the age of 3 and 6 years, i.e. prophylactic use of bacterial lysate generated lower costs by leading to lower prevalence compared to placebo.

Effects of Korean red ginseng extract on the prevention of atopic dermatitis and its mechanism on early lesions in a murine model

Ethnopharmacological relevanceKorean red ginseng (KRG) has been shown to possess various biological activities including anti-inflammatory properties. Aim of the studyWe aimed to investigate the effects and mechanism of KRG on the prevention of atopic dermatitis (AD) using a mouse model. Materials and methodsThe effect of KRG in trinitrochlorobenzene (TNCB)-treated NC/Nga mice was assessed by measuring ear thickness, transepidermal water loss (TEWL), total serum IgE, histologic changes of lesional skin, mRNA and protein expression of thymic stromal lymphopoietin (TSLP) and tumor necrosis factor (TNF)-α, immunohistochemistry for tissue interleukin (IL)-4, IL-17, and interferon (IFN)-γ. ResultsKRG significantly reduced ear thickness. Oral administration of KRG significantly prevented the increase in TEWL induced by TNCB. The serum IgE level was significantly lower in the KRG group. Histologically, lymphocyte infiltration was markedly decreased by KRG. CD1a positive (CD1a+) cells were diminished by KRG. Immunohistochemically, KRG significantly suppressed the protein expression of TSLP and TNF-α. The mRNA expression of TSLP in the lesions was significantly reduced by KRG. These results demonstrate that oral administration of KRG may inhibit the development of AD-like skin lesions in NC/Nga mice by modifying TSLP, DCs, and at least in part, the Th2 response. ConclusionKRG may be a potential therapeutic modality for the prevention of AD.

RETRACTED: Preventative and Therapeutic Role of Probiotics in Various Allergic and Autoimmune Disorders: An Up-to-Date Literature Review of Essential Experimental and Clinical Data

"Preventative and Therapeutic Role of Probiotics in Various Allergic and Autoimmune Disorders: An Up-to-Date Literature Review of Essential Experimental and Clinical Data," by Öner Özdemir, Journal of Evidence-Based Complementary & Alternative Medicine, April 2013 (18:2), doi: 10.1177/2156587212461279 . This article has been retracted due to unattributed overlap with material from other sources and due to duplicate publication. The unattributed excerpts in the article were taken from the following sources: Ouwehand AC. Antiallergic effects of probiotics. J Nutr. 2007;137(3 suppl 2):794S-797S. Saavedra JM. Use of probiotics in pediatrics: rationale, mechanisms of action, and practical aspects. Nutr Clin Pract. 2007;22:351-365. doi:10.1177/0115426507022003351. Rook GA, Brunet LR. Microbes, immunoregulation, and the gut. Gut. 2005;54:317-320. doi:10.1136/gut.2004.053785. Michail S. The role of probiotics in allergic diseases. Allergy Asthma Clin Immunol. 2009;5:5. doi:10.1186/1710-1492-5-5. The author also published the following works that include significant unattributed excerpts from the article: Özdemir Ö, Erol AY. Preventative and therapeutic probiotic use in allergic skin conditions: experimental and clinical findings. BioMed Res Int. 2013;2013:932391. doi:10.1155/2013/932391. Özdemir Ö. The role of probiotics in atopic dermatitis prevention and therapy. In: Esparza-Gordillo J, Dekio I, eds. Atopic Dermatitis: Disease Etiology and Clinical Management. Rijeka, Croatia: InTech; 2012:353-386. doi:10.5772/25301.

