Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy. Reduced occurrence of early atopic dermatitis because of immunoactive prebiotics among low-atopy-risk infants. A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age Effects of probiotic and prebiotic on gastrointestinal motility in newborns. Effects of probiotics on atopic dermatitis: a randomised controlled trial Effect of a New Synbiotic Mixture on Atopic Dermatitis in Children: a Randomized-Controlled Trial Early neutral prebiotic oligosaccharide supplementation reduces the incidence of some allergic manifestations in the first 5 years of life. Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomised controlled trial Certain hydrolyzed formulas reduce the incidence of atopic dermatitis but not that of asthma: three-year results of the German Infant Nutritional Intervention Study. The impact of early nutrition on incidence of allergic manifestations and common respiratory illnesses in children. Randomized, Double-Blind, Placebo-Controlled Trial of Probiotics for Primary Prevention: No Clinical Effects of Lactobacillus GG Supplementation Probiotic Supplement Reduces Atopic Dermatitis in Preschool Children A randomized, single-blind and crossover study of an amino acid-based milk formula in treating young children with atopic dermatitis. Gamma-linolenic acid supplementation for prophylaxis of atopic dermatitis--a randomized controlled trial in infants at high familial risk. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews. Dietary supplementation with very long‐chain n‐3 fatty acids in patients with atopic dermatitis. A double‐blind, multicentre study Non-digestible oligosaccharides reduce immunoglobulin free light-chain concentrations in infants at risk for allergy. FOXP3 mRNA expression at 6 months of age is higher in infants who develop atopic dermatitis, but is not affected by giving probiotics from birth. Development of atopic dermatitis during the first 3 years of life: the Copenhagen prospective study on asthma in childhood cohort study in high-risk children. A randomized trial of Lactobacillus plantarum CJLP133 for the treatment of atopic dermatitis. Natural history of sensitizations in atopic dermatitis. A 3-year follow-up in 250 children: food allergy and high risk of respiratory symptoms. Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis.
Polyunsaturated fatty acids ( PUFAs ) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis ( AD ) . The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants . Based on the parents ' decision on their babies ' primary feeding , mothers and newborns were r and omized to the supplementation with gamma-linolenic acid ( GLA ) or placebo for up to 6 months . Breastfed infants received GLA by supplementing their mothers . Formula diet was commercial whey hydrolysate unsupplemented with PUFAs .  Of 131 eligible infants , 24 developed AD within the first year of life . Of these , nine belonged to the exclusively breastfed group ( n = 58 ) , 14 to the combined-fed group ( n = 53 ) , and one to the never breastfed group ( n = 20 ) . We could not find an influence of GLA on the development of AD . In subjects with AD , at 1 yr of age the serum-immunoglobulin E ( IgE ) was the lowest in the GLA-supplemented group A-subjects . In the GLA-supplemented group , GLA-levels in breast milk were similar in atopic and non-atopic infants . In the non-supplemented group the GLA-content of breast milk was 0.07 % of total fatty acids in atopic infants vs. 0.17 % in non-atopic infants ( p < 0.01 ) . Dietary GLA-supplementation could not prevent AD . Interestingly , the number of infants developing AD was the lowest in never breastfed children . In infants suffering from AD , GLA-supplementation seemed to reduce total IgE in the first year of life BACKGROUND Most infants developing atopic dermatitis have a low risk for atopy . Primary prevention of atopic dermatitis is difficult . OBJECTIVE To assess the effect of supplementation of an infant and follow-on formula with prebiotic and immunoactive oligosaccharides on the occurrence of atopic dermatitis in the first year of life . METHODS Healthy term infants from 5 European countries with low atopy risk were recruited before the age of 8 weeks , either having started with formula feeding or being on full