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World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics
Open accessAbstract
BACKGROUND: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. OBJECTIVE: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. METHODS: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. RESULTS: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. CONCLUSIONS: WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.
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“These guidelines concluded that currently there is no evidence supporting probiotic supplementation for reducing the risk of allergy incidence in children. However, there is likely to be a net benefit using probiotics for eczema prevention, which requires further clinical trials to increase the sample size and the reliability of the results.”
From Bifidobacteria and Their Health-Promoting Effects (2017) · cites this paper as [166]
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Bacterial Metabolites: A Link between Gut Microbiota and Dermatological Diseases
Stec, A., Sikora, M., Maciejewska, M., Paralusz-Stec, K., Michalska, M. N., Sikorska, E., & Rudnicka, L. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24043494 · Cited by 89
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Probiotics as treatment for food allergies among pediatric patients: a meta-analysis
Tan‐Lim, C. S. C., & Esteban‐Ipac, N. A. R. (2018) · World Allergy Organization Journal · doi:10.1186/s40413-018-0204-5 · Cited by 80
“Probiotic use among infants at high risk of allergic disease was conditionally recommended due to its net benefit of preventing eczema; however this had very low quality of evidence [16].”
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The Role of Probiotics in Preventing Allergic Disease
Wang, H. T., Anvari, S., & Anagnostou, A. (2019) · Children · doi:10.3390/children6020024 · Cited by 79
Probiotics in Asthma and Allergy Prevention
Mennini, M., Dahdah, L., Artesani, M. C., Fiocchi, A. G., & Martelli, A. (2017) · Frontiers in Pediatrics · doi:10.3389/fped.2017.00165 · Cited by 79
Self-citationExploring the Science behind Bifidobacterium breve M-16V in Infant Health
Wong, C. B., Iwabuchi, N., & Xiao, J. (2019) · Nutrients · doi:10.3390/nu11081724 · Cited by 78
“Collectively, these findings are cautiously promising with respect to the use of probiotics for the primary prevention of eczema in pregnant mothers of infants at high risk for developing allergy and in high-risk infants, as recommended in recent guidelines from the World Allergy Organization [115].”
Barthow, C. A., Wickens, K. L., Stanley, T., Mitchell, E. A., Maude, R., Abels, P., Purdie, G., Murphy, R., STONE, P. R., Kang, J., et al. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-0923-y · Cited by 79
“A recent 2015 World Allergy Organisation guideline has for the first time suggested that pregnant women whose infants are at high risk for allergy should take probiotics; however this recommendation is recorded as conditional and based on very low quality evidence [80].”
BackgroundFood Allergy: Our Evolving Understanding of Its Pathogenesis, Prevention, and Treatment
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Self-citationProbiotics in late infancy reduce the incidence of eczema: A randomized controlled trial
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“Due to the beneficial effects on the development of eczema, The World Allergy Organization 81 guideline panel suggested in 2015 to use probiotics in pregnant women at high risk of having an 82 allergic child; women, who breastfeed infants a t high risk of developing allergy; and infants at high 83 risk of developing a…”
BackgroundPrebiotics and probiotics in atopic dermatitis (Review)
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Microbial Dysbiosis Tunes the Immune Response Towards Allergic Disease Outcomes
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Term Infant Formulas Influencing Gut Microbiota: An Overview
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“However, the WAO guideline panel recognizes that the recommendations of both probiotics and prebiotics are conditional and based on very low quality evidence.”
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“The available data suggest that the efficacy of traditional probiotics is limited to the prevention of eczema in high-risk infants (156, 167, 168).”
BackgroundHuman milk microbiome: From actual knowledge to future perspective
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Current Use of Probiotics and Prebiotics in Allergy
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Self-citationManipulating Microbiota to Treat Atopic Dermatitis: Functions and Therapies
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Allergy prevention by breastfeeding: possible mechanisms and evidence from human cohorts
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Food allergy and atopic dermatitis: Prediction, progression, and prevention
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Epicutaneous sensitization to food allergens in atopic dermatitis: What do we know?
