Postnatal probiotics administration does not prevent asthma in children, but using prebiotics or synbiotics may be effective potential strategies to decrease the frequency of asthma in high-risk children – a meta-analysis of clinical trials

Main Article Content

Ewelina Wawryk-Gawda
Ewa Markut-Miotła
Andrzej Emeryk

Keywords

probiotics, prebiotics, synbiotics, asthma, children, allergy

Abstract

Background: The role of probiotics, prebiotics, and synbiotics in preventing asthma and other allergic diseases has been widely explored via many randomized controlled trials. However, the results on the effect of their supplementation during infancy to the incidence of allergic rhinitis or asthma, are conflicting.
The study was designed to bring to light the potential effects of pro-, pre-, and synbiotics supplementation in early childhood with regard to the future occurrence of allergic diseases.
Method: The results of randomized controlled trials were searched for in several medical data bases. The study protocol was prepared in accordance with PRISMA guidelines and applied a Revised Cochrane risk-of-bias tool for randomized trials. Two writers were designed to perform studies selection.
Results: Eleven randomized controlled trials, among 1659 children (525 in the probiotic group, 342 in prebiotic group, 128 in synbiotic group and 833 in control groups) were analyzed. There was no difference in asthma risk development between the groups that received probiotics or placebo. We observed lower risk of asthma in children receiving prebiotic and synbiotic than in control groups.
Conclusion: The current study indicates that probiotics supplementation in the first months after birth does not decrease the risk of asthma development in the first years of life in high-risk children, although prebiotics and synbiotics may be the potential preventive factors that reduce the incidence of asthma in children.

