February 08, 2016
JAMA Pediatrics
TAKE-HOME MESSAGE
- This meta-analysis of the use of synbiotics for atopic dermatitis (AD) in children identified eight studies that met inclusion criteria, including two prevention studies and six treatment studies. The pooled change in Severity Scoring of Atopic Dermatitis (SCORAD) index for the treatment studies was ─6.56 at 8 weeks of treatment. However, the beneficial effect was only significant when mixed bacterial strains were used and for children aged 1 year or older.
- Treatment of AD with synbiotics may be effective in children older than 1 year of age and when mixed bacterial strains are included. More evidence is needed to support the use of synbiotics in the prevention of AD in children.
Abstract
IMPORTANCE
Atopic dermatitis (AD) is a highly prevalent condition that may be associated with an altered gastrointestinal microbiota that promotes an immune environment more susceptible to allergic disease. Synbiotics, a mixture of prebiotics and probiotics, have been used for the prevention and treatment of AD.
OBJECTIVE
To investigate the efficacy of synbiotics for primary prevention and treatment of AD.
DATA SOURCES
PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the CAB Abstracts Archive searchable database were searched from the inception of all databases to October 15, 2015, with no language restrictions.
STUDY SELECTION
We included all published randomized clinical trials of synbiotics for prevention and/or treatment of AD. To be included, a publication needed to clearly define the intervention as oral administration of synbiotics (combination of probiotics and prebiotics) and must have included an assessment of AD disease severity, such as the Severity Scoring of Atopic Dermatitis (SCORAD) index, or the incidence of AD as an outcome measure. Only 8 of 257 initially identified studies (3%) met selection criteria.
DATA EXTRACTION AND SYNTHESIS
Data extraction was independently done by multiple observers and cross-checked to avoid errors. The quality of the selected studies was critically examined following the Cochrane guidelines. Data were pooled using a random-effects model.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the SCORAD index (treatment studies) and the relative risk of AD (prevention studies). The hypothesis was formulated before data collection.
RESULTS
A total of 257 abstracts were screened to identify 6 treatment studies (369 children enrolled; aged 0 months to 14 years) and 2 prevention studies (1320 children enrolled; up to age 6 months in one study and term neonates aged
CONCLUSIONS AND RELEVANCE
This meta-analysis shows evidence that supports the use of synbiotics for the treatment of AD, particularly synbiotics with mixed strains of bacteria and for children aged 1 year or older. Further studies are needed to evaluate the effectiveness of synbiotics for primary prevention of AD.