Plain language summary
It is estimated that atopic dermatitis (AD) affects around 10-20% of children. This systematic review and meta-analysis evaluates the evidence for using probiotics for the treatment of AD in children. 13 randomised controlled trials (RCT) were included in the review, all but one were of a double-blind design. They included a total of 1070 children, 553 receiving probiotics and 517 controls. Overall, a beneficial effect of probiotics in AD was observed. Subgroup analysis showed a) positive results in children aged 1-18 years, but probiotics being ineffective in infants younger than 1 year; b) probiotics reduced AD in Asian, but not European studies, and c) certain strains proved beneficial (Lactobacillus salivarius, Lactobacillus fermentum and a multi-strain probiotic), whilst Lactobacillus rhamnosus GG and Lactobacillus plantarum showed no effect. The authors discuss that their meta-analysis is limited by the heterogeneity among the trials and inclusion of studies with small sample sizes. They conclude that probiotics may be of benefit in children with AD but that more adequately powered trials assessing specific probiotics and dosages are needed, to inform the best treatment protocols.
Abstract
Objective: Atopic dermatitis (AD) is a prevalent, burdensome, and psychologically important pediatric concern. Probiotics have been suggested as a treatment for AD. Some reports have explored this topic; however, the utility of probiotics for AD remains to be firmly established. Methods: To assess the effects of probiotics on AD in children, the PubMed/Medline, Cochrane Library Scopus, and OVID databases were searched for reports published in the English language. Results: Thirteen studies were identified. Significantly higher SCORAD values favoring probiotics over controls were observed (mean difference [MD], -3.07; 95% confidence interval [CI], -6.12 to -0.03; P < 0.001). The reported efficacy of probiotics in children < 1 year old was -1.03 (95%CI, -7.05 to 4.99) and that in children 1-18 years old was -4.50 (95%CI, -7.45 to -1.54; P < 0.001). Subgroup analyses showed that in Europe, SCORAD revealed no effect of probiotics, whereas significantly lower SCORAD values were reported in Asia (MD, -5.39; 95%CI, -8.91 to -1.87). Lactobacillus rhamnosus GG (MD, 3.29; 95%CI, -0.30 to 6.88; P = 0.07) and Lactobacillus plantarum (MD, -0.70; 95%CI, -2.30 to 0.90; P = 0.39) showed no significant effect on SCORAD values in children with AD. However, Lactobacillus fermentum (MD, -11.42; 95%CI, -13.81 to -9.04), Lactobacillus salivarius (MD, -7.21; 95%CI, -9.63 to -4.78), and a mixture of different strains (MD, -3.52; 95%CI, -5.61 to -1.44) showed significant effects on SCORAD values in children with AD. Conclusions: Our meta-analysis indicated that the research to date has not robustly shown that probiotics are beneficial for children with AD. However, caution is needed when generalizing our results, as the populations evaluated were heterogeneous. Randomized controlled trials with larger samples and greater power are necessary to identify the species, dose, and treatment duration of probiotics that are most efficacious for treating AD in children.
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