breast-feeding ( breast-feeding group ) . Formula-fed infants were r and omized to feeding with a regular formula containing a specific mixture of neutral oligosaccharides and pectin-derived acidic oligosaccharides ( prebiotic formula group ) or regular formula without oligosaccharides ( control formula group ) . RESULTS A total of 414 infants were r and omized to the prebiotic group and 416 infants to the control group . A total of 300 infants were followed in the breast-feeding group . Up to the first birthday , atopic dermatitis occurred in significantly fewer infants from the prebiotic group ( 5.7 % ) than from the control group ( 9.7 % ; P = .04 ) . The cumulative incidence of atopic dermatitis in the prebiotic group was in the low range of the breast-feeding group ( 7.3 % ) . In a Cox regression model , the rate of atopic dermatitis was significantly lower by 44 % in the prebiotic group versus the control group ( P = .04 ) . The number needed to prevent 1 case of atopic dermatitis by supplementation of prebiotics was 25 infants . CONCLUSION Formula supplementation with a specific mixture of oligosaccharides was effective as primary prevention of atopic dermatitis in low atopy risk infants Background : Oligosaccharides may alter postnatal immune development by influencing the constitution of gastrointestinal bacterial flora . Aims : To investigate the effect of a prebiotic mixture of galacto- and long chain fructo-oligosaccharides on the incidence of atopic dermatitis ( AD ) during the first six months of life in formula fed infants at high risk of atopy . Methods : Prospect i ve , double-blind , r and omised , placebo controlled trial ; 259 infants at risk for atopy were enrolled . A total of 102 infants in the prebiotic group and 104 infants in the placebo group completed the study . If bottle feeding was started , the infant was r and omly assigned to one of two hydrolysed protein formula groups ( 0.8 g/100 ml prebiotics or maltodextrine as placebo ) . All infants were examined for clinical evidence of atopic dermatitis . In a subgroup of 98 infants , faecal flora was analysed . Results : Ten infants ( 9.8 % ; 95 CI 5.4–17.1 % ) in the intervention group and 24 infants ( 23.1 % ; 95 CI 16.0–32.1 % ) in the control group developed AD . The severity of the dermatitis was not affected by diet . Prebiotic supplements were associated with a significantly higher number of faecal bifidobacteria compared with controls but there was no significant difference in lactobacilli counts . Conclusion : Results show for the first time a beneficial effect of prebiotics on the development of atopic dermatitis in a high risk population of infants . Although the mechanism of this effect requires further investigation , it appears likely that oligosaccharides modulate postnatal immune development by altering bowel flora and have a potential role in primary allergy prevention during infancy To fortify the biological role of milk formula has been suggested to use probiotics and prebiotics as functional components to mimic the effect of breast milk . The aim of this study was to evaluate the effects of prebiotic , probiotic added to a st and ard formula on gastrointestinal motility respect to placebo-formula .  Cutaneous electrogastrography ( EGG ) and ultrasound gastric emptying ( GE ) were performed in 49 preterm newborns . 17 newborns were exclusively breast-fed ; 32 were r and omly assigned to receive prebiotic-added formula ( 0.8 g/dl of a mixture from scGOS and lcFOS , ratio 9:1 ) ( 10 ) , a probiotic-added formula ( L. reuteri at dose of 1x10(8 ) colony forming units ( CFU ) per day ) ( 10 ) , a formula with placebo ( 12 ) for 30 days . No difference was seen in the nutritional parameters and no adverse events were reported . After the intervention period , the prebiotic , probiotic , and breast milk groups showed a higher percentage of EGG slow wave propagation and faster gastric half emptying time respect to placebo group ( ANOVAon ranks p<0.001 ; Dunn test vs control : prebiotic , probiotic and breast-milk vs placebo formula p<0.05 ; and ANOVA on ranks p=0.005 ; Dunn test vs control : prebiotic , probiotic and breast-milk vs placebo formula p<0.05 , respectively ) . Feeding preterm infants with a formula supplemented with prebiotics or probiotics may stimulate