Cited by 473Probiotics and Fermented FoodsFood Allergy and Anaphylaxis ResearchAsthma and respiratory diseases

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World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics

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Fiocchi, Alessandro, Pawankar, Ruby, Cuello-Garcia, Carlos, Ahn, Kangmo, Al-Hammadi, Suleiman, Agarwal, Arnav, Beyer, Kirsten, Burks, Wesley, Canonica, Giorgio W, Ebisawa, Motohiro, Gandhi, Shreyas, Kamenwa, Rose, Lee, Bee Wah, Li, Haiqi, Prescott, Susan, Riva, John J, Rosenwasser, Lanny, Sampson, Hugh, Spigler, Michael, Terracciano, Luigi, Vereda-Ortiz, Andrea, Waserman, Susan, Yepes-Nuñez, Juan José, Brożek, Jan L, Schünemann, Holger J·2015·World Allergy Organization Journal

DOI 10.1186/s40413-015-0055-2PMC PMC4307749

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Abstract

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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1 retracted

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Background
Prevention of Food Allergies
Koplin, J. J., Peters, R. L., & Allen, K. J. (2017) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2017.09.001 · Cited by 10
Effect of Supplementation with a Specific Probiotic (Bifidobacterium bifidum PRL2010) in Pregnancy for the Prevention of Atopic Dermatitis in Children: Preliminary Results of a Randomized Trial
Anania, C., Matys, V., Marra, S., De Canditiis, D., Olivero, F., Carraro, C., Giugliano, A., Zicari, A. M., & Piccioni, M. G. (2025) · Nutrients · doi:10.3390/nu17040673 · Cited by 9
“The results show that probiotic supplementation does not reduce the risk of allergies in general but can provide benefits in the prevention of eczema, suggesting the beneficial use of probiotics in pregnant women at high risk of allergies in their children [15].”
The influence of modern living conditions on the human microbiome and potential therapeutic opportunities for allergy prevention
Zhang, G., & Souëf, P. N. L. (2024) · World Allergy Organization Journal · doi:10.1016/j.waojou.2023.100857 · Cited by 9
“46 However, for eczema, a recent review assessed the evidence regarding the use of probiotic supplementation for atopic dermatitis prevention in children.”
Background
Update: Do probiotics prevent or treat pediatric atopic dermatitis?
Blattner, C. M., Crosby, M. S., Goedken, M. L., & Murase, J. E. (2016) · Pediatric Allergy and Immunology · doi:10.1111/pai.12539 · Cited by 9
“However, each recommendation is based on limited evidence, with no specific recommendation regarding strains, dose, or treatment duration (11).”
Background
Dust mite allergen, glutathione S‐transferase, induces T cell immunoglobulin mucin domain‐4 in dendritic cells to facilitate initiation of airway allergy
Mo, L., Yang, L., Zeng, L., Xu, L. ‐., Zhang, H., Li, L., Liu, J. ‐., Xiao, X. ‐., Zheng, P., Liu, Z., et al. (2016) · Clinical & Experimental Allergy · doi:10.1111/cea.12800 · Cited by 9
Probiotics and infantile atopic eczema
Akelma, A. Z., & Biten, A. A. (2015) · Pediatric Health Medicine and Therapeutics · doi:10.2147/phmt.s50476 · Cited by 9
“Similarly, the World Allergy Organization guideline panel suggests using probiotics in infants at high risk of developing allergies.(29) However, these are conditional recommendations and very low quality evidence.”
Examining the Evidence for Using Synbiotics to Treat or Prevent Atopic Dermatitis
Tang, M. L. K., & Lodge, C. (2016) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2015.4406 · Cited by 9
Further Insights into the Gut Microbiota of Cow’s Milk Allergic Infants: Analysis of Microbial Functionality and Its Correlation with Three Fecal Biomarkers
Zubeldia‐Varela, E., Barker‐Tejeda, T. C., Mera‐Berriatua, L., Bazire, R., Cabrera‐Freitag, P., Úbeda, C., Barber, D., Francino, M. P., Rojo, D., Ibáñez-Sandín, M. D., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24119247 · Cited by 9
