Clinical Use of Probiotics in Pediatric Allergy (CUPPA): A World Allergy Organization Position Paper

Authors

Alessandro Fiocchi, Pediatric Hospital Bambino GesùFollow
Wesley Burks, University of North Carolina at Chapel Hill
Sami L. Bahna, Louisiana State University Health Sciences Center
Leonard Bielory, University of Medicine and Dentistry of New Jersey Medical School
Robert J. Boyle, Imperial College London
Renata Cocco, Federal University of São Paulo
Sten Dreborg, University of Uppsala
Richard E. Goodman, University of Nebraska-LincolnFollow
Mikael Kuitunen, University of Helsinki
Tari Haahtela, University of Helsinki
Ralf G. Heine, University of Melbourne
Gideon Lack, King’s College London
David A. Osborn, University of Sydney
Hugh Sampson, Mount Sinai School of Medicine
Gerald W. Tannock, University of Otago
Bee Wah Lee, National University of Singapore

Document Type

Article

Date of this Version

2012

Citation

WAO Journal 2012; 5:148–167.

Comments

Copyright 2012 by World Allergy Organization

Abstract

Background: Probiotic administration has been proposed for the prevention and treatment of specific allergic manifestations such as eczema, rhinitis, gastrointestinal allergy, food allergy, and asthma. However, published statements and scientific opinions disagree about the clinical usefulness.

Objective: A World Allergy Organization Special Committee on Food Allergy and Nutrition review of the evidence regarding the use of probiotics for the prevention and treatment of allergy.

Methods: A qualitative and narrative review of the literature on probiotic treatment of allergic disease was carried out to address the diversity and variable quality of relevant studies. This variability precluded systematization, and an expert panel group discussion method was used to evaluate the literature. In the absence of systematic reviews of treatment, meta-analyses of prevention studies were used to provide data in support of probiotic applications.

Results: Despite the plethora of literature, probiotic research is still in its infancy. There is a need for basic microbiology research on the resident human microbiota. Mechanistic studies from biology, immunology, and genetics are needed before we can claim to harness the potential of immune modulatory effects of microbiota. Meanwhile, clinicians must take a step back and try to link disease state with alterations of the microbiota through well-controlled longterm studies to identify clinical indications.

Conclusions: Probiotics do not have an established role in the prevention or treatment of allergy. No single probiotic supplement or class of supplements has been demonstrated to efficiently influence the course of any allergic manifestation or long-term disease or to be sufficient to do so. Further epidemiologic, immunologic, microbiologic, genetic, and clinical studies are necessary to determine whether probiotic supplements will be useful in preventing allergy. Until then, supplementation with probiotics remains empirical in allergy medicine. In the future, basic research should focus on homoeostatic studies, and clinical research should focus on preventive medicine applications, not only in allergy. Collaborations between allergo-immunologists and microbiologists in basic research and a multidisciplinary approach in clinical research are likely to be the most fruitful.