gastric emptying and improve maturation of the EGG activity mimicking the effect of breast milk Background : The aim of the study was to investigate the effects of probiotics on  moderate or severe atopic dermatitis ( AD ) in young children . Methods : Fifty six children aged 6–18 months with moderate or severe AD were recruited into a r and omised double blind placebo controlled trial in Perth , Western Australia ; 53 children completed the study . The children were given a probiotic ( 1 × 109Lactobacillus fermentum VRI-033 PCC ; Probiomics ) or an equivalent volume of placebo , twice daily for 8 weeks . A final assessment at 16 weeks was performed . Results : The main outcome measures were severity and extent of AD at the end of the study , as measured by the Severity Scoring of Atopic Dermatitis ( SCORAD ) index . The reduction in the SCORAD index over time was significant in the probiotic group ( p = 0.03 ) but not the placebo group . Significantly more children receiving probiotics ( n = 24 , 92 % ) had a SCORAD index that was better than baseline at week 16 compared with the placebo group ( n = 17 , 63 % ) ( p = 0.01 ) . At the completion of the study more children in the probiotic group had mild AD ( n = 14 , 54 % ) compared to the placebo group ( n = 8 , 30 % ) . Conclusion : Supplementation with probiotic L fermentum VRI-003 PCC is beneficial in improving the extent and severity of AD  in young children with moderate or severe disease Objective Atopic dermatitis ( AD ) is the most common chronic relapsing skin disease seen in infancy and childhood . The intestinal microbiota play an important role in immune development and may play a role in the development of allergic disorders . Manipulation of the intestinal microbiota by synbiotics may therefore offer an approach to the prevention or treatment of AD and allergic diseases . We studied the clinical and immunologic effects of a new symbiotic ( a mixture of seven probiotic strains of bacteria and Fructooligosaccharide ) in infants and children with AD . Methods In a r and omized , double-blind , placebo-controlled study , 40 infants and children aged 3 months to 6 years with AD received either a synbiotic or placebo for 8 weeks . The Severity Scoring of Atopic Dermatitis ( SCORAD ) index was recorded at baseline and also at 4 and 8 weeks of treatment . Findings There was no significant difference between the probiotic and placebo group in baseline characteristics including sex , age , family history , corticosteroid usage and prick testing . Mean age was 23 months . The synbiotic group showed a significantly greater reduction in SCORAD than did the placebo group ( P=0.001 ) . No specific effect was demonstrated of the probiotics employed on cytokine profile ( P=0.4 , P=0.6 ) . Egg white was the most common ( 45 % ) allergen followed by peanut and cow 's milk . Conclusion This study provides evidence that a mixture of seven strains of probiotics and Fructooligosaccharide can clinical ly improve the severity of  AD in young children . Further studies are needed to investigate the effects on underlying immune responses and the potential long term benefits for patients with AD BACKGROUND A mixture of neutral prebiotic oligosaccharides has been shown to reduce the incidence of atopic dermatitis ( AD ) and allergy associated symptoms during the first 2 years of life . OBJECTIVE To evaluate if this protective effect against allergy lasted beyond the intervention period until 5 y of age . METHODS In a prospect i ve , double blind , placebo-controlled fashion , healthy term infants at risk of atopy were fed either a prebiotic-supplemented ( 0.8 g/100 ml scGOS/lcFOS ) or placebo-supplemented ( 0.8 g/100 ml maltodextrin ) hypoallergenic formula during the first 6 mo of life . Following this intervention period , follow-up continued until 5 y of life . The present study evaluated ( i ) the cumulative incidence of allergic manifestations during 5 y , and ( ii ) the prevalence of allergic and persistent allergic manifestations at 5 y. Monitored allergic manifestations were AD , recurrent wheezing , allergic rhinoconjunctivitis and urticaria . RESULTS Ninety-two children ( 50 in placebo group , 42 in intervention group ) completed the 5-y follow-up . The 5-y cumulative incidences of any allergic