The potential of live biotherapeutic products in allergic disease: current findings and future directions
Tarrant, I., & Finlay, B. B. (2024) · Frontiers in Microbiomes · doi:10.3389/frmbi.2024.1418633 · Cited by 8
“Accordingly, the World Allergy Organization (WAO), recommends probiotic supplements for pregnant and breastfeeding women, and infants, at high-risk of allergy, for the prevention of atopic dermatitis (Fiocchi et al., 2015).”
Probiotics in infants for prevention of allergic disease
Wang, H. Z., Hayles, E. H., Fiander, M., Sinn, J. K. H., & Osborn, D. A. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006475.pub3 · Cited by 14
Microbial Strains in Fermented Dairy: Unlocking Biofunctional Properties and Health Benefits
Wijesekara, A. V., Weerasingha, V., Jayarathna, S., Vidanarachchi, J. K., & Priyashantha, H. (2025) · International Journal of Food Science · doi:10.1155/ijfo/6672700 · Cited by 8
“All data summarized in the text and tables of this review article were obtained from previously published studies with appropriate attribution cited in the text and tables and complete references provided in the Reference section.”
Evaluation of selected aspects of the hygiene hypothesis and their effect on the incidence of allergy
Krzych‐Fałta, E., Wojas, O., Furmańczyk, K., Dziewa-Dawidczyk, D., Piekarska, B., Samolinski, B. K., & Sybilski, A. J. (2023) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.01880 · Cited by 8
Efficacy and Safety of Oral Probiotics in Children with Allergic Rhinitis: A Review
Klain, A., Dinardo, G., Indolfi, C., Contieri, M., Salvatori, A., Vitale, S., Decimo, F., Ciprandi, G., & del Giudice, M. M. (2023) · Allergies · doi:10.3390/allergies3010006 · Cited by 8
Filaggrin Mutation Status and Prevention of Atopic Dermatitis with Maternal Probiotic Supplementation
Zakiudin, D. P., Thyssen, J. P., Zachariae, C. O. C., Videm, V., Øien, T., & Simpson, M. R. (2024) · Acta Dermato Venereologica · doi:10.2340/actadv.v104.24360 · Cited by 8
“This recommendation reflects the fact that most studies have been conducted on “high-risk” populations, which the WAO defined as having a biological parent or sibling with existing or a history of allergic rhinitis, asthma, eczema, or food allergy (17).”
BackgroundInfluential
OPINION : Primary prevention of allergy – Will it soon become a reality?
Bever, H. P. V., Nagarajan, S. A., Shek, L. P., & Lee, B. (2015) · Pediatric Allergy and Immunology · doi:10.1111/pai.12497 · Cited by 8
Self-citation
Therapeutic effects of isomaltodextrin in a BALB/c mouse model of egg allergy
Mine, Y., Jin, Y., Zhang, H., Majumder, K., Zeng, Y., Sakurai, T., Taniguchi, Y., Takagaki, R., Watanabe, H., & Mitsuzumi, H. (2019) · Journal of Functional Foods · doi:10.1016/j.jff.2019.02.038 · Cited by 8
Association of vitamin D gene polymorphisms in children with asthma - A systematic review
Ashok, N., Kirubakaran, R., & Saraswathy, R. (2020) · Heliyon · doi:10.1016/j.heliyon.2020.e04795 · Cited by 8
Food allergy prevention, including early food introduction
Leonard, S. A. (2020) · Journal of Food Allergy · doi:10.2500/jfa.2020.2.200007 · Cited by 8
“28 Although American and European allergy societies have not recommended the use of probiotics in primary prevention of allergy, 29 recommended considering probiotics in infants at high risk due to the reported bene ﬁ t seen in primary prevention of eczema.”
Background
Probiotics: current regulatory aspects of probiotics for use in different disease conditions
Pogačar, M. Š., Mičetić‐Turk, D., & Fijan, S. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-823733-5.00021-0 · Cited by 9
Manipulating the infant respiratory microbiomes to improve clinical outcomes: A review of the literature
