Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial Early Probiotic Supplementation for Eczema and Asthma Prevention: A Randomized Controlled Trial A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. An Evaluation of the Ability of the Probiotic Strain Lactobacillus rhamnosus GG to Eliminate the Gastrointestinal Carrier State of Vancomycin-resistant Enterococci in Colonized Children Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial. Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years: does it also reduce atopic sensitization? Microarray analysis reveals marked intestinal microbiota aberrancy in infants having eczema compared to healthy children in at-risk for atopic disease Evaluation of diet and growth in children with and without atopic eczema: follow-up study from birth to 4 years. Lack of efficacy of Lactobacillus GG in reducing pulmonary exacerbations and hospital admissions in children with cystic fibrosis: A randomised placebo controlled trial. Probiotic effects on faecal inflammatory markers and on faecal IgA in food allergic atopic eczema/dermatitis syndrome infants. Probiotic Bacteria in the Management of Atopic Disease: Underscoring the Importance of Viability Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow's milk allergy: 3‐year randomized controlled trial Effect of probiotic Lactobacillus strains in children with atopic dermatitis. A Randomized, Double‐blind Trial of Lactobacillus GG Versus Placebo in Addition to Standard Maintenance Therapy for Children with Crohn's Disease Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations Probiotic Lactobacillus rhamnosus GG therapy and microbiological programming in infantile colic: a randomized, controlled trial Induction of inflammation as a possible mechanism of probiotic effect in atopic eczema-dermatitis syndrome. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Effects of bifidobacterial supplementation to pregnant women and infants in the prevention of allergy development in infants and on fecal microbiota. Probiotics: a novel approach in the management of food allergy.
Perinatal administration of the probiotic Lactobacillus rhamnosus strain GG ( ATCC 53103 ) , reduces incidence of atopic eczema in at-risk children during the first 2 years of life ( infancy ) . We have therefore assessed persistence of the potential to prevent atopic eczema at 4 years . Atopic disease was diagnosed on the basis of a question naire and a clinical examination . 14 of 53 children receiving lactobacillus had developed atopic eczema , compared with 25 of 54 receiving placebo  ( relative risk 0.57 , 95 % CI 0.33 - 0.97 ) . Skin prick test reactivity was the same in both groups : ten of 50 children previously given lactobacillus compared with nine of 50 given placebo tested positive . Our results suggest that the preventive effect of lactobacillus GG on atopic eczema extends beyond infancy In this r and omized controlled trial , we examined the effect of early LGG infant supplementation in decreasing the risk of childhood eczema .  OBJECTIVES : To determine if probiotic administration during the first 6 months of life decreases  childhood asthma and eczema . METHODS : We conducted a r and omized , double-blind controlled trial of Lactobacillus rhamnosus GG ( LGG ) supplementation on the cumulative incidence of eczema ( primary end point ) and  asthma and rhinitis  ( secondary end points ) in high-risk infants . For the first 6 months of life , intervention infants ( n = 92 ) received a daily dose of 10 billion colony-forming units of LGG and 225 mg of inulin ( Amerifit Br and s , Cromwell , CT ) , and control infants ( n = 92 ) received 325 mg of inulin alone . We used survival analysis methods to estimate disease incidences in the presence or absence of LGG and to estimate the efficacy of LGG in delaying or preventing these diseases . RESULTS : Infants were accrued over a 6-year period ( median follow-up : 4.6 years ; 95 % retention rate at 2 years ) . At 2 years of age , the estimated cumulative incidence of eczema was 30.9 % ( 95 % confidence interval [ CI ] , 21.4%–40.4 % ) in the control arm and 28.7 % ( 95 % CI , 19.4%–38.0 % ) in the LGG arm , for a hazard ratio of 0.95 ( 95 % CI , 0.59–1.53 ) ( log-rank P = .83 ) . At 5 years of age , the cumulative incidence of asthma was 17.4 % ( 95 % CI , 7.6%–27.1 % ) in the control arm and 9.7 % ( 95 % CI , 2.7%–16.6 % ) in the LGG arm , for a hazard ratio of 0.88 ( 95 % CI , 0.41–1.87 ) ( log-rank P = .25 ) . CONCLUSIONS : For high-risk infants , early LGG supplementation for the first 6 months of life does not appear to prevent the development of eczema or asthma at 2 years of age BACKGROUND The role of probiotics in prevention of allergic disease is still not clearly established , although early reports suggested Lactobacillus GG halved the risk of eczema at 2 years . OBJECTIVE To determine whether probiotic supplementation in early life could prevent development of eczema