manifestation and atopic dermatitis were significantly lower in the scGOS/lcFOS group ( 30.9 , 19.1 % , respectively ) compared to placebo group ( 66 , 38 % , respectively ) ( p < 0.01 and < 0.05 ) . Children in the scGOS/lcFOS group tended to have a lower incidence of allergic rhinoconjunctivitis , and allergic urticaria ( 4.8 vs 16 % for both manifestations , p=0.08 ) . There was no difference in the cumulative incidence of recurrent wheezing . With regard to the prevalences at 5 y , intervention group had significantly lower prevalence of any persistent allergic manifestation and rhinoconjunctivitis ( 4.8 , 2.4 % , respectively ) compared to placebo ( 26 , 14 % , respectively ) ( p < 0.01 and = 0.05 ) . Prevalence of persistent AD tended to be lower in the intervention group ( 2.4 vs 12 % , p= 0.09 ) . Although intervention group had 75 % reduction in the prevalence of persistent wheezing ( 4.8 vs 14 % ) , no significance was shown . CONCLUSION Oligosaccharide prebiotics ( scGOS/lcFOS ) , when started early in life have a protective effect against allergic manifestations in high risk infants . The protection lasts beyond infancy until 5 y of life , for AD and allergic rhinoconjunctivitis . Long-term follow-up studies in larger population s are warranted to evaluate the potential preventive effect of this mixture on asthma Background Perinatal probiotics supplementation has been shown to be effective in the primary prevention of  atopic dermatitis ( AD ) in early childhood , although the long term effects of probiotics on AD and other allergic diseases is less certain . We have previously reported a significant reduction in the cumulative incidence of AD at 2 years after maternal probiotic supplementation . In this study we present the effects of perinatal probiotics given to women from a general population on allergy related diseases in their offspring at 6 years . Methods Four hundred and fifteen pregnant women were r and omised to receive  probiotic or placebo milk  in a double-blinded trial from 36 week gestation until 3 months postpartum . Probiotic milk contained Lactobacillus rhamnosos GG , L. acidophilus La-5 and Bifidobacterium animalis subsp . lactis Bb-12 . At 6 years , children were re-assessed for AD , atopic sensitisation , asthma and allergic rhinoconjunctivitis ( ARC ) . Results At 6 years , 81 and 82 children were assessed for AD in the probiotic and placebo groups , respectively . In a multiple imputation analysis , there was as trend towards a lower cumulative incidence of AD in the probiotic group compared to the placebo group ( OR 0.64 , 95 % CI 0.39 - 1.07 , p = 0.086 ; NNT = 10 ) . This finding was statistically significantly in the complete case analysis ( OR 0.48 , 95 % CI 0.25 - 0.92 , p = 0.027 , NNT = 6 ) . The prevalence of asthma and atopic sensitisation , and the cumulative incidence of ARC were not significantly affected by the probiotic regime at 6 years of age . Conclusions Maternal probiotic ingestion alone may be sufficient for long term reduction in the cumulative incidence of AD , but not other allergy related diseases . Trial registration Clinical Trials.gov identifier : BACKGROUND Recommendations for primary prevention of allergic diseases in high-risk children include feeding with hydrolyzed formulas if breast-feeding is insufficient . OBJECTIVE The primary objective of the German Infant Nutritional Intervention study was to investigate the allergy preventive effect of 3 hydrolyzed formulas compared with cow 's milk formula in the first 3 years of life in a r and omized , double-blind trial . METHODS Between 1995 and 1998 , 2252 newborns with atopic heredity were allocated to a group receiving cow 's milk formula , partially or extensively hydrolyzed whey formula , or extensively hydrolyzed casein formula as a milk substitute for the first 4 months if breast-feeding was insufficient . Main outcome parameters were allergic manifestations , atopic dermatitis ( AD ) , and asthma . RESULTS After 3 years , 396 of 2252 children ( 17.6 % ) had dropped out . Breast-fed infants without formula feeding during the intervention ( n = 889 ) were considered separately . A significant reduction of the incidence of AD was achieved with the extensively hydrolyzed casein formula in the intention-to-treat ( ITT ; n = 1363 ) and per