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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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Tapiovaara, L. K., Pitkäranta, A., & Korpela, R. (2016) · Pediatric Infectious Diseases Open Access · doi:10.21767/2573-0282.100019 · Cited by 32
“In 2015, the World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations for the use of probiotics in the prevention of allergy [21].”
BackgroundConsenso mexicano sobre probióticos en gastroenterología
Valdovinos, M. A., Montijo, E., y Abreu, A. T. A., Heller, S., Garay, A. G. G., Nogales, D. B., Bielsa-Fernández, M. V., Bojórquez-Ramos, M. D. C., Bosques‐Padilla, F., Burguete-García, A. I., et al. (2017) · Revista de Gastroenterología de México · doi:10.1016/j.rgmx.2016.08.004 · Cited by 31
Gut microbiota modifications and weight gain in early life
Angelakis, E., & Raoult, D. (2018) · Human Microbiome Journal · doi:10.1016/j.humic.2018.01.002 · Cited by 27
Martínez, L. A., Ravi, K., Huffnagle, G. B., Lukacs, N. W., & Fonseca, W. (2024) · Frontiers in Microbiomes · doi:10.3389/frmbi.2023.1345330 · Cited by 26
Taking a prebiotic approach to early immunomodulation for allergy prevention
Pretorius, R. A., Prescott, S. L., & Palmer, D. J. (2017) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2018.1411191 · Cited by 25
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The clinical implications of the microbiome in the development of allergy diseases
Koidl, L., & Untersmayr, E. (2021) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2021.1874353 · Cited by 25
“tion of allergic eczema in families with a high risk for allergy development [98].”
BackgroundWiercioch, W., Nieuwlaat, R., Zhang, Y., Alonso‐Coello, P., Dahm, P., Iorio, A., Manja, V., Mustafa, R. A., Neumann, I., Ortel, T. L., et al. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.11.031 · Cited by 26
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Review of Environmental Impact on the Epigenetic Regulation of Atopic Diseases
Sabounchi, S., Bollyky, J., & Nadeau, K. C. (2015) · Current Allergy and Asthma Reports · doi:10.1007/s11882-015-0533-1 · Cited by 26
Probiotics SOD inhibited food allergy via downregulation of STAT6-TIM4 signaling on DCs
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Allergic diseases in infancy: I - Epidemiology and current interpretation
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“While it is recommended by a World Allergy Organization (WAO) panel, national guidelines have not yet adopted any such recommendation.(42,43)”
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GRADE-ing the Benefit/Risk Equation in Food Immunotherapy
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Vandenplas, Y., Meyer, R. W., Chouraqui, J.-P., Dupont, C. M., Fiocchi, A. G., Salvatore, S., Shamir, R., Szajewska, H., Thapar, N., Venter, C., et al. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.10.025 · Cited by 25
Self-citationLactobacillus rhamnosus GG for Cow's Milk Allergy in Children: A Systematic Review and Meta-Analysis
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(R)Evolution in Allergic Rhinitis Add-On Therapy: From Probiotics to Postbiotics and Parabiotics
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“In summary, current evidence does not support the administration of probiotics to prevent any form of allergic disease, except for eczema in high-risk infants (WAO recommendation), but it does favor probiotic supplementation in pregnant/lactating women or infants with a family history of allergic disease [94].”
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Implementation gaps for asthma prevention and control
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The Mexican consensus on probiotics in gastroenterology
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Nieuwlaat, R., Wiercioch, W., Brożek, J., Santesso, N. A., Kunkle, R., Alonso‐Coello, P., Anderson, D. R., Bates, S. M., Dahm, P., Iorio, A., et al. (2021) · Blood Advances · doi:10.1182/bloodadvances.2020003577 · Cited by 21
“The first ASH guideline template was drafted by HJS and JLB based on guideline unpublished templates used for various organizations, including the WAO, WHO, government guideline groups and the existing template sections in GRADEpro.(7-17) The draft was then iteratively refined using input from the ASH VTE Guidelines M…”
MethodSelf-citationVenter, C., Pickett‐Nairne, K., Leung, D. Y. M., Fleischer, D. M., O’Mahony, L., Glueck, D. H., & Dabelea, D. (2024) · Allergy · doi:10.1111/all.16292 · Cited by 20
Promising candidates for allergy prevention
Gern, J. E. (2015) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.05.017 · Cited by 20
Dosage-Related Prebiotic Effects of Inulin in Formula-Fed Infants
Oswari, H., Widodo, A. D., Handayani, F., Juffrie, M., Sundjaya, T., BINDELS, J. G., & Hegar, B. (2019) · Pediatric Gastroenterology Hepatology & Nutrition · doi:10.5223/pghn.2019.22.1.63 · Cited by 20
Targeting different signaling pathways for food allergy regulation and potential therapy: a review
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“In 2015, the World Allergy Organization guideline panel suggested to use probiotics to prevent food allergy in pregnant women at high risk for having an allergic child (Fiocchi et al. 2015).”
Nowicka, D., Chilicka, K., & Dzieńdziora-Urbińska, I. (2022) · Pathogens · doi:10.3390/pathogens11010071 · Cited by 20
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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