and atopy at 2 years . METHODS Double-blind , r and omized placebo-controlled trial of infants at risk of allergic disease . Pregnant women were r and omized to take Lactobacillus rhamnosus HN001 ( L rhamnosus ) , Bifidobacterium animalis subsp lactis strain HN019 or placebo daily from 35 weeks gestation until 6 months if breast-feeding , and their infants were r and omized to receive the same treatment from birth to 2 years ( n = 474 ) . The infant 's cumulative prevalence of eczema and point prevalence of atopy , using skin prick tests to common allergens , was assessed at 2 years . RESULTS Infants receiving L rhamnosus had a significantly ( P = .01 ) reduced risk of eczema ( hazard ratio [ HR ] , 0.51 ; 95 % CI , 0.30 - 0.85 ) compared with placebo , but this was not the case for B animalis subsp lactis ( HR , 0.90 ; 95 % CI , 0.58 - 1.41 ) . There was no significant effect of L rhamnosus ( HR , 0.74 ; 95 % CI , 0.46 - 1.18 ) or B animalis subsp lactis ( HR , 0.82 ; 95 % CI , 0.52 - 1.28 ) on atopy . L rhamnosus ( 71.5 % ) was more likely than B animalis subsp lactis ( 22.6 % ) to be present in the feces at 3 months , although detection rates were similar by 24 months . CONCLUSION We found that supplementation with L rhamnosus , but not B animalis subsp lactis , substantially reduced the cumulative prevalence of eczema , but not atopy , by 2 years . Underst and ing how Lactobacilli act to prevent eczema requires further investigation BACKGROUND Reversal of the progressive increase in frequency of atopic disease would be an important breakthrough for health care and wellbeing in western societies . In the hygiene hypothesis this increase is attributed to reduced microbial exposure in early life . Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora . We assessed the effect on atopic disease of Lactobacillus GG ( which is safe at an early age and effective in treatment of allergic inflammation and food allergy ) . METHODS In a double-blind , r and omised placebo-controlled trial we gave Lactobacillus GG prenatally to mothers who had at least one first-degree relative ( or partner ) with atopic eczema , allergic rhinitis , or asthma , and postnatally for 6 months to their infants .  Chronic recurring atopic eczema , which is the main sign of atopic disease in the first years of life , was the primary endpoint . FINDINGS  Atopic eczema was diagnosed in 46 of 132 ( 35 % ) children aged 2 years . Asthma  was diagnosed in six of these children and allergic rhinitis in one . The frequency of atopic eczema in the probiotic group was half that of the placebo group ( 15/64 [ 23 % ] vs 31/68 [ 46 % ] ; relative risk 0.51 [ 95 % CI 0.32 - 0.84 ] ) . The number needed to treat was 4.5 ( 95 % CI 2.6 - 15.6 ) . INTERPRETATIONS Lactobacillus GG was effective in prevention of  early atopic disease in children at high risk . Thus , gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics , for prevention of atopic disease BACKGROUND Probiotics have shown promising potential in reducing the risk of eczema in infants . Optimal probiotic intervention regimen remains to be determined . OBJECTIVE We investigated whether maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of developing eczema in high-risk infants . METHODS This was a parallel , double-blind placebo-controlled trial of 241 mother-infant pairs . Mothers with allergic disease and atopic sensitization were r and omly assigned to receive ( 1 ) Lactobacillus rhamnosus LPR and Bifidobacterium longum BL999 ( LPR+BL999 ) , ( 2 ) L paracasei ST11 and B longum BL999 ( ST11+BL999 ) , or ( 3 ) placebo , beginning 2 months before delivery and during the first 2 months of breast-feeding . The infants were followed until the age of 24 months . Skin prick tests were performed at the ages of 6 , 12 , and 24 months . RESULTS Altogether 205 infants completed the follow-up and were included in the analyses . The risk of developing eczema during the first 24 months of life was significantly reduced in infants of mothers receiving LPR+BL999 ( odds ratio [ OR ] , 0.17 ; 95 % CI , 0.08 - 0.35 ; P < .001 ) and ST11+BL999 ( OR , 0.16 ; 95 % CI , 0.08 - 0.35 ; P < .001 ) . The respective ORs for chronically persistent eczema were 0.30 ( 95 % CI , 0.12 - 0.80 ; P = .016 ) and 0.17 ( 95 % CI , 0.05 - 0.56 ; P = .003 ) . Probiotics had no effect on the risk of atopic sensitization in the infants . No adverse effects were related to the use of probiotics . CONCLUSION Prevention regimen with specific probiotics administered to the pregnant and breast-feeding mother , that is , prenatally and postnatally , is safe and effective in reducing the risk of eczema in infants with allergic mothers positive for skin prick test Goals : To evaluate the efficacy of Lactobacillus rhamnosus GG ( LGG ) supplementation in eliminating the gastrointestinal carrier state of vancomycin-resistant enterococci ( VRE ) in colonized children , and to evaluate the affect of the probiotic on Lactobacillus