protocol ( PP ; n = 904 ) analyses ( ITT : population odds ratio [ 95 % CI ] , 0.67 [ 0.45 - 0.99 ] ; PP : adjusted odds ratio [ OR(adj ) ] , 0.53 [ 0.32 - 0.88 ] ) , and with the partially hydrolyzed whey formula in the PP analysis ( ITT : population odds ratio , 0.76 [ 0.52 - 1.11 ] ; PP : OR(adj ) , 0.60 [ 0.37 - 0.97 ] ) . None of the formulas reduced the incidence of asthma . CONCLUSION The risk for AD , but not for asthma , can be reduced with certain cow 's milk hydrolyzates in high-risk infants when breast-feeding is insufficient . CLINICAL IMPLICATION S Early nutritional intervention in high-risk children has significant influence on the incidence of AD , but not of asthma OBJECTIVE To investigate the incidence of  allergic and respiratory diseases  through age 3 years in children fed docosahexaenoic acid (DHA)- and arachidonic acid (ARA)-supplemented formula during infancy . STUDY DESIGN Children who completed r and omized , double-blind studies of DHA/ARA-supplemented  ( 0.32%-0.36%/0.64%-0.72 % of total fatty acids , respectively ) versus nonsupplemented ( control ) formulas , fed during the first year of life , were eligible . Blinded study nurses review ed medical charts for upper respiratory infection ( URI ) , wheezing , asthma , bronchiolitis , bronchitis , allergic rhinitis , allergic conjunctivitis , otitis media , sinusitis , atopic dermatitis ( AD ) , and urticaria . RESULTS From the 2 original cohorts , 89/179 children participated ; 38/89 were fed DHA/ARA formula . The DHA/ARA group had significantly lower odds for developing URI ( odds ratio [ OR ] , 0.22 ; 95 % confidence interval [ CI ] , 0.08 - 0.58 ) , wheezing/asthma ( OR , 0.32 ; 95 % CI , 0.11 - 0.97 ) , wheezing/asthma/AD ( OR , 0.25 ; 95 % CI , 0.09 - 0.67 ) , or any allergy ( OR , 0.28 ; 95 % CI , 0.10 - 0.72 ) . The control group had significantly shorter time to first diagnosis of URI ( P = .006 ) , wheezing/asthma ( P = .03 ) , or any allergy ( P = .006 ) . CONCLUSIONS DHA/ARA supplementation was associated with delayed onset and reduced incidence of URIs and common allergic diseases up to 3 years of age BACKGROUND . The value of probiotics for primary prevention is controversial . Published trials vary considerably in study design and the applied probiotics , thereby limiting comparability of the results . OBJECTIVE . The purpose of this trial was to study the preventive effect of the probiotic Lactobacillus GG on the development of atopic dermatitis . METHODS . In a double-blind , placebo-controlled prospect i ve trial , 105 pregnant women from families with ≥1 member ( mother , father , or child ) with an atopic disease were r and omly assigned to receive either the probiotic Lactobacillus GG ( American Type Culture Collection 53103 ; 5 × 109 colony-forming units of Lactobacillus GG twice daily ) or placebo .  Ninety-four families ( 89.5 % ) completed the trial . The supplementation period started 4 to 6 weeks before expected delivery , followed by a postnatal period of 6 months . The primary end point was the occurrence of atopic dermatitis at the age of 2 years . Secondary outcomes were severity of atopic dermatitis , recurrent episodes of wheezing bronchitis , and allergic sensitization at the age of 2 years . RESULTS . Atopic dermatitis was diagnosed in 14 ( 28 % ) of 50 in the Lactobacillus GG group and in 12 ( 27.3 % ) of 44 in the placebo group . The risk of atopic dermatitis in children on probiotics relative to placebo was 0.96 ( confidence interval 0.38–2.33 ) . Severity of atopic dermatitis was comparable between the 2 groups . Notably , children with recurrent ( ≥5 ) episodes of wheezing bronchitis were more frequent in the Lactobacillus GG group ( 26 % ; n = 13 ) , as compared with the placebo group ( 9.1 % ; n = 4 ) . No difference was observed between both groups in total immunoglobulin E concentrations or numbers of specific sensitization to inhalant allergens . CONCLUSIONS . Supplementation with Lactobacillus GG during pregnancy and early infancy neither reduced the incidence of atopic dermatitis nor altered the severity of atopic dermatitis in affected children but was associated with an increased rate of recurrent episodes of wheezing bronchitis . Therefore , Lactobacillus GG can not be generally recommended for primary prevention Abstract