Probiotics in prevention of IgE-associated eczema: A double-blind, randomized, placebo-controlled trial

Background

An altered microbial exposure may underlie the increase of allergic diseases in affluent societies. Probiotics may alleviate and even prevent eczema in infants.

Objective

To prevent eczema and sensitization in infants with a family history of allergic disease by oral supplementation with the probiotic Lactobacillus reuteri.

Methods

Double-blind, randomized, placebo-controlled trial, which comprised 232 families with allergic disease, of whom 188 completed the study. The mothers received L reuteri ATCC 55730 (1 × 10⁸ colony forming units) daily from gestational week 36 until delivery. Their babies then continued with the same product from birth until 12 months of age and were followed up for another year. Primary outcome was allergic disease, with or without positive skin prick test or circulating IgE to food allergens.

Results

The cumulative incidence of eczema was similar, 36% in the treated versus 34% in the placebo group. The L reuteri group had less IgE-associated eczema during the second year, 8% versus 20% (P = .02), however. Skin prick test reactivity was also less common in the treated than in the placebo group, significantly so for infants with mothers with allergies, 14% versus 31% (P = .02). Wheeze and other potentially allergic diseases were not affected.

Conclusion

Although a preventive effect of probiotics on infant eczema was not confirmed, the treated infants had less IgE-associated eczema at 2 years of age and therefore possibly run a reduced risk to develop later respiratory allergic disease.

Clinical implication

Probiotics may reduce the incidence of IgE-associated eczema in infancy.

Key words: Children, eczema, IgE, Lactobacillus, prevention, probiotics, sensitization, skin prick test

Abbreviations used: ARC, Allergic rhinoconjunctivitis, CFU, Colony forming units, LGG, Lactobacillus rhamnosus GG, OR, Odds ratio, SCORAD, Scoring Atopic Dermatitis, SPT, Skin prick test