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References

1. Papadopoulos NG, Čustović A, Cabana MD, Dell SD, Deschildre A, Hedlin G et al. Pediatric asthma: An unmet need for more effective, focused treatments. Pediatr Allergy Immunol. 2019;30(1):7–16. http://dx.doi.org/10.1111/pai.12990
2. Wei X, Jiang P, Liu J, Sun R, Zhu L. Association between probiotic supplementation and asthma incidence in infants: A meta-analysis of randomized controlled trials. J Asthma. 2020;57(2):167–78. http://dx.doi.org/10.1080/02770903.2018.1561893
3. Frati F, Salvatori C, Incorvaia C, Bellucci A, Di Cara G, Marcucci F, et al. The role of the microbiome in asthma: The gut-lung axis. Int J Mol Sci. 2018;20(1):123. http://dx.doi.org/10.3390/ijms20010123
4. Abreo A, Gebretsadik T, Stone CA, Hartert TV. The impact of modifiable risk factor reduction on childhood asthma development. Clin Transl Med. 2018;7(1):15. http://dx.doi.org/10.1186/s40169-018-0195-45.
5. Pocket Guide For aAsthma Management And Preventiona Pocket Guide for Health Professionals Updated 2019 (for Adults and Child ren Older than 5 Years). Based on the global strategy for asthma management and prevention. © 2019 Global Initiative for Asthma. Available from: https://ginasthma.org/wp-content/uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf .
6. Durack J, Kimes NE, Lin DL, Rauch M, McKean M, McCauley K, et al. Delayed gut microbiota development in high-risk for asthma infants is temporarily modifiable by Lactobacillus supplementation. Nat Commun. 2018;9(1):707. http://dx.doi.org/10.1038/s41467-018-03157-4
7. Gorissen DM, Rutten NB, Oostermeijer CM, Niers LE, Hoekstra MO, Rijkers GT, et al. Preventive effects of selected probiotic strains on the development of asthma and allergic rhinitis in childhood. The Panda study. Clin Exp Allergy. 2014;44(11):1431–3. http://dx.doi.org/10.1111/cea.12413
8. Moossavi S, Miliku K, Sepehri S, Khafipour E, Azad MB. The prebiotic and probiotic properties of human milk: Implications for infant immune development and pediatric asthma. Front Pediatr. 2018;6:197. http://dx.doi.org/10.3389/fped.2018.00197
9. Gore C, Custovic A, Tannock GW, Munro K, Kerry G, Johnson K, et al. Treatment and secondary prevention effects of the probiotics Lactobacillus paracasei or Bifidobacterium lactis on early infant eczema: Randomized controlled trial with follow-up until age 3 years. Clin Exp Allergy. 2012;42(1):112–22. http://dx.doi.org/10.1111/j.1365-2222.2011.03885.x
10. Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutr. 2008;138(6):1091–5. http://dx.doi.org/10.1093/jn/138.6.1091
11. Morisset M, Aubert-Jacquin C, Soulaines P, Moneret-Vautrin DA, Dupont C. A non-hydrolyzed, fermented milk formula reduces digestive and respiratory events in infants at high risk of allergy. Eur J Clin Nutr. 2011;65(2):175–83. http://dx.doi.org/10.1038/ejcn.2010.250
12. Tan-Lim CSC, Esteban-Ipac NAR. Probiotics as treatment for food allergies among pediatric patients: A meta-analysis. World Allergy Organ J. 2018;11(1):25. http://dx.doi.org/10.1186/s40413-018-0204-5
13. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. Expert consensus document. The international scientific association for probiotics and prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506–14. http://dx.doi.org/10.1038/nrgastro.2014.66
14. Cuello-Garcia C, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Morgano GP, Zhang Y, et al. Prebiotics for the prevention of allergies: A systematic review and meta-analysis of randomized controlled trials. Clin Exp Allergy. 2017;47(11):1468–77. http://dx.doi.org/10.1111/cea.13042
15. Shamasbi SG, Ghanbari-Homayi S, Mirghafourvand M. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: A systematic review and meta-analysis. Eur J Nutr. 2020;59(2):433–50. http://dx.doi.org/10.1007/s00394-019-02033-1
16. Zuccotti G, Meneghin F, Aceti A, Barone G, Callegari ML, Di Mauro A, et al. Probiotics for prevention of atopic diseases in infants: Systematic review and meta-analysis. Allergy. 2015;70(11):1356–71. http://dx.doi.org/10.1111/all.12700
17. Zawistowska-Rojek A, Tyski S. Are probiotic really safe for humans? Pol J Microbiol. 2018;67(3):251–8. http://dx.doi.org/10.21307/pjm-2018-044
18. Doron S, Snydman DR. Risk and safety of probiotics. Clin Infect Dis. 2015;60(Suppl 2):S129–34. http://dx.doi.org/10.1093/cid/civ085
19. Aguilar-Toalá JE, Garcia-Varela R, Garcia HS, Mata-Haro V, González-Córdova AF, Vallejo-Cordoba B, et al. Postbiotics: An evolving term within the functional foods field. Trends Food Sci Technol. 2018;75:105–14. http://dx.doi.org/10.1016/j.tifs.2018.03.009
20. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097
21. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. http://dx.doi.org/10.1136/bmj.l4898
22. Arslanoglu S, Moro GE, Boehm G, Wienz F, Stahl B, Bertino E. Early neutral prebiotic oligosaccharide supplementation reduces the incidence of some allergic manifestations in the first 5 years of life. J Biol Regul Homeost Agents. 2012;26(3 Suppl):49–59.
23. Ivakhnenko OS, Nyankovskyy SL. Effect of the specific infant formula mixture of oligosaccharides on local immunity and development of allergic and infectious disease in young children: Randomized study. Pediatria Polska. 2013;88(5):398–404. http://dx.doi.org/10.1016/j.pepo.2013.07.002
24. van der Aa LB, van Aalderen WM, Heymans HS, Henk Sillevis Smitt J, Nauta AJ, Knippels LM, et al. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy. 2011;66(2):170–7. http://dx.doi.org/10.1111/j.1398-9995.2010.02416.x
25. Cabana MD, McKean M, Caughey AB, Fong L, Lynch S, Wong A, et al. Early probiotic supplementation for eczema and asthma prevention: A randomized controlled trial. Pediatrics. 2017;140(3):e20163000. http://dx.doi.org/10.1542/peds.2016-3000
26. West CE, Hammarström ML, Hernell O. Probiotics during weaning reduce the incidence of eczema. Pediatr Allergy Immunol. 2009;20(5):430–7. http://dx.doi.org/10.1111/j.1399-3038.2009.00745.x
27. West CE, Hammarström ML, Hernell O. Probiotics in primary prevention of allergic disease--follow-up at 8-9 years of age. Allergy. 2013;68(8):1015–20. http://dx.doi.org/10.1111/all.12191
28. Jensen MP, Meldrum S, Taylor AL, Dunstan JA, Prescott SL. Early probiotic supplementation for allergy prevention: Long-term outcomes. J Allergy Clin Immunol. 2012;130(5):1209–1211.e5. http://dx.doi.org/10.1016/j.jaci.2012.07.018
29. Loo EX, Llanora GV, Lu Q, Aw MM, Lee BW, Shek LP. Supplementation with probiotics in the first 6 months of life did not protect against eczema and allergy in at-risk Asian infants: A 5-year follow-up. Int Arch Allergy Immunol. 2014;163(1):25–8. http://dx.doi.org/10.1159/000356338
30. Soh SE, Aw M, Gerez I, Chong YS, Rauff M, Ng YP, et al. Probiotic supplementation in the first 6 months of life in at risk Asian infants – effects on eczema and atopic sensitization at the age of 1 year. Clin Exp Allergy. 2009;39(4):571–78. http://dx.doi.org/10.1111/j.1365-2222.2008.03133.x
31. Schmidt RM, Pilmann Laursen R, Bruun S, Larnkjaer A, Mølgaard C, Michaelsen KF, et al. Probiotics in late infancy reduce the incidence of eczema: A randomized controlled trial. Pediatr Allergy Immunol. 2019;30(3):335–40. http://dx.doi.org/10.1111/pai.13018
32. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:ED000142. http://dx.doi.org/10.1002/14651858.ED000142
33. Azad MB, Coneys JG, Kozyrskyj AL, Field CJ, Ramsey CD, Becker AB, et al. Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: Systematic review and meta-analysis. BMJ. 2013;347:f6471. http://dx.doi.org/10.1136/bmj.f6471
34. Elazab N, Mendy A, Gasana J, Vieira ER, Quizon A, Forno E. Probiotic administration in early life, atopy, and asthma: A meta-analysis of clinical trials. Pediatrics. 2013;132(3):e666–76. http://dx.doi.org/10.1542/peds.2013-0246
35. Bode L. Human milk oligosaccharides in the prevention of necrotizing enterocolitis: A journey from in vitro and in vivo models to mother-infant cohort studies. Front Pediatr. 2018;6:385. http://dx.doi.org/10.3389/fped.2018.00385
36. Eslami M, Bahar A, Keikha M, Karbalaei M, Kobyliak NM, Yousefi B. Probiotics function and modulation of the immune system in allergic diseases. Allergol Immunopathol (Madr). 2020 Aug 3;S0301–0546(20):30113771-778–120 . http://dx.doi.org/10.1016/j.aller.2020.04.005
37. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: A randomized controlled trial. J Allergy Clin Immunol. 2007;119(1):184–91. http://dx.doi.org/10.1016/j.jaci.2006.08.036
38. Björkstén B, Naaber P, Sepp E, Mikelsaar M. The intestinal microflora in allergic Estonian and Swedish 2-year-old children [published correction appears in Clin Exp Allergy 2000 Jul;30(7):1047]. Clin Exp Allergy. 1999;29(3):342–6. http://dx.doi.org/10.1046/j.1365-2222.1999.00560.x
39. Kukkonen AK, Kuitunen M, Savilahti E, Pelkonen A, Malmberg P, Mäkelä M. Airway inflammation in probiotic-treated children at 5 years. Pediatr Allergy Immunol. 2011;22(2):249–51. http://dx.doi.org/10.1111/j.1399-3038.2010.01079.x
40. Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014;69(5):590–601. http://dx.doi.org/10.1111/all.12398