Background : The role of probiotics in the treatment of atopic dermatitis ( AD ) remains controversial . A recent systematic review of the available evidence called for further clinical trials with new probiotic formulations . Objective : To assess the clinical efficacy and impact of Lactobacillus acidophilus DDS-1 , Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide on peripheral blood lymphocyte subsets in preschool children with moderate-to-severe AD . Method : R and omized , double-blind , placebo-controlled , prospect i ve trial of 90 children aged 1–3 years with moderate-to-severe AD who were treated with a mixture of L. acidophilus DDS-1 , B. lactis UABLA-12 with fructo-oligosaccharide at a dosage of 5 billion colony-forming units twice daily for 8 weeks versus placebo . The primary outcome measure was the percentage change in Scoring of Atopic Dermatitis ( SCORAD ) value . Other outcome measures were changes in Infant Dermatitis Quality Of Life ( IDQOL ) and Dermatitis Family Impact ( DFI ) scores , frequency and amount of topical corticosteroid used , and lymphocyte subsets in peripheral blood measured by laser flow cytometry . Results : At the final visit , the percentage decrease in SCORAD was 33.7 % in the probiotic group compared with 19.4 % in the placebo group ( p = 0.001 ) . Children receiving probiotic showed a greater decrease in the mean [ SD ] SCORAD score than did children from the placebo group at week 8 ( −14.2 [ 9.9 ] vs −7.8 [ 7.7 ] , respectively ; p = 0.001 ) . IDQOL and DFI scores decreased significantly from baseline by 33.0 % and 35.2 % in the probiotic group and by 19.0 % and 23.8 % in the placebo group , respectively ( p = 0.013 , p = 0.010 ) . Use of topical corticosteroids during the 8-week trial period averaged 7.7 g less in probiotic patients ( p = 0.006 ) . CD3 , CD16 , and CD22 lymphocyte subsets remained unchanged , whereas the percentage of CD4 , and the percentage and absolute count of CD25 decreased , and the percentage and absolute count of CD8 increased in the probiotic group at week 8 ( p < 0.007 vs placebo ) . There was a significant correlation between CD4 percentage , CD25 percentage , CD25 absolute count , and SCORAD values ( r = 0.642 , r = 0.746 , r = 0.733 , respectively ; p < 0.05 ) in the probiotic group at week 8 . Conclusion : The administration of a probiotic mixture containing L. acidophilus DDS-1 , B. lactis UABLA- 12 , and fructo-oligosaccharide was associated with significant clinical improvement in children with AD , with corresponding lymphocyte subset changes in peripheral blood . The efficacy of probiotic therapy in adults with AD requires further investigation Cow 's milk and soy protein allergies are commonly associated with atopic dermatitis ( AD ) in young children .  Amino acid (AA)-based elemental milk formula may improve AD control in these patients . This study investigates the efficacy of AA-based formula in treating young AD patients irrespective of their food allergy status . AD patients younger than 3 yr old were eligible . Sensitization to food allergens was ascertained by skin prick tests and allergen-specific immunoglobulin E ( IgE ) assay . Patients were then r and omly allocated to take either active treatment or pre-existing formulae ( placebo ) for 6 wk . They were allowed a 6-wk washout period before crossed over to the other intervention for another 6 wk . Fifteen AD patients , with median ( interquartile range , IQR ) age of 1.4 ( 0.6 - 2.6 ) yr , were recruited . Their median ( IQR ) SCORAD score was 23.9 ( 10.5 - 29.7 ) . Seven of them were sensitized to cow 's milk or soybean . Among 11 patients who completed the study , the median changes for all scores and urinary eosinophil protein X ( EPX ) concentration were not statistically significant . There was also no evidence of carry-over effects for SCORAD and its various components and global health score , except for urinary EPX concentration ( p = 0.05 ) . Our results do not support the use of AA-based elemental milk formula in treating young children with AD irrespective of their food allergy status BACKGROUND Studies suggest that low concentrations of n-6 long-chain polyenes in early life are correlated to atopic disease in later life . OBJECTIVE The purpose of the study was to investigate the possible