Theodosiou, A. A., Dorey, R. B., Laver, J. R., Cleary, D. W., Read, R. C., & Jones, C. E. (2021) · Journal of Infection · doi:10.1016/j.jinf.2021.03.012 · Cited by 8
Pathophysiological mechanisms of gut dysbiosis and food allergy and an investigation of probiotics as an intervention for atopic disease
Crabtree, D., Seidler, K., & Barrow, M. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.11.019 · Cited by 7
Probiotics, Prebiotics, and Synbiotics as Oral Supplements for Skin Health, Function, and Disease Throughout the Life Course: A Scoping Review
Hillier, R. A., Gibson, R., Maruthappu, T., Whelan, K., Prpa, E. J., Neill, H. R., Phillips, C. G., & Hall, W. L. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf205 · Cited by 11
“34 Notably, this is a conditional recommendation based on low-quality evidence.”
Susceptibility to allergy in adoptive children: a cross-sectional study at “Bambino Gesù Children’s Hospital”
Tchidjou, H. K., Vescio, M. F., Serafinelli, J., Giampaolo, R., Jenkner, A., Tadonkeng, M. C., Avellis, L., Fiocchi, A. G., Pezzotti, P., Rezza, G., et al. (2018) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-017-0440-2 · Cited by 7
“These few data suggest that the development of atopy could present different characteristics in children than in adults both with regard to specific patterns of allergies and to the timing of occurrence [7].”
BackgroundSelf-citation
Environmental Interventions for Preventing Atopic Diseases
Pfirrman, S., Devonshire, A. L., & Winslow, A. W. (2024) · Current Allergy and Asthma Reports · doi:10.1007/s11882-024-01141-1 · Cited by 10
Early Oral Nutritional Supplements in the Prevention of Wheezing, Asthma, and Respiratory Infections
Trivillin, A., Zanella, S., Castaldo, R. J., Prati, F., Zanconato, S., Carraro, S., & Ferraro, V. A. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.866868 · Cited by 7
An Overview of Integrated Risk Factors with Prevention and Prevalence of Asthma at the Global Level
Garg, R., Piplani, M., Singh, Y., Bhateja, P., & Rana, R. (2023) · Current Traditional Medicine · doi:10.2174/2215083810666230525153908 · Cited by 8
Effects of gender and age on immune responses of human peripheral blood mononuclear cells to probiotics: A large scale pilot study
Ho, Y.-H., Huang, Y.-T., Lu, Y.-C., Lee, S.-Y., Tsai, M.-F., Hung, S.-P., & Hsu, T.-Y. (2017) · The Journal of nutrition, health and aging · doi:10.1007/s12603-016-0818-7 · Cited by 6
“However, many studies strongly support the potential of probiotics to become alternative treatments for some diseases, although the insufficient evidence and inconsistencies generated by related research have created large obstacles to overcome (10, 11).”
Nutrition and Allergic Diseases
van Neerven, R. J. J., & Savelkoul, H. F. J. (2018) · MDPI eBooks · doi:10.3390/books978-3-03842-850-3 · Cited by 6
OFFSPRING: A SPRING Follow-Up Study Assessing the Efficacy of Maternal Probiotics and Allergic Disease in the Child
Shipton, E. V., Foxcroft, K., Nitert, M. D., McIntyre, D. H., Barrett, H. L., Tang, M. L. K., & Callaway, L. K. (2023) · International Archives of Allergy and Immunology · doi:10.1159/000535179 · Cited by 11
Probiotics and allergic diseases
Akelma, A. Z., & Topçu, Z. İ. K. (2016) · World Journal of Immunology · doi:10.5411/wji.v6.i1.75 · Cited by 6
Microbiota-Mediated Immunomodulation and Asthma: Current and Future Perspectives
Boutin, R. C. T., & Finlay, B. B. (2016) · Current Treatment Options in Allergy · doi:10.1007/s40521-016-0087-z · Cited by 6
Doctor, when should I feed solid foods to my infant?
Fiocchi, A. G., Dahdah, L., Bahna, S. L., Mazzina, O., & Assa’ad, A. (2016) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0000000000000291 · Cited by 6
Self-citation
Impact of Early Nutrition on Intestinal Microbiome: Effects on Immunity and Long-Term Health