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Self-citationFood Allergy Prevention and Treatment by Targeted Nutrition
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Awareness, Knowledge, and Interest about Prebiotics—A Study among Romanian Consumers
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The role of the commensal microbiota in the regulation of tolerance to dietary allergens
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“Recently published guidelines for atopic disease prevention from the World Allergy Organization concluded that there is a likely net benefit in using probiotics for eczema prevention [35].”
BackgroundWest, C. E., Jenmalm, M. C., Kozyrskyj, A. L., & Prescott, S. L. (2016) · Expert Review of Clinical Immunology · doi:10.1586/1744666x.2016.1147955 · Cited by 61
“In 2015, the WAO launched guidelines on the use of probiotics as a preventive strategy to reduce allergic diseases [96].”
BackgroundMethodSelf-citationScalabrin, D., Harris, C. L., Johnston, W., & Berseth, C. L. (2016) · European Journal of Pediatrics · doi:10.1007/s00431-016-2825-4 · Cited by 62
“Although safety issues associated with the use of live probiotic bacteria are rare and have been reported only in immunocompromised or seriously ill individuals, there are still safety concerns associated with the use of live probiotic bacteria [33, 34].”
BackgroundProbiotics: a proactive approach to health. A symposium report
Thomas, L. V., Suzuki, K., & Zhao, J. (2015) · British Journal Of Nutrition · doi:10.1017/s0007114515004043 · Cited by 62
“∙ Prevention of allergic disease: in 2015, the World Allergy Organization published new evidence-based guidelines relating to probiotic use((57)).”
Background
Metadata
- Authors
- Fiocchi, A., Pawankar, R., Cuello-Garcia, C., Ahn, K., Al-Hammadi, S., Agarwal, A., Beyer, K., Burks, W., Canonica, G. W., Ebisawa, M., Gandhi, S., Kamenwa, R., Lee, B. W., Li, H., Prescott, S., Riva, J. J., Rosenwasser, L., Sampson, H., Spigler, M., Terracciano, L., Vereda-Ortiz, A., Waserman, S., Yepes-Nuñez, J. J., Brożek, J. L., & Schünemann, H. J.
- Affiliations
- Bambino Gesù Children's Hospital (IT)
- Nippon Medical School (JP)
- Samsung Medical Center (KR)
- University of Toronto (CA)
- Stiftung Charité (DE)
- University of North Carolina at Chapel Hill (US)
- Ospedale Policlinico San Martino (IT)
- National Sagamihara Hospital (JP)
- Aga Khan University Hospital Nairobi (KE)
- National University of Singapore (SG)
- Children's Hospital of Chongqing Medical University (CN)
- The Kids Research Institute Australia (AU)
- McMaster University (CA)
- Children's Mercy Hospital (US)
- Icahn School of Medicine at Mount Sinai (US)
- Food Allergy Research and Education (US)
- University of Milan (IT)
- Hospital Infantil Universitario Niño Jesús (ES)
- Corresponding author
- Fiocchi, Alessandro
- Pawankar, Ruby
- Brożek, Jan L
- ORCID
- Venue
- World Allergy Organization Journal
- Publisher
- Elsevier BV
- Published
- 2015
- Volume
- 8
- Issue
- 1
- Pages
- 4
- ISSN
- 1939-4551 (ISSN-L)
- PMC
- PMC4307749
- OpenAlex
- W2141887889
- Cited by
- 473
- References
- 119
- Citations by year
- 2026: 6 · 2025: 23 · 2024: 40 · 2023: 43 · 2022: 36 · 2021: 45 · 2020: 54 · 2019: 48 · 2018: 47 · 2017: 45 · 2016: 56 · 2015: 29
- FWCI
- 78.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- World Allergy Organization Journal (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Repository University of Antioquia (University of Antioquia) (publishedVersion, cc-by-nc-nd)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- TSpace (University of Toronto) (submittedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- UNC Libraries
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Keywords
- probiotics, allergy prevention, infants, eczema prevention, gut microbiota, probiotic supplementation, pregnancy, breastfeeding, high-risk infants, immunomodulation
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