Prebiotics May Guard Against Infant Eczema

Larry Hand

March 29, 2013

A prebiotic added to infant formula or breast milk may prevent eczema in infants up to 2 years old, but evidence is unclear about whether prebiotics help to prevent other infant allergic diseases, according to a study published online September 27 in the Cochrane Database of Systematic Reviews.

David A. Osborn, PhD, of the Central Clinical School, Discipline of Obstetrics, Gynaecology and Neonatology, and John KH Sinn, of the Department of Neonatology, Royal North Shore Hospital, both of the University of Sydney, Australia, conducted a systematic review of published studies, conference reports, and clinical trial registries in August 2012, searching for randomized or quasirandomized trials regarding the effects of prebiotics vs no prebiotics on infant allergies. In the final analysis, 4 studies involving 1428 infants reported on allergy outcomes in children aged 4 months to 2 years.

Up to 8% of young children develop food allergies, up to 20% develop atopic eczema, and up to 34% develop asthma, the researchers write. Prebiotics — indigestible components of breast milk, fruit, and vegetables that can be added to human milk or infant formula — stimulate activity of healthy bacteria in the gut and are distinct from probiotics, which are live bacteria cultures that can be added to yogurts and infant formula.

In a meta-analysis of the studies, the researchers found a significant reduction in eczema (1218 infants; typical risk ratio, 0.68; 95% confidence interval [CI], 0.48 - 0.97; typical risk difference, -0.04; 95% CI, -0.07 to -0.00; number needed to treat to benefit [NNTB], 25; 95% CI, 14 to > 100; P = 0.03). They found no significant difference between risk for allergy and type of infant milk.

Although some individual studies found a significant reduction in asthma and eczema with the supplementation of prebiotics, the quality of the evidence for the effect of prebiotics on asthma prevention was "very low," and the quality of evidence regarding prevention of eczema was "low," the researchers write. Only 1 study evaluated effects in high-risk children, finding reductions in asthma and eczema but not in allergies overall, they write.

"Given these findings, it remains unclear whether the use of prebiotics should be restricted to infants at high risk of allergy or may have an effect in low-risk populations," lead researcher Sinn said in a news release. "Overall, we found some evidence that infant formula containing prebiotic supplements can help prevent eczema in children up to 2 years of age. However, the quality of existing evidence is generally low or very low. More high-quality research is needed before we can recommend routine use of prebiotics for prevention of allergy."

This effort was supported by the Australian Satellite of the Cochrane Neonatal Review Group and the Eunice Kennedy Shriver National Institute of Child Health and Development, US National Institutes of Health. John Sinn reports that he has been an invited speaker at industry funded meetings. No other authors have disclosed any relevant financial relationships.

Cochrane Database Syst Rev. Published online March 27, 2013. Abstract