Laitinen, K., Mokkala, K., & Kalliomäki, M. A. (2016) · Elsevier eBooks · doi:10.1016/b978-0-08-100168-4.00008-2 · Cited by 5
Probiotic interventions to optimize the infant and child microbiota
Vandenplas, Y., & Huysentruyt, K. (2018) · World Nutrition Journal · doi:10.25220/wnj.v01i2.0005 · Cited by 6
“All recommendations are conditional and supported by very low quality evidence.(39)”
Background
Probiotics for humans: hoax, hype, hope, or help
Crane, J., Barthow, C. A., Kang, J., Hood, F. E., Stanley, T., & Wickens, K. L. (2019) · Journal of the Royal Society of New Zealand · doi:10.1080/03036758.2019.1692364 · Cited by 6
“Only the World Allergy Organisation supports the use of probiotics for infants at high risk of developing eczema (Fiocchi et al. 2015).”
Background
An integrative medicine review of primary prevention of allergy in pediatrics
Boolchandani, H., Horwitz, R., & Soffer, G. K. (2021) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2021.102695 · Cited by 6
Preventing allergies through the skin
Winslow, A. W., & Keet, C. A. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.04.013 · Cited by 6
Trends of vitamin D in asthma in the pediatric population for two decades: a systematic review
Sung, M. (2023) · Korean Journal of Pediatrics · doi:10.3345/cep.2022.01109 · Cited by 5
Maternal diet and complementary food diversity on allergy prevention
Venter, C. (2023) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2023-000675 · Cited by 6
“Systematic reviews 20–22 summarising this body of work showed no association between any of these factors studied and offspring allergy outcomes, other than perhaps taking probiotics in pregnancy, breast feeding and prevention of atopic dermatitis in early life.”
BackgroundMethod
Knowledge, attitude, and practice of Chinese parents with infants (aged 0–3 years) toward immunity, gut microbiota and biotics: a comprehensive study
Wang, J. P., Liu, N., Chen, Y., You, J., Yang, Y., Jin, Y. C., Sun, G., & Zhou, J. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1396087 · Cited by 5
Investigations on incidence and relevant factors of allergies in 5725 urban pregnant women: a cohort study in China
Gao, Q., Sun, H., Bo, S., Di, J., Xu, T., Shuo, W., Lu, Z., & Ailing, W. (2023) · BMC Public Health · doi:10.1186/s12889-022-14355-7 · Cited by 5
“Recently, probiotics supplementation is a popular theme to prevent allergies [29], and current available evidence indicates the net benefit of eczema prevention.”
Background
Causal relationship between Butyricimonas and allergic asthma: a two-sample Mendelian randomization study
Wan, W., Qiu, Y., Ren, Y., Huang, X., Peng, A., & Yang, C. (2023) · Frontiers in Microbiology · doi:10.3389/fmicb.2023.1190765 · Cited by 5
What’s new in atopic eczema? An analysis of systematic reviews published in 2018. Part 1: prevention and topical therapies
Tasker, F., Brown, A. C., Grindlay, D. J. C., Rogers, N. K., & Harman, K. E. (2020) · Clinical and Experimental Dermatology · doi:10.1111/ced.14303 · Cited by 5
Probiotics in pediatrics
Depoorter, L., & Vandenplas, Y. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-85170-1.00014-2 · Cited by 5

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: Fiocchi, Alessandro
Pawankar, Ruby
Ahn, Kangmo
Agarwal, Arnav
Beyer, Kirsten
Canonica, Giorgio W
Ebisawa, Motohiro
Kamenwa, Rose
Lee, Bee Wah
Prescott, Susan
Riva, John J
Rosenwasser, Lanny
Sampson, Hugh
Terracciano, Luigi
Waserman, Susan
Brożek, Jan L
Schünemann, Holger J
Venue: World Allergy Organization Journal
Publisher: Elsevier BV
Published: 2015
Volume: 8
Issue: 1
Pages: 4
ISSN: 1939-4551 (ISSN-L)
DOI: 10.1186/s40413-015-0055-2
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: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor, 1583 d)
www.springer.com/tdm (unspecified)
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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