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Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort

https://doi.org/10.1016/j.jaci.2008.11.019Get rights and content

Background

Less microbial exposure in early childhood is associated with more allergic disease later. Allergic children have a different fecal microflora, with less lactobacilli and bifidobacteria. Beneficial effects regarding the development of allergy have been suggested to come through probiotic supplementation.

Objective

We sought to study the effect of probiotic and prebiotic supplementation in preventing allergies.

Methods

In a double-blinded, placebo-controlled study we randomized 1223 mothers with infants at high risk for allergy to receive a probiotic mixture (2 lactobacilli, bifidobacteria, and propionibacteria) or placebo during the last month of pregnancy and their infants to receive it from birth until age 6 months. Infants also received a prebiotic galacto-oligosaccharide or placebo. At 5 years, we evaluated the cumulative incidence of allergic diseases (eczema, food allergy, allergic rhinitis, and asthma) and IgE sensitization.

Results

Of the 1018 intent-to-treat infants, 891 (88%) attended the 5-year visit. Frequencies of allergic and IgE-associated allergic disease and sensitization in the probiotic and placebo groups were similar: 52.6% versus 54.9% and 29.5% versus 26.6%, respectively, and 41.3% in both. No significant difference appeared in frequencies of eczema (39.3% vs 43.3%), atopic eczema (24.0% vs 25.1%), allergic rhinitis (20.7% vs 19.1%), or asthma (13.0% vs 14.1%) between groups. However, less IgE-associated allergic disease occurred in cesarean-delivered children receiving probiotics (24.3% vs 40.5%; odds ratio, 0.47; 95% CI, 0.23% to 0.96%; P = .035).

Conclusions

No allergy-preventive effect that extended to age 5 years was achieved with perinatal supplementation of probiotic bacteria to high-risk mothers and children. It conferred protection only to cesarean-delivered children.

Section snippets

Methods

Pregnant mothers whose fetuses were at high risk for allergy (at least 1 parent with doctor-diagnosed asthma, allergic rhinitis, or atopic eczema) were randomized at 35 weeks of gestation to receive probiotics or placebo in a double-blind manner. From 36 weeks of gestation, mothers in the probiotic group took a capsule containing freeze-dried LGG (American Type Culture Collection 53103; 5 × 109 colony-forming units [cfu]), L rhamnosus LC705 (DSM 7061; 5 × 109 cfu), Bifidobacterium breve Bb99

Results

Characteristics of study children are depicted in Table I. Initially, 1223 mothers were randomized. The intent-to-treat infants numbered 1018. Of these infants, 891 (88%) attended the 5-year visit, and participation was unaffected by probiotic intervention (87.9% among the probiotic group vs 87.1% among the placebo group) or allergy status by age 2 years (96.1% among allergic children vs 95.0% among nonallergic children, Fig 1). Mean (SD) age at the 5-year visit was 4.92 (0.09) years in both

Discussion

One month of prenatal dosage for each mother and 6 months of postnatal supplementation for the infants with a combination of 4 probiotic strains and a prebiotic failed to reduce the prevalence of allergic or atopic disease in this large cohort of almost 900 children followed until age 5 years. It affected neither any single allergic symptom (eczema, allergic rhinitis, or asthma) nor IgE sensitization. At age 2 years, we saw a significant reduction in IgE-associated allergic diseases,

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    Supported by the Helsinki University Central Hospital Research Funds, the Foundation for Pediatric Research, and Valio, Ltd, Helsinki, Finland. M.K. received part-time and K.K. received monthly salaries from the Clinical Research Institute, Helsinki University Central Hospital, funded by Valio Ltd.

    Disclosure of potential conflict of interest: R. Korpela and T. Tuure are employees of Valio Ltd, which provided research support for this study. The rest of the authors have declared that they have no conflict of interest.

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    Copyright © 2009 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.