PRS30 Cost-Effectiveness Analysis of 100% Whey-Based Partially Hydrolyzed Infant Formula Used for Prevention of Atopic Dermatitis in Germany

PRS30 Cost-Effectiveness Analysis of 100% Whey-Based Partially Hydrolyzed Infant Formula Used for Prevention of Atopic Dermatitis in Germany

Cohort study for prevention of atopic dermatitis using hair mineral contents

We undertook a cohort study to determine the association between hair mineral content and the onset of atopic dermatitis (AD) in infants. Eight hundred and thirty-four mother–infant pairs, who donated hair samples during one and ten-month health checkups, had their samples analyzed by proton induced X-ray emission (PIXE) for 32 mineral concentrations, and these mineral concentration data together with their AD family history were statistically examined for any relationships between them. Results indicated that of all minerals, only selenium (Se) and strontium (Sr) showed statistically significant associations for infants, while the same two elements were only marginally significant for mothers. Se deficiency in either infant or mother increased the AD risk. A Sr deficiency in infants increased AD risk, while the same deficiency in mothers decreased the risk. To predict the probability of AD development using this data, we performed logistic regression analysis, which provided a sensitivity of 65.9%, a specificity of 70.5%, a positive predictive value (PPV) of 10.3%, a negative predictive value (NPV) of 97.6% and a relative risk (RR) of 4.2, all far better than any corresponding figures explicitly mentioned in previously published papers.

The Editor takes a closer look at some of this month's articles

The Editor takes a closer look at some of this month's articles

Probiotics and Atopic Dermatitis in Children

There is increasing interest in the potential beneficial role of probiotic supplementation in the prevention and treatment of atopic diseases in children. Probiotics are defined as ingested live microorganisms that, when administered in an adequate amount, confer a health benefit to the host. They are mainly represented by Lactobacilli and Bifidobacteria. Several epidemiological data demonstrate that intestinal microflora of atopic children is different from the one of healthy children. Many literature data show that probiotics may modulate the intestinal microflora composition and may have immunomodulatory effect. Based on this hypothesis, probiotics are supposed to confer benefits to allergic diseases. Administration of probiotics when a natural population of indigenous intestinal bacteria is still developing could theoretically influence immune development by favoring the balance between Th1 and Th2 inflammatory responses. For this reason, some studies have evaluated the potential impact of probiotics supplementation in the prevention of atopic dermatitis, with contrasting results. Clinical improvement in immunoglobulin (Ig)E-sensitized (atopic) eczema following probiotic supplementation has been reported in some published studies and the therapeutic effects of probiotics on atopic dermatitis seemed to be encouraging. However, as far as the usefulness of probiotics as a prevention strategy is concerned, results are still inconclusive. In fact, the clinical benefits of probiotic therapy depend upon numerous factors, such as the type of bacteria, dosing regimen, delivery method and other underlying host factors, such as age and diet. More studies are still needed to definitively prove the role of probiotics in the treatment of allergic eczema.

Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia

Objective:To perform an economic evaluation of a specific brand of partially hydrolyzed infant formula (PHF-W) in the prevention of atopic dermatitis (AD) among Australian infants.Methods:A cost-effectiveness analysis was undertaken from the perspectives of the Department of Health and Aging (DHA), of the family of the affected subject and of society as a whole in Australia, based on a decision-analytic model following a hypothetical representative cohort of Australian newborns who are not exclusively breastfed and who have a familial history of allergic disease (i.e., are deemed ‘at risk’). Costs, consequences, and incremental cost-effectiveness ratios (ICER) were calculated for PHF-W vs standard cow’s milk based infant formula (SF), and, in a secondary analysis, vs extensively hydrolyzed infant formula (EHF-Whey), when the latter was used for the prevention of AD.Results:From a representative starting cohort of 87,724 ‘at risk’ newborns in Australia in 2009, the expected ICERs for PHF-W vs SF were AU$496 from the perspective of the DHA and savings of AUD1739 and AU$1243 from the family and societal perspectives, respectively. When compared to EHF-Whey, PHF-W was associated with savings for the cohort of AU$5,183,474 and AU$6,736,513 from the DHA and societal perspectives.Limitations:The generalizability and transferability of results to other settings, populations, or brands of infant formula should be made with caution. Whenever possible, a conservative approach directing bias against PHF-W rather than its comparators was applied in the base case analysis. Assumptions were verified in one-way and probabilistic sensitivity analyses, which confirmed the robustness of the model.Conclusions:PHF-W appears to be cost-effective when compared to SF from the DHA perspective, dominant over SF from the other perspectives, and dominant over EHF-Whey from all perspectives, in the prevention of AD in ‘at risk’ infants not exclusively breastfed, in Australia.