spp . counts in the gastrointestinal tract . Study : A r and omized , single-blind , placebo-controlled study . Children ( 0 to 18 y old ) hospitalized at the wards of the children ’s hospital who were diagnosed with gastrointestinal carrier state of VRE were r and omized to group receiving 3 billion colony forming unit of  LGG/day or placebo for 21 consecutive days . A total of 61 children completed the study ( 32 in the treatment group and 29 in the control group ) . Rectal swabs for VRE and Lactobacillus spp . were collected at baseline , during supplementation at weekly intervals and 1 month after supplementation . Antibiotic supply was controlled throughout the duration of the analysis . Results : A significant difference in the number of children colonized with VRE between the groups was observed at 3 weeks ( P=0.002 ) . The VRE carrier state was lost by 20 of 32 participants in the treatment group and 7 of 29 in the control group . We also observed increased gastrointestinal counts of Lactobacillus spp . in children receiving LGG . A statistically significant difference in the occurrence of bacteria was observed from week 1 onwards , whereas in the aspect of growth intensity from week 2 onwards . Conclusions : LGG supplementation temporarily eliminates the VRE carrier state and increases gastrointestinal counts of Lactobacillus spp . in children versus placebo Controversy exists regarding the preventive effect of probiotics on the development of  eczema or atopic dermatitis .  We investigated whether supplementation of probiotics prevents the development of  eczema in infants at high risk . In a r and omized , double-blind , placebo-controlled trial , 112 pregnant women with a family history of allergic diseases received a once-daily supplement , either a mixture of Bifidobacterium bifidum BGN4 , B. lactis AD011 , and Lactobacillus acidophilus AD031 , or placebo , starting at 4 - 8 wks before delivery and continuing until 6 months after delivery . Infants were exclusively breast-fed during the first 3 months , and were subsequently fed with breastmilk or cow 's milk formula from 4 to 6 months of age . Clinical symptoms of the infants were monitored until 1 yr of age , when the total and specific IgE against common food allergens were measured . A total of 68 infants completed the study . The prevalence of eczema at 1 yr in the probiotic group was significantly lower than in the placebo group ( 18.2 % vs. 40.0 % , p=0.048 ) . The cumulative incidence of eczema during the first 12 months was reduced significantly in probiotic group ( 36.4 % vs. 62.9 % , p=0.029 ) ; however , there was no difference in serum total IgE level or the sensitization against food allergens between the two groups . Prenatal and postnatal supplementation with a mixture of B. bifidum BGN4 , B. lactis AD011 , and L. acidophilus AD031 is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life BACKGROUND Although recent reports suggest that supplementation with probiotics may enhance intestinal function in premature infants , the mechanisms are unclear , and questions remain regarding the safety and efficacy of probiotics in extremely low-birth-weight infants . OBJECTIVE The objective was to evaluate the efficacy of probiotics on the digestive tolerance to enteral feeding in preterm infants born with a very low or extremely low birth weight . DESIGN In a bicentric , double-blind , r and omized controlled clinical trial that was stratified for center and birth weight , 45 infants received enteral probiotics ( Bifidobacterium longum BB536 and Lactobacillus rhamnosus GG ; BB536-LGG )  and 49 received placebo .  The primary endpoint was the percentage of infants receiving > 50 % of their nutritional needs via enteral feeding on the 14th day of life . A triangular test was used to perform sequential analysis . RESULTS The trial was discontinued after the fourth sequential analysis concluded a lack of effect . The primary endpoint was not significantly different between the probiotic ( 57.8 % ) and placebo ( 57.1 % ) groups ( P = 0.95 ) . However , in infants who weighed > 1000 g , probiotic supplementation was associated with a shortening in the time to reach full enteral feeding ( P = 0.04 ) . Other than colonization by the probiotic strains , no alteration in the composition of intestinal microbiota or changes in the fecal excretion of calprotectin was observed . No colonization by probiotic strains was detected in infants who weighed < or = 1000 g , presumably because of more frequent suspensions of enteral feeding , more courses of antibiotic treatment , or both . CONCLUSIONS Supplementation with BB536-LGG may not improve the gastrointestinal tolerance to enteral feeding in very-low-birth-weight infants but may improve gastrointestinal tolerance in infants weighing > 1000 g. This trial was registered at clinical trials.gov as NCT 00290576 The role of probiotics in prevention of  allergic disease  is still not clear ; efficacy may depend on the timing , dose , duration , and specific probiotic used . Using a double‐blind r and omized placebo‐controlled trial ( Australian New Zeal and Clinical Trials Registry : ACTRN12607000518460 ) , we have shown that in a high‐risk birth cohort , maternal supplementation from 35 weeks gestation until 6 months if breastfeeding and infant supplementation from birth until 2 years with Lactobacillus rhamnosus HN001 ( HN001 ) ( 6 × 109 cfu/day ) halved the cumulative prevalence of eczema at 2 and 4 years . Bifidobacterium animalis subsp lactis HN019 ( HN019 ) ( 9 × 109 cfu/day ) had no significant effect Background Deviations in composition and diversity of intestinal microbiota in infancy have been associated with both the development and recurrence of atopic eczema . Thus , we decided to use a deep and global microarray-based method to characterize the diversity and temporal changes of the intestinal microbiota in infancy and to define specific bacterial signatures associated with eczema . Faecal microbiota at 6 and 18 months of age were analysed from 34 infants ( 15 with eczema and 19 healthy controls ) selected from a prospect i ve follow-up study based on the availability of faecal sample s. The infants were originally r and omized to receive either Lactobacillus rhamnosus GG or placebo . Results Children with eczema harboured a more diverse total microbiota than control subjects as assessed by the Simpson ’s reciprocal diversity index of the microarray profiles . Composition of the microbiota did not differ between study groups at age of 6 months , but was significantly different at age of 18 months as assessed by MCPP ( p=0.01 ) . At this age healthy children harboured 3 -fold greater amount of members of the Bacteroidetes ( p=0.01 ) . Microbiota of  children  suffering from  eczema  had increased abundance of the Clostridium clusters IV and XIVa , which are typically abundant in adults . Probiotic Lactobacillus rhamnosus GG supplementation in early infancy was observed to have minor long-term effects on the microbiota composition . Conclusion A diverse and adult-type microbiota in early childhood is associated with eczema and it may contribute to the perpetuation of eczema Current research into dietary factors contributing to the development of allergic diseases is directed towards new active approaches instead of passive elimination diets . The present study aim ed to investigate the explanatory role of the diet in a probiotic intervention study on the appearance of atopic eczema ( AE ) in childhood and the safety of perinatal supplementation with probiotics ( Lactobacillus rhamnosus strain GG ; ATCC 53 103 ) . A prospect i ve follow-up study from birth to 48 months of children ( n 159 ) with a family history of allergic disease was carried out . Outcome measures included growth , dietary intake assessed with 4 d food diaries and their association with AE by logistic regression models . Increased intakes of retinol , Ca and Zn , with perinatal administration of probiotics , reduced the risk of AE , whilst an increase in intake of ascorbic acid increased the likelihood of AE . Perinatal administration of probiotics was safe , as it did not influence the height ( mean difference 0.04 ( 95 % CI -0.33 , 0.40 ) sd scores , P=0.852 ) or the weight-for-height ( mean difference -3.35 ( 95 % CI -7.07 , 0.37)% , P=0.077 ) of the children at 48 months with and without perinatal administration of probiotics . Up to 48 months , AE did not affect height ( mean difference -0.05 ( 95 % CI -0.42 , 0.33 ) sd scores , P=0.815 ) , but mean weight-for-height in children with AE was -5.1 % ( 95 % CI -8.9 , -1.2 % ) lower compared with children without ( P=0.010 ) . The joint effects of nutrients and probiotics need to be considered in active prevention and management schemes for allergic diseases BACKGROUND Intestinal dysbiosis has been described in Cystic Fibrosis ( CF ) and probiotics have been proposed to restore microbial composition . Aim of the study was to investigate the effects of Lactobacillus rhamnosus GG ( LGG ) on clinical outcomes in children with cystic fibrosis ( CF ) . METHODS A multicentre , r and omised double-blind , clinical trial was conducted in children with CF . After 6months of baseline assessment , enrolled children ( 2 to 16years of age ) received Lactobacillus GG ( 6 × 109CFU/day ) or placebo for 12months . Primary outcomes were proportion of subjects with at least one pulmonary exacerbation and hospitalisation over 12months . Secondary endpoints were total number of exacerbations and hospitalisations , pulmonary function , and nutritional status . RESULTS Ninety-five patients were enrolled ( 51/95 female ; median age of 103±50months ) . In a multivariate GEE logistic analysis , the odds of experiencing at least one exacerbation was not significantly different between the two groups , also after adjusting for the presence of different microbial organisms and