preventive effect of gamma-linolenic acid ( GLA ) supplementation on the development of  atopic dermatitis in infants at risk . DESIGN In a double-blind , r and omized , placebo-controlled trial , formula-fed infants ( n = 118 ) with a maternal history of atopic disease received borage oil supplement ( containing 100 mg GLA ) or sunflower oil supplement as a placebo daily for the first 6 mo of life . Main outcome measures were the incidence of atopic dermatitis in the first year of life ( by UK Working Party criteria ) , the severity of atopic dermatitis ( SCORing Atopic Dermatitis ; SCORAD ) , and the total serum immunoglobulin E ( IgE ) concentration at the age of 1 y. RESULTS The intention-to-treat analysis showed a favorable trend for severity of atopic dermatitis associated with GLA supplementation ( x+/- SD SCORAD : 6.32 + /- 5.32 ) in the GLA-supplemented group as compared with 8.28 + /- 6.54 in the placebo group ( P = 0.09 ; P = 0.06 after adjustment for total serum IgE at baseline , age 1 wk ) , but no significant effects on the other atopic outcomes . The increase in GLA concentrations in plasma phospholipids between baseline and 3 mo was negatively associated with the severity of atopic dermatitis at 1 y ( Spearman 's correlation coefficient = -0.233 , P = 0.013 ) . There was no significant effect on total serum IgE concentration . CONCLUSION Early supplementation with GLA in children at high familial risk does not prevent the expression of atopy as reflected by total serum IgE , but it tends to alleviate the severity of atopic dermatitis in later infancy in these children 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 BACKGROUND : Eczema is the most common inflammatory skin disease of childhood , characterized by an itchy red rash that usually involves the face and skin folds . There is currently no curative treatment for eczema , so the reduction of eczema incidence through disease prevention is a desirable goal . Potential interventions for preventing eczema include exclusive breastfeeding , hydrolysed protein formulas and soy formulas when bottle feeding , maternal antigen avoidance , omega oil supplementation , prebiotics and probiotics . OBJECTIVES : This overview of review s aims to present the current body of data from Cochrane and non-Cochrane review s to provide the most up-to- date evidence on the efficacy and safety of interventions to prevent eczema in infants and children at different risk levels for developing allergic disease . METHODS : Our pool of Cochrane and non-Cochrane review s came from the 2010 United Kingdom National Health Service ( NHS ) Evidence Skin Disorders Annual Evidence Up date s Mapping Exercise on Atopic Eczema . This group used a comprehensive search strategy last conducted in August 2010 to identify all systematic review s on eczema prevention . We identified all review s that met our pre-specified inclusion criteria , and data were extracted , analysed , compiled into tables and synthesized using quantitative and qualitative methods . MAIN RESULTS : Seven systematic review s containing 39 relevant trials with 11 897 participants were included in this overview . Overall , there was no clear evidence that any of the main interventions review ed reduced eczema incidence . In subgroup analyses of infants at high risk of allergic disease , an observational study found that exclusive breastfeeding for at least six months compared with introduction of solids at three to six months decreased the incidence of eczema by 60 % ( risk ratio ( RR ) : 0.40 ; 95 % confidence interval ( CI ) : 0.21 , 0.78 ) , and a r and omized controlled trial found that prebiotics compared with no prebiotics  decreased incidence by 58 % ( RR : 0.42 ; 95 % CI : 0.21 , 0.84 ) . However , each of these findings was based on the results of a single small trial , and no intervention reduced eczema incidence beyond the first two years of life . Although we pre-specified incidence of atopic eczema ( i.e. eczema associated with immunoglobulin E ( IgE ) sensitization ) as a primary outcome , data on whether participants diagnosed with eczema were truly atopic were largely lacking from systematic review s. Similarly , data on atopy , measured using skin prick tests or specific IgE tests to allergens , were not reported in many review s. No