The Journal of Allergy and Clinical Immunology
Volume 121, Issue 1 , Pages 116-121.e11, January 2008

Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis

  • Joohee Lee, AB

      Affiliations

    • University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
    • ,
  • David Seto, BA

      Affiliations

    • University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, NJ
    • ,
  • Leonard Bielory, MD

      Affiliations

    • Department of Medicine, UMDNJ–New Jersey Medical School, Newark, NJ
    • Corresponding Author InformationReprint requests: Leonard Bielory, MD, Department of Medicine, UMDNJ–New Jersey Medical School, 90 Bergen Street, DOC Suite 4700, Newark, NJ 07103-2499.

Received 6 August 2007; received in revised form 2 October 2007; accepted 26 October 2007.

Background

Prenatal and postnatal probiotic supplementation for prevention and treatment of pediatric atopic dermatitis (PAD) has been studied in clinical trials, but results have been mixed and hindered by heterogeneity of study design.

Objectives

To summarize and interpret quantitatively clinical trial findings on the efficacy of probiotics for PAD and to define key trial features correlating with high methodologic quality.

Methods

PubMed and Cochrane database searches yielded 21 trials (n = 1898; age 0-13 y) published between February 1997 and May 2007 for review and quality assessment. Ten double-blind randomized controlled clinical trials were meta-analyzed by using RevMan. Data from the 6 prevention studies (n = 1581) and 4 treatment trials (n = 299) were pooled by using fixed-effects and random-effects models of relative risk ratios and of weighted mean difference, respectively.

Results

Prevention corresponded with summary effect sizes of 0.69 (0.57, 0.83) and 0.66 (0.49, 0.89), respectively, supporting probiotics' PAD prevention potential, which decreased further to 0.61 after exclusion of the 1 trial of postnatal-only probiotics. The clinical significance of the treatment trial findings of intergroup Scoring Atopic Dermatitis (quantification of PAD severity) score reduction by –6.64 points (–9.78, –3.49) and –8.56 (–18.39, 1.28), and intragroup change of –1.06 (–3.86, 1.73) and –1.37 (–4.81, 2.07), is questionable.

Conclusion

Current evidence is more convincing for probiotics' efficacy in prevention than treatment of PAD.

Key words: Meta-analysis, pediatric atopic dermatitis, atopic dermatitis, probiotics, Lactobacillus, SCORAD, quality scales

Abbreviations used: AD, Atopic dermatitis, CR, Clinical Relevance, ES, Effect size, FE, Fixed-effects, LGG, Lactobacillus rhamnosus GG, MQ, Methodological Quality, PAD, Pediatric atopic dermatitis, RE, Random-effects, RR, Risk ratio, SCORAD, Scoring Atopic Dermatitis, WMD, Weighted mean difference

 

 Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

PII: S0091-6749(07)02172-0

doi:10.1016/j.jaci.2007.10.043

The Journal of Allergy and Clinical Immunology
Volume 121, Issue 1 , Pages 116-121.e11, January 2008

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