World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics

被引:285
作者
Fiocchi, Alessandro [1 ]
Pawankar, Ruby [2 ]
Cuello-Garcia, Carlos [3 ,4 ]
Ahn, Kangmo [5 ]
Al-Hammadi, Suleiman [6 ]
Agarwal, Arnav [3 ,7 ]
Beyer, Kirsten [8 ]
Burks, Wesley [9 ]
Canonica, Giorgio W. [10 ]
Ebisawa, Motohiro [11 ]
Gandhi, Shreyas [3 ,7 ]
Kamenwa, Rose [12 ]
Lee, Bee Wah [13 ]
Li, Haiqi [14 ]
Prescott, Susan [15 ]
Riva, John J. [16 ]
Rosenwasser, Lanny [17 ,18 ]
Sampson, Hugh [19 ]
Spigler, Michael [20 ]
Terracciano, Luigi [21 ]
Vereda-Ortiz, Andrea [23 ]
Waserman, Susan [22 ]
Yepes-Nunez, Juan Jose [3 ]
Brozek, Jan L. [3 ,22 ]
Schuenermann, Holger J. [3 ,22 ]
机构
[1] Pediat Hosp Bambino Gesu, Vatican City, Vatican
[2] Nippon Med Sch, Dept Pediat, Tokyo 113, Japan
[3] McMaster Univ, Hlth Sci Ctr, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada
[4] Tecnol Monterrey Sch Med & Hlth Sci, Monterrey, Mexico
[5] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Pediat, Seoul, South Korea
[6] United Arab Emirates Univ, Coll Med & Hlth Sci, Dept Pediat, Al Ain, U Arab Emirates
[7] Univ Toronto, Fac Med, Toronto, ON, Canada
[8] Charite Kiln Padiat, Berlin, Germany
[9] Univ N Carolina, Dept Pediat, Chapel Hill, NC USA
[10] Univ Genoa, IRCCS AOU San Martino IST, Genoa, Italy
[11] Sagamihara Natl Hosp, Clin Res Ctr Allergol & Rheumatol, Dept Allergy, Kanagawa, Japan
[12] Aga Khan Univ Hosp, Dept Pediat & Child Hlth, Nairobi, Kenya
[13] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Paediat, Singapore 117548, Singapore
[14] Chongqing Med Univ, Childrens Hosp, Dept Primary Child Care, Chongqing, Peoples R China
[15] Univ Western Australia, Sch Paediat & Child Hlth, Perth Childrens Hosp, Dept Immunol,Telethon KIDS Inst, Perth, WA 6009, Australia
[16] McMaster Univ, Dept Family Med, Hamilton, ON L8S 4L8, Canada
[17] Childrens Mercy Hosp, Allergy Immunol Div, Kansas City, MO 64108 USA
[18] Univ Missouri, Kansas City Sch Med, Kansas City, MO 64110 USA
[19] Mt Sinai Sch Med, Jaffe Food Allergy Inst, New York, NY USA
[20] FARF, Mclean, VA USA
[21] Univ Milan, Sch Med, Melloni Hosp, Dept Child & Maternal Med, Milan, Italy
[22] McMaster Univ, Dept Med, Hamilton, ON, Canada
[23] Hosp Infantil Univ Nino Jesus, Allergol Dept, Madrid, Spain
来源
WORLD ALLERGY ORGANIZATION JOURNAL | 2015年 / 8卷
关键词
Allergy; Prevention; Probiotics; Practice guidelines; GRADE; DOUBLE-BLIND; ATOPIC-DERMATITIS; ESPGHAN COMMITTEE; EARLY-LIFE; FOLLOW-UP; ECZEMA; PREGNANCY; SUPPLEMENTATION; LACTOBACILLUS; CHILDREN;
D O I
10.1186/s40413-015-0055-2
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. Methods: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. Results: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. Conclusions: WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.
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