for the number of pulmonary exacerbations within 6months before r and omisation ( OR 0.83 ; 95 % CI 0.38 to 1.82 , p=0.643 ) . Similarly , LGG supplementation did not significantly affect the odds of hospitalisations ( OR 1.67 ; 95 % CI 0.75 to 3.72 , p=0.211 ) . No significant difference was found for body mass index and FEV1 . CONCLUSIONS LGG supplementation had no effect on respiratory and nutritional outcomes in this large study population of children with CF under stringent r and omised clinical trial conditions . Whether earlier interventions , larger doses , or different strains of probiotics may be effective is unknown Probiotic bacteria are proposed to alleviate intestinal inflammation in infants with atopic eczema/dermatitis syndrome ( AEDS ) and food allergy . In such infants we investigated effects of probiotic bacteria on faecal IgA , and on the intestinal inflammation markers tumour necrosis factor-alpha ( TNF-alpha ) , alpha1-antitrypsin ( AT ) , and eosinophil cationic protein ( ECP ) . A total of 230 infants with AEDS and suspected cow 's milk allergy ( CMA ) received in a r and omized double-blinded manner , concomitant with elimination diet , Lactobacillus GG ( LGG ) , a mixture of four probiotic strains ( MIX ) , or placebo for 4 wk . Four weeks after treatment , CMA was diagnosed with a double-blind placebo-controlled milk challenge . Faecal sample s of 102 infants , r and omly chosen for analysis , were collected before treatment , after 4-wk treatment , and on the first day of milk challenge . After treatment , IgA levels tended to be higher in probiotic groups than in the placebo group ( LGG vs. placebo , p=0.064 ; MIX vs. placebo , p=0.064 ) , and AT decreased in the LGG group , but not in other treatment groups . After challenge in IgE-associated CMA infants , faecal IgA was higher for LGG than for placebo ( p=0.014 ) , and TNF-alpha was lower for LGG than for placebo , but non-significantly ( p=0.111 ) . In conclusion , 4-wk treatment with LGG may alleviate intestinal inflammation in infants with AEDS and CMA Objectives The aim of this study was to assess the efficacy of oral supplementation of viable and heat-inactivated probiotic bacteria in the management of atopic disease and to observe their effects on the composition of the gut microbiota . Methods The study population included 35 infants with atopic eczema and allergy to cow 's milk . At a mean age of 5.5 months , they were assigned in a r and omized double-blind manner to receive either extensively hydrolyzed whey formula ( placebo group ) or the same formula supplemented with viable ( viable LGG group ) or heat-inactivated Lactobacillus GG ( heat-inactivated LGG group ) , respectively . The changes in symptoms were assessed by the SCORAD method and the presence of some predominant bacterial genera in the feces detected with 16S rRNA-specific probes . Results The treatment with heat-inactivated LGG was associated with adverse gastrointestinal symptoms and diarrhea . Consequently , the recruitment of patients was stopped after the pilot phase . Within the study population , atopic eczema and subjective symptoms were significantly alleviated in all the groups ; the SCORAD scores ( interquartile range ) decreased from 13 ( range , 4–29 ) to 8 ( range , 0–29 ) units in the placebo group , from 19 ( range , 4–47 ) to 5 ( range , 0–18 ) units in the viable LGG group , and from 15 ( range , 0–29 ) to 7 ( range , 0–26 ) units in the heat-inactivated LGG group . The decrease in the SCORAD scores within the viable LGG group tended to be greater than within the placebo group . The treatments did not appear to affect the bacterial numbers within the genera enumerated . Conclusions Supplementation of infant formulas with viable but not heat-inactivated LGG is a potential approach for the management of atopic eczema and cow 's milk allergy Background Children with cow 's milk allergy ( CMA ) have an increased risk of other allergic manifestations ( AMs ) . Objective We performed a parallel‐arm r and omized controlled trial to test whether administration of an extensively hydrolyzed casein formula ( EHCF ) containing the probiotic Lactobacillus rhamnosus GG ( LGG ) can reduce the occurrence of other AMs in children with CMA . Methods Children with IgE‐mediated CMA were r and omly allocated to the EHCF or EHCF+LGG groups and followed for 36 months . The main outcome was occurrence of at least 1 AM ( eczema , urticaria , asthma , and rhinoconjunctivitis ) . The secondary outcome was tolerance acquisition , which was defined as the negativization of a double‐blind food challenge results at 12 , 24 , and 36 months . AMs were diagnosed according to st and ardized criteria . Tolerance acquisition was evaluated every 12 months . Results A total of 220 children ( 147 boys [ 67 % ] ) with a median age of 5.0 months ( interquartile range , 3.0‐8.0 months ) were r and omized ; 110 children were placed in the EHCF group , and 110 children