Volume 122, Issue 4 , Pages 788-794, October 2008
A differential effect of 2 probiotics in the prevention of eczema and atopy: A double-blind, randomized, placebo-controlled trial
Background
The role of probiotics in prevention of allergic disease is still not clearly established, although early reports suggested Lactobacillus GG halved the risk of eczema at 2 years.
Objective
To determine whether probiotic supplementation in early life could prevent development of eczema and atopy at 2 years.
Methods
Double-blind, randomized placebo-controlled trial of infants at risk of allergic disease. Pregnant women were randomized to take Lactobacillus rhamnosus HN001 (L rhamnosus), Bifidobacterium animalis subsp lactis strain HN019 or placebo daily from 35 weeks gestation until 6 months if breast-feeding, and their infants were randomized to receive the same treatment from birth to 2 years (n = 474). The infant's cumulative prevalence of eczema and point prevalence of atopy, using skin prick tests to common allergens, was assessed at 2 years.
Results
Infants receiving L rhamnosus had a significantly (P = .01) reduced risk of eczema (hazard ratio [HR], 0.51; 95% CI, 0.30-0.85) compared with placebo, but this was not the case for B animalis subsp lactis (HR, 0.90; 95% CI, 0.58-1.41). There was no significant effect of L rhamnosus (HR, 0.74; 95% CI, 0.46-1.18) or B animalis subsp lactis (HR, 0.82; 95% CI, 0.52-1.28) on atopy. L rhamnosus (71.5%) was more likely than B animalis subsp lactis (22.6%) to be present in the feces at 3 months, although detection rates were similar by 24 months.
Conclusion
We found that supplementation with L rhamnosus, but not B animalis subsp lactis, substantially reduced the cumulative prevalence of eczema, but not atopy, by 2 years. Understanding how Lactobacilli act to prevent eczema requires further investigation.
Key words: Probiotics, eczema, atopy, allergic disease, infants, allergy prevention, randomized controlled trial
Abbreviations used: HR, Hazard ratio, OR, Odds ratio, SCORAD, SCORing Atopic Dermatitis, SPT, Skin prick test
Supported by the Health Research Council of New Zealand and Fonterra Co-operative Group (Auckland, New Zealand). Fonterra Co-operative Group provided the study capsules and maintained quality control of the products throughout the study. All other aspects of the study were conducted independently of Fonterra Co-operative Group.
Disclosure of potential conflict of interest: K. Wickens has received research funding from the Health Research Council and Fonterra Co-operative Group. P. N. Black has received research funding from the Health Research Council of New Zealand, the Child Health Research Foundation, Fonterra Co-operative Group, and Boehringer-Ingelheim. T. V. Stanley has received research funding from the Health Research Council of New Zealand, Fonterra Co-operative Group, the Asthma and Respiratory Foundation of New Zealand, and the Wellington Medical Research Foundation. E. Mitchell has received research funding from the Child Health Research Foundation and the National Heart Foundation of New Zealand and has served as trustee in the past year for the Wilson & Sweet Trust and the Child Health Research Foundation. P. Fitzharris has received research funding from the Marsden Fund and the Foundation for Research, Science & Technology. G. W. Tannock has received research support from the Marsden Fund and the Foundation for Research, Science, and Technology. G. Purdie has received research funding from the Health Research Council of New Zealand, Fonterra Co-operative Group, and the Ministry of Health. J. Crane has received research funding from the Health Research Council of New Zealand, Fonterra Co-operative Group, Rex Medical, the Asthma and Respiratory Foundation of New Zealand, and the National Institute of Environmental Health Sciences.
PII: S0091-6749(08)01319-5
doi:10.1016/j.jaci.2008.07.011
© 2008 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Volume 122, Issue 4 , Pages 788-794, October 2008
