Atopic Dermatitis: Could Probiotics and Prebiotics Help?

Lara C. Pullen, PhD

January 28, 2016

Synbiotics (a combination of probiotics and prebiotics) may be an effective treatment for atopic dermatitis (AD). In particular, synbiotics that include mixed strains of bacteria appear able to provide symptom relief for children aged 1 year or older.

Yung-Sen Chang, MD, MPH, from the National Yan-Ming University in Taipei, Taiwan, and colleagues published the results of their meta-analysis online January 25 in JAMA Pediatrics. Their review identified 257 studies, only eight of which clearly defined the intervention as oral administration of synbiotics and included an assessment of AD severity. Their final analysis included six treatment studies with 369 children and two prevention studies with 1320 children.

"To our knowledge, this is the first meta-analysis of [randomized controlled trials] of synbiotics for the treatment and prevention of AD. We did not find evidence of publication bias, and according to our quality assessment there were not many opportunities for other kinds of biases," the authors write.

The treatment effect studies found an overall pooled change in Severity Scoring of Atopic Dermatitis (SCORAD) index in those treated with synbiotics (8 weeks) of −6.56 (95% confidence interval, −11.43 to −1.68; P = .008). A subgroup analysis revealed that mixed-strain bacterial species were able to improve the SCORAD index (weighted mean difference, −7.32; 95% confidence interval, −13.98 to −0.66; P = .03), whereas single strains were not. Moreover, treatment durations longer than 8 weeks conferred no additional benefits relative to a duration of 8 weeks or less.

Recently, many researchers have begun to investigate the role of probiotics, prebiotics, and synbiotics in AD. A different meta-analysis found that probiotics reduced the incidence of AD in infants younger than 2 years of age. The current meta-analysis, however, found such a wide 95% confidence interval on this outcome that they were unable to make a conclusion about primary prevention of AD.

The authors thus call for further studies to determine whether synbiotics are useful for primary prevention of AD.

Mimi L. K. Tan, MBBS, PhD, and Caroline J. Lodge, MBBS, PhD, from the University of Melbourne in Australia, wrote an accompanying editorial, in which they recognize the need for additional studies, but remain unconvinced by the current clinical evidence in support of the use of synbiotics.

"In summary, based on the current evidence, it is not appropriate to recommend synbiotics for the treatment of AD at this time. The meta-analysis conducted by Chang and colleagues offers encouraging findings, but the small number of studies and the significant heterogeneity of those studies limit the quality of evidence and confidence in the findings. Moreover, several issues around the practicalities of using synbiotics in the clinical setting are yet to be resolved," Dr Tan and Dr Lodge write.

They identify optimal bacterial and prebiotic components and optimal doses as important practicalities that need to be determined before recommending the use of synbiotics.

The authors have disclosed no relevant financial relationships. Dr Tang reports being a member of the medical advisory boards of the Nestlé Nutrition Institute and Danone Nutricia and serving on the Danone Nutricia Global Scientific Advisory Board. She has also received honoraria for presenting at symposia sponsored by Danone Nutricia and is an inventor on a patent owned by the Murdoch Children's Research Institute.

JAMA Pediatr. Published online January 25, 2016. Article abstract, Editorial extract

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