were placed in the EHCF+LGG group . In the complete case analysis the absolute risk difference for the occurrence of at least 1 AM over 36 months was −0.23 ( 95 % CI , −0.36 to −0.10 ; P < .001 ) , and the absolute risk difference for the acquisition of cow 's milk tolerance was 0.20 ( 95 % CI , 0.05‐0.35 ; P < .01 ) at 12 months , 0.24 ( 95 % CI , 0.08‐0.41 ; P < .01 ) at 24 months , and 0.27 ( 95 % CI , 0.11‐0.43 ; P < .001 ) at 36 months . In the sensitivity analysis the effect size of the main outcome was virtually unchanged when the occurrence of AMs was assigned to all 27 missing children . Conclusions EHCF+LGG reduces the incidence of other AMs and hastens the development of oral tolerance in children with IgE‐mediated CMA BACKGROUND Recent studies suggest that oral bacteriotherapy with probiotics might be useful in the management of atopic dermatitis ( AD ) . OBJECTIVE The purpose of this investigation was to evaluate the clinical and anti-inflammatory effect of probiotic supplementation in children with AD . METHODS In a double-blind , placebo-controlled , crossover study , 2 probiotic Lactobacillus strains ( lyophilized Lactobacillus rhamnosus 19070 - 2 and Lactobacillus reuteri DSM 122460 ) were given in combination for 6 weeks to 1- to 13-year-old children with AD . The patients ' evaluations were registered after each intervention ( ie , better , unchanged , or worse ) . The clinical severity of the eczema was evaluated by using the scoring atopic dermatitis ( SCORAD ) score . As inflammatory markers , eosinophil cationic protein in serum and cytokine production by P BMC s were measured . RESULTS After active treatment , 56 % of the patients experienced improvement of the eczema , whereas only 15 % believed their symptoms had improved after placebo ( P = .001 ) . The total SCORAD index , however , did not change significantly . The extent of the eczema decreased during active treatment from a mean of 18.2 % to 13.7 % ( P = .02 ) . The treatment response was more pronounced in allergic patients ( at least one positive skin prick test response and elevated IgE levels ) , and in this group the SCORAD score decreased ( P = .02 compared with nonallergic patients ) . During active treatment , serum eosinophil cationic protein levels decreased ( P = .03 ) . No significant changes in the production of the cytokines IL-2 , IL-4 , IL-10 , or IFN-gamma were found . CONCLUSIONS A combination of L rhamnosus 19070 - 2 and L reuteri DSM 122460 was beneficial in the management of AD . The effect was more pronounced in patients with a positive skin prick test response and increased IgE levels & NA ; Probiotics are widely used by patients with Crohn 's disease ( CD ) in an attempt to improve their health , but few controlled studies have been done to evaluate the efficacy of these therapies . We conducted a r and omized , placebo‐controlled trial of the probiotic Lactobacillus rhamnosus strain GG ( LGG ) to see if the addition of LGG to st and ard therapy prolonged remission in children with CD . Concomitant medications allowed in the study included aminosalicylates , 6‐mercaptopurine , azathioprine , and low‐dose alternate day corticosteroids .  Seventy‐five children ( age range , 5‐21 yr ) with CD in remission were r and omized to either LGG ( n = 39 ) or placebo ( n = 36 ) and followed for up to 2 years .  The median time to relapse was 9.8 months in the LGG group and 11.0 months in the placebo group ( P = 0.24 ) ; 31 % ( 12/39 ) of patients in the LGG group developed a relapse compared with 6/36 ( 17 % ) of the placebo group ( P = 0.18 ) . The LGG was well tolerated , with a side effect profile comparable with placebo . This study suggests that LGG does not prolong time to relapse in children with CD when given as an adjunct to st and ard therapy Objective To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children . Design R and omised controlled clinical trial in collaboration with family paediatricians over 12 months . Setting Primary care . Participants Children aged 3 - 36 months visiting a family paediatrician for acute diarrhoea . Intervention Children 's parents were r and omly assigned to receive written instructions to purchase a specific probiotic product : oral rehydration solution ( control group ) ; Lactobacillus rhamnosus strain GG ; Saccharomyces boulardii ; Bacillus clausii ; mix of L delbrueckii var bulgaricus , Streptococcus thermophilus , L acidophilus , and Bifidobacterium bifidum ; or Enterococcus faecium SF68 . Main outcome measures Primary outcomes were duration of diarrhoea and daily number and consistency of stools . Secondary outcomes were duration of vomiting and fever and rate of admission to hospital . Safety and tolerance were also recorded . Results 571 children were allocated to intervention .  