Fiocchi Alessandro, Pawankar Ruby, Cuello-Garcia Carlos, Ahn Kangmo, Al-Hammadi Suleiman, Agarwal Arnav, Beyer Kirsten, Burks Wesley, Canonica Giorgio W, Ebisawa Motohiro, Gandhi Shreyas, Kamenwa Rose, Lee Bee Wah, Li Haiqi, Prescott Susan, Riva John J, Rosenwasser Lanny, Sampson Hugh, Spigler Michael, Terracciano Luigi, Vereda-Ortiz Andrea, Waserman Susan, Yepes-Nuñez Juan José, Brożek Jan L, Schünemann Holger J
Pediatric Hospital Bambino Gesù, Vatican City, Italy.
Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
World Allergy Organ J. 2015 Jan 27;8(1):4. doi: 10.1186/s40413-015-0055-2. eCollection 2015.
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.
The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.
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.
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.
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.
父母和兄弟姐妹无过敏症的婴儿中，过敏性疾病的患病率约为10%，而一级亲属有过敏症的婴儿中，患病率则达到20%-30%。肠道微生物群可能调节免疫和炎症性全身反应，从而影响致敏和过敏的发展。据报道，益生菌可调节免疫反应，有人提议补充益生菌作为一种预防性干预措施。
世界过敏组织（WAO）召集了一个指南小组，以制定关于使用益生菌预防过敏的循证建议。
我们确定了最相关的临床问题，并对益生菌预防过敏的随机对照试验进行了系统评价。我们采用推荐分级评估、制定和评价（GRADE）方法来制定建议。我们检索并审查了有关健康影响、患者价值观和偏好以及资源使用（截至2014年11月）的证据。我们遵循GRADE证据到决策框架来制定建议。
目前可得的证据并未表明补充益生菌可降低儿童发生过敏的风险。然而，考虑到这方面的所有关键结果，WAO指南小组确定使用益生菌可能有净益处主要源于预防湿疹。WAO指南小组建议：a）在生育过敏儿童风险高的孕妇中使用益生菌；b）在母乳喂养有发生过敏高风险婴儿的妇女中使用益生菌；c）在有发生过敏高风险的婴儿中使用益生菌。所有建议都是有条件的，且得到的是极低质量证据的支持。
WAO关于补充益生菌预防过敏的建议旨在支持父母、临床医生和其他医护人员在是否在孕期和哺乳期使用益生菌以及是否给婴儿使用益生菌方面做出决策。
