Allergology International

Allergology International

Volume 66, Issue 4, October 2017, Pages 529-538
Allergology International

Invited review article
Bugging allergy; role of pre-, pro- and synbiotics in allergy prevention

https://doi.org/10.1016/j.alit.2017.08.001Get rights and content
Under a Creative Commons license
open access

Abstract

Large-scale biodiversity loss and complex changes in social behaviors are altering human microbial ecology. This is increasingly implicated in the global rise in inflammatory diseases, most notably the “allergy epidemic” in very early life. Colonization of human ecological niches, particularly the gastrointestinal tract, is critical for normal local and systemic immune development and regulation. Disturbances in composition, diversity and timing of microbial colonization have been associated with increased allergy risk, indicating the importance of strategies to restore a dysbiotic gut microbiota in the primary prevention of allergic diseases, including the administration of probiotics, prebiotics and synbiotics. Here, we summarize and discuss findings of randomized clinical trials that have examined the effects of these microbiome-related strategies on short and long-term allergy preventative effects – including new guidelines from the World Allergy Organization which now recommend probiotics and prebiotics for allergy prevention under certain conditions. The relatively low quality evidence, limited comparative studies and large heterogeneity between studies, have collectively hampered recommendations on specific probiotic strains, specific timing and specific conditions for the most effective preventive management. At the same time the risk of using available products is low. While further research is needed before specific practice guidelines on supplement probiotics and prebiotics, it is equally important that the underlying dietary and lifestyle factors of dysbiosis are addressed at both the individual and societal levels.

Keywords

Asthma
Biodiversity
Eczema
Microbiome
Probiotic

Abbreviations

GRADE
Grading of Recommendation Assessment Development and Evaluation
HMO
Human milk oligosaccharide
NCD
non-communicable disease
RCT
randomized controlled trial
RR
relative risk
SCORAD
Scoring Atopic Dermatitis
SCFA
short-chain fatty acid
Treg
regulatory T-cell
TLR
Toll-like receptor
WAO
World Allergy Organization

Cited by (0)

Peer review under responsibility of Japanese Society of Allergology.