Median duration of diarrhoea was significantly shorter ( P<0.001 ) in children who received L rhamnosus strain GG ( 78.5 hours ) and the mix of four bacterial strains ( 70.0 hours ) than in children who received oral rehydration solution alone ( 115.0 hours ) . One day after the first probiotic administration , the daily number of stools was significantly lower ( P<0.001 ) in children who received L rhamnosus strain GG and in those who received the probiotic mix than in the other groups . The remaining preparations did not affect primary outcomes . Secondary outcomes were similar in all groups . Conclusions Not all commercially available probiotic preparations are effective in children with acute diarrhoea . Paediatricians should choose bacterial preparations based on effectiveness data . Trial registration number Current Controlled Trials IS RCT N56067537 Background : Probiotic Lactobacillus reuteri and reduced allergen load may lessen the daily crying of colic infants , but the role of Lactobacillus rhamnosus GG ( LGG ) has remained obscure . Methods : Infants with colic ( n = 30 ) were enrolled during the first 6 wk of life . All families received behavioral support and allergen avoidance diet :  breastfeeding mothers followed cow ’s milk elimination diet and formula-fed infants received extensively hydrolyzed casein formula . The r and omized , double-blind intervention employed of LGG 4.5 × 109 cfu/d or placebo for a 4-wk study period . Daily crying was recorded by diaries and parental interviews . Fecal calprotectin and gut microbiota composition by quantitative PCR were evaluated before and after the intervention . Results : Daily crying time was comparable between the probiotic ( 173 min ) and the placebo group ( 174 min ; P = 0.99 ) at the end of the intervention according to the parental diary . However , parents reported a decrease of 68 % ( 95 % confidence interval ( CI ) : 58–78 ) in daily crying in the probiotic and 49 % ( 95 % CI : 32–66 ) in the placebo group ( P = 0.05 ) . Conclusion : LGG in infants treated in t and em with behavioral support and a cow ’s milk elimination diet did not provide additional treatment effect for diary-verified colic crying although parental report of crying suggested the probiotic intervention effective BACKGROUND The immunomodulating mechanisms of Lactobacillus GG ( LGG ) and other probiotics are poorly understood . OBJECTIVE We studied in vivo the immunologic effects of probiotics in infants with atopic eczema-dermatitis syndrome ( AEDS ) and cow 's milk allergy ( CMA ) . METHODS Two hundred thirty infants with AEDS and suspected CMA received , concomitant with elimination diet , either LGG , a mixture of 4 probiotic strains ( MIX ) , or placebo for 4 weeks . All available paired pretreatment and posttreatment plasma sample s ( n = 132 ) were analyzed for concentrations of IL-2 , IL-4 , IL-6 , IL-10 , TNF-alpha , IFN-gamma , soluble intercellular adhesion molecule 1 , soluble E-selectin , TGF-beta1 , TGF-beta2 , and C-reactive protein . RESULTS In infants with IgE-associated AEDS , treatment with LGG induced higher C-reactive protein levels than in the placebo group ( geometric mean , 0.83 microg/mL [ 95 % CI , 0.56 - 0.81 ] vs 0.42 microg/mL [ 95 % CI , 0.27 - 0.65 ] ; P = .021 ) . Concomitantly , IL-6 levels increased after treatment with LGG ( P = .023 ) but not with MIX or placebo . Soluble E-selectin levels were higher after probiotic than after placebo treatment in infants with IgE-mediated CMA ( LGG geometric mean , 86.7 ng/mL [ 95 % CI , 75.2 - 100 ] ; MIX geometric mean , 91.6 ng/mL [ 95 % CI , 74.8 - 111.9 ] ; and placebo geometric mean , 64.9 ng/mL [ 95 % CI , 53 - 79.3 ] ; analysis of covariance , P = .035 ; LGG vs placebo , P = .023 ; MIX vs placebo , P = .020 ) . Use of MIX induced an increase in plasma IL-10 levels ( P = .016 ) . CONCLUSION Probiotics induced systemically detectable low- grade inflammation , which might explain the clinical effects of probiotics in AEDS and CMA The perinatal nutritional environment impacts upon the health and well-being of mother and child also in the long term . The aim of the present study was to determine the safety and efficacy of perinatal probiotic-supplemented dietary counselling by evaluating pregnancy outcome and fetal and infant growth during the 24 months ' follow-up . Altogether , 256 women were r and omised at their first trimester of pregnancy into a control and a dietary intervention group . The intervention group received intensive dietary counselling provided by a nutritionist and were further r and omised , double-blind to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) . Firstly , probiotic intervention reduced the frequency of gestational diabetes mellitus ( GDM ) ; 13 % ( diet/probiotics ) v. 36 % ( diet/placebo ) and 34 % ( control ) ; P = 0.003 . Secondly , the safety of this approach was attested by normal duration of pregnancies with no adverse events in mothers or children . No significant differences in prenatal or postnatal growth rates among the study groups were detected . Thirdly , distinctive effects of the two interventions