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Systematic review and meta-analysis on probiotics as treatment for food allergies among pediatric patients: A 2024
Carol Stephanie C Tan-Lim1, Natasha Ann R Esteban-Ipac2
1Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
Insights
This review found probiotics likely do not reduce eczema in cow
Area of Science:
- Pediatric Allergy and Immunology
- Microbiome Research
- Gastroenterology
Background:
- Food allergy is a growing concern in pediatric populations.
- Probiotics are being explored as a potential therapeutic intervention.
- Evidence on their efficacy and safety in children remains inconclusive.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) on probiotics for pediatric food allergy.
- To evaluate the effectiveness and safety of probiotic treatments.
- To identify factors influencing treatment outcomes.
Main Methods:
- Systematic search of RCTs up to March 2024.
- Data extraction and analysis by two independent reviewers.
- Synthesis using Review Manager 5.4 software.
Main Results:
- 13 RCTs with 1608 pediatric patients were included.
- Probiotics showed no significant effect on eczema in cow's milk allergy (CMA).
- A potential benefit for eczema was observed in broader allergic conditions.
- Tolerance induction was uncertain in CMA infants, but significant after 2 years.
- The Lactobacillus rhamnosus GG (LGG) strain showed promise.
Conclusions:
- Probiotics may offer benefits for allergy tolerance, particularly with prolonged use (≥2 years) and specific strains like LGG.
- Current evidence for eczema reduction is limited and varies by allergy type.
- Further high-quality RCTs are needed to confirm efficacy and establish optimal protocols.
Abstract:
This systematic review updated the available evidence on the effectiveness and safety of probiotics as treatment of food allergy among pediatric patients. We conducted a systematic search for all randomized controlled trials available until March 13, 2024 that evaluated the effectiveness and safety of probiotics for treating pediatric food allergy. Two authors independently conducted the search, screening, and data extraction. Data analysis and synthesis were done using Review Manager 5.4 software. We included 13 articles involving 1608 pediatric patients with food allergy. Probiotics probably has no effect on reducing eczema scores among infants with CMA (MD -1.29 points, 95% CI -4.14, 1.56; moderate certainty of evidence), based on two studies. Probiotics may reduce eczema scores for children with various types of allergy (MD -23.08 points, 95% CI -27.55, -18.61; low certainty of evidence), based on one study. It is uncertain whether probiotics may lead to tolerance acquisition among infants with CMA (RR 0.58, 95% CI 0.34, 1.00) due to very low certainty of evidence. Subgroup analysis based on time period showed significant benefit in inducing tolerance after at least 2 years (RR 0.44, 95% CI 0.29, 0.67; moderate certainty of evidence), suggesting a duration-dependent effect of probiotic usage. Subgroup analysis by probiotic preparation showed significant benefit for the LGG strain (RR 0.41, 95% CI 0.28, 0.62). Probiotics were generally well tolerated by the study participants. Further well-designed RCTs focusing on specific types of food allergy, as well as the use of standardized probiotic strains, outcome measurement, and longer follow-up periods are needed to draw clinically relevant conclusions on the role of probiotics in treating children with food allergy.
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