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World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics
Carlos A Cuello-Garcia1,2, Alessandro Fiocchi3, Ruby Pawankar4
1Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.
Insights
Prebiotic supplementation may help prevent allergies in some infants, but not those exclusively breastfed. Recommendations for use in pregnancy or by breastfeeding mothers are not yet available due to limited evidence.
Area of Science:
- Allergy and immunology
- Microbiome research
- Pediatric health
Background:
- Allergic diseases affect a significant portion of infants, with higher prevalence in those with a family history of allergies.
- Intestinal microbiota plays a crucial role in modulating systemic immune and inflammatory responses, influencing allergy development.
- Prebiotics, which promote beneficial gut bacteria, are being investigated for their potential to modulate immune responses and prevent allergies.
Purpose of the Study:
- To develop evidence-based recommendations on the use of prebiotics for allergy prevention.
- To guide healthcare professionals and parents in making informed decisions regarding prebiotic supplementation.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) on prebiotic use for allergy prevention.
- Inclusion of evidence on patient values, preferences, and resource requirements.
- Application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for guideline development.
Main Results:
- A conditional recommendation for prebiotic supplementation in not-exclusively breastfed infants.
- A conditional recommendation against prebiotic supplementation in exclusively breastfed infants.
- Insufficient evidence to provide recommendations for prebiotic use during pregnancy or breastfeeding.
Conclusions:
- World Allergy Organization (WAO) provides conditional recommendations on prebiotic supplementation for allergy prevention in healthy term infants.
- Recommendations aim to support decision-making for parents and healthcare providers.
- Further research is needed to establish definitive guidelines for prebiotic use in specific populations and contexts.
Background:
The 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. Prebiotics - non-digestible oligosaccharides that stimulate growth of probiotic bacteria - 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 prebiotics in the prevention of allergy.
Methods:
The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy. We performed a systematic review of randomized controlled trials of prebiotics, and reviewed the evidence about patient values and preferences, and resource requirements (up to January 2015, with an update on July 29, 2015). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.
Results:
Based on GRADE evidence to decision frameworks, the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants. Both recommendations are conditional and based on very low certainty of the evidence. We found no experimental or observational study of prebiotic supplementation in pregnant women or in breastfeeding mothers. Thus, the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding, at this time.
Conclusions:
WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy, term infants.
