Clinical use of probiotics in pediatric allergy (CUPPA): A world allergy organization position paper

Alessandro Fiocchi, Wesley Burks, Sami L. Bahna, Leonard Bielory, Robert J. Boyle, Renata Cocco, Sten Dreborg, Richard Goodman, Mikael Kuitunen, Tari Haahtela, Ralf G. Heine, Gideon Lack, David A. Osborn, Hugh Sampson, Gerald W. Tannock, Bee Wah Lee

Research output: Contribution to journalArticle

92 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)148-167
Number of pages20
JournalWorld Allergy Organization Journal
Volume5
Issue number11
DOIs
StatePublished - Nov 2012

Keywords

  • Pediatric allergy
  • Prevention of allergy
  • Probiotics

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine

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    Fiocchi, A., Burks, W., Bahna, S. L., Bielory, L., Boyle, R. J., Cocco, R., Dreborg, S., Goodman, R., Kuitunen, M., Haahtela, T., Heine, R. G., Lack, G., Osborn, D. A., Sampson, H., Tannock, G. W., & Lee, B. W. (2012). Clinical use of probiotics in pediatric allergy (CUPPA): A world allergy organization position paper. World Allergy Organization Journal, 5(11), 148-167. https://doi.org/10.1097/WOX.0b013e3182784ee0