Integrative Medicine as Adjunct Therapy in the Treatment of Atopic Dermatitis—the Role of Traditional Chinese Medicine, Dietary Supplements, and Other Modalities

Atopic dermatitis (AD) is becoming increasingly prevalent in the pediatric population, with rates reportedly as high as 18-25 %. Westernized medicine has traditionally used a combination of emollients, antihistamines, corticosteroids, and immunomodulating agents to combat this often frustrating disease. Of late, integrative medicine has become the subject of more research as concerns grow regarding prolonged use of corticosteroids and their side effects in pediatric patients. Probiotics have been extensively studied to define their role in the treatment and prevention of AD in children. Unfortunately, results are varying showing significant improvement in some patients but not all. With regard to prevention, studies show that the use of probiotics during pregnancy does decrease the incidence of AD in children. Prebiotics and synbiotics are also a conceivable option for prevention of AD. A number of studies on Chinese herbal medicine have been performed, with a collective result of symptom improvement and decreased levels of inflammatory cytokines. However, there were reports of asymptomatic transaminitis in a few patients that warrant further testing. While the herbs tested in more recent randomized clinical trials were free from corticosteroids, a previous study showed high levels of dexamethasone in unlabeled herbal eczema creams. Vitamins and minerals have also been suggested as an alternative treatment of AD. Studies however have not yet demonstrated improvement of AD with vitamin or mineral supplementation. Topical vitamin B(12) is the exception to this; however, no topical vitamin B(12) preparation is available for use. Finally, relaxation techniques are also being investigated as adjunctive methods of treatment, but well-designed scientific studies are lacking.

Is prevention of atopic eczema with hydrolyzed formulas cost‐effective? A health economic evaluation from Germany

The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4 months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478 € per child treated in the ITT analysis (CI95%: 12 €; 852 €) and 979 € in the PP analysis (95%CI: 355 €; 1455 €) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404 €, PP -6358 €). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.

Probiotics Supplementation During Pregnancy or Infancy for the Prevention of Atopic Dermatitis

The study of probiotics to prevent allergic conditions has yielded conflicting results in children. We undertook a meta-analysis of randomized controlled trials to investigate whether probiotic use during pregnancy and early life decreases the incidence of atopic dermatitis and immunoglobulin E (IgE)-associated atopic dermatitis in infants and young children. We performed a systematic literature search in Medline, Embase, and Cochrane Library, updated to October 2011. The intervention was diet supplementation with probiotics versus placebo. Primary outcomes were incidence of atopic dermatitis and IgE-associated atopic dermatitis. We calculated summary relative risks (RRs) and corresponding 95% confidence intervals (CIs), using both fixed- and random-effects models. We computed summary estimates across several strata, including study period, type of patient, dose, and duration of intervention, and we assessed the risk of bias within and across trials. We identified 18 publications based on 14 studies. Meta-analysis demonstrated that probiotic use decreased the incidence of atopic dermatitis (RR = 0.79 [95% CI = 0.71-0.88]). Studies were fairly homogeneous (I = 24.0%). The corresponding RR of IgE-associated atopic dermatitis was 0.80 (95% CI = 0.66-0.96). No appreciable difference emerged across strata, nor was there evidence of publication bias. This meta-analysis provided evidence in support of a moderate role of probiotics in the prevention of atopic dermatitis and IgE-associated atopic dermatitis in infants. The favorable effect was similar regardless of the time of probiotic use (pregnancy or early life) or the subject(s) receiving probiotics (mother, child, or both).