were detected ; probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases ; P = 0.035 for birth weight and P = 0.028 for birth length . The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic . In view of the fact that birth size is a risk marker for later obesity , the present results are of significance for public health in demonstrating that this risk is modifiable BACKGROUND Probiotic administration may be a useful method for preventing allergies in infants ; however , there have been controversial results about the efficacy . We investigated the effects of bifidobacterial supplementation on the risk of developing allergic diseases in the Japanese population . METHODS In an open trial , we gave Bifidobacterium breve M-16V and Bifidobacterium longum BB536 prenatally to 130 mothers beginning 1 month prior to delivery and postnatally to their infants for 6 months . Another 36 mother-infant pairs served as controls and did not receive the bifidobacterial supplementation . Development of allergic symptoms in the infants was assessed at 4 , 10 and 18 months of age . Fecal sample s were collected from the mothers and infants . RESULTS The risk of developing eczema/atopic dermatitis ( AD ) during the first 18 months of life was significantly reduced in infants in the probiotic group ( OR : 0.231 [ 95 % CI : 0.084 - 0.628 ] and 0.304 [ 0.105 - 0.892 ] at 10 and 18 months of age , respectively ) . Pyrosequencing analyses indicated an altered composition of the fecal microbiota at 4 months for infants who developed eczema/AD at 4 and 10 months of age . The proportion of Proteobacteria was significantly lower ( P = 0.007 ) in mothers at the time of delivery who received the supplementation when compared with the control group and was positively correlated ( r = 0.283 , P = 0.024 ) with that of infants at 4 months of age . No adverse effects were related to the use of probiotics . CONCLUSIONS These data suggest that the prenatal and postnatal supplementation of bifidobacteria is effective in primary preventing allergic diseases . Some limited changes in the composition of fecal microbiota by the bifidobacterial supplementation were observed BACKGROUND The gastrointestinal microflora is an important constituent of the gut mucosal defense barrier . We have previously shown that a human intestinal floral strain , Lactobacillus GG ( ATCC 53103 ) , promotes local antigen-specific immune responses ( particularly in the IgA class ) , prevents permeability defects , and confers controlled antigen absorption . OBJECTIVE The aim of this study was to evaluate the clinical and immunologic effects of cow 's milk elimination without ( n = 14 ) and with ( n = 13 ) the addition of Lactobacillus GG ( 5 x 10(8 ) colony-forming units/gm formula ) in an extensively hydrolyzed whey formula in infants with atopic eczema and cow 's milk allergy . The second part of the study involved 10 breast-fed infants who had atopic eczema and cow 's milk allergy . In this group Lactobacillus GG was given to nursing mothers . METHODS The severity of atopic eczema was assessed by clinical scoring . The concentrations of fecal alpha 1- antitrypsin , tumor necrosis factor-alpha , and eosinophil cationic protein were determined as markers of intestinal inflammation before and after dietary intervention . RESULTS The clinical score of atopic dermatitis improved significantly during the 1-month study period in infants treated with the extensively hydrolyzed whey formula fortified with Lactobacillus GG . The concentration of alpha 1-antitrypsin decreased significantly in this group ( p = 0.03 ) but not in the group receiving the whey formula without Lactobacillus GG ( p = 0.68 ) . In parallel , the median ( lower quartile to upper quartile ) concentration of fecal tumor necrosis factor-alpha decreased significantly in this group , from 709 pg/gm ( 91 to 1131 pg/gm ) to 34 pg/gm ( 19 to 103 pg/gm ) ( p = 0.003 ) , but not in those receiving the extensively hydrolyzed whey formula only ( p = 0.38 ) . The concentration of fecal eosinophil cationic protein remained unaltered during therapy . CONCLUSION These results suggest that probiotic bacteria may promote endogenous barrier mechanisms in patients with atopic dermatitis and food allergy , and by alleviating intestinal inflammation , may act as a useful tool in the treatment of food allergy
High to moderate certainty in the body of evidence suggests that LGG supplementation ( regardless of the timing of administration ) did not reduce the risk of eczema .
There was also no consistent effect on other allergic outcomes .
This meta- analysis shows that LGG was ineffective in reducing eczema .
Current guidelines recommend the use of probiotics to reduce the risk of  eczema .
It remains unclear which strain(s ) to use .
We systematic ally evaluated data on the efficacy of Lactobacillus rhamnosus GG ( LGG ) supplementation prenatally and /or postnatally for the primary prevention of eczema .