interventions were found to decrease atopy when reported . Adverse events data were generally lacking , but data from a trial of probiotics versus no probiotics showed significantly more spitting up in the first one ( RR : 1.88 ; 95 % CI : 1.03 , 3.45 ) and two ( RR : 1.69 ; 95 % CI : 1.02 , 2.80 ) months of life , but no overall increase in risk of gastrointestinal symptoms in the first year . AUTHORS # ENTITYSTARTX02019 ; CONCLUSIONS : Although there is currently no clear evidence showing that any of the interventions examined in this overview prevent eczema in participants not selected for risk of allergic disease , there is some evidence that exclusive breastfeeding for at least six months and prebiotics might reduce eczema incidence in high-risk participants . However , these conclusions are based on limited evidence with method ological shortcomings . Future research on prevention of eczema is needed and should examine different types of hydrolysed formulas , prebiotics and probiotics , as well as enhancement of the skin barrier and other novel approaches in infants at different risk levels for developing allergic disease The purpose of this study was to investigate whether fish oil and /or corn oil had a beneficial effect on the clinical state of atopic dermatitis , and to evaluate the dietary intake of nutrients in this group of patients . In a double‐blind , multicentre study lasting 4 months , during wintertime , 145 patients with moderate to severe atopic dermatitis were r and omly assigned to receive either 6 g/day of concentrated n‐3 fatty acids , or an isoenergetic amount of corn oil . As local treatment , only an emollient cream or hydrocortisone cream was allowed . The fatty acid pattern in serum phospholipids , and the dietary intake of nutrients were monitored in a subgroup of patients , and the results were compared with a group of patients with psoriasis . The overall clinical score , as evaluated by the physicians , improved during the trial by 30 % in the fish oil ( P<0.001 ) and 24 % in the corn oil group ( P<0.001 ) . This was also consistent with the results from a selected skin area , and it was further confirmed by the total subjective clinical score reported by the patients . There were no significant differences in the clinical scores between the two groups at baseline , and at the end of the study . In the fish oil group , the amount of n‐3 fatty acids in serum phospholipids was significantly increased at the end of the trial , compared with pretreatment values ( P<0.001 ) , whereas the level of n‐6 fatty acids was decreased ( P<0.001 ) . In the corn  oil group , arachidonic acid , docosahexaenoic acid , and total n‐6 fatty acids , increased significantly ( P<0.05 ) , whereas the other fatty acids were similar after corn oil supplementation , compared with baseline . Clinical improvement was significantly correlated with an increase in the concentration of docosahexaenoic acid ( 22:6 , n‐3 ) in serum phospholipids for the total group ( P<0.05 ) . Our patients with atopic dermatitis had significantly lower levels of both n‐6 ( P<0.01 ) and n‐3 ( P<0.001 ) fatty acids in serum phospholipids prior to the start of the trial compared with patients with psoriasis Prebiotic oligosaccharides influence the intestinal microbiota and can positively modulate the infant 's immune system . It was demonstrated that a special prebiotic mixture ( Immunofortis ( ® ) ) of short-chain galacto-oligosaccharides ( scGOS ) and long-chain fructo-oligosaccharides ( lcFOS ) can reduce the cumulative incidence of atopic dermatitis ( AD ) in infants at risk for allergy as determined using the AD symptom score ( SCORAD ) . Additionally , it was shown very recently that immunoglobulin free light-chain ( Ig-fLC ) might be involved in the pathophysiology of allergic disease . Increased Ig-fLC concentrations were found in patients suffering from AD , cow 's milk allergy , allergic rhinitis , or asthma . In this study , the effect of supplementation of scGOS/lcFOS on the Ig-fLC plasma concentrations in infants at risk for allergy was assessed . The plasma kappa and lambda Ig-fLC concentrations were measured in a double-blind , placebo-controlled , r and omized trial , in which infants at risk for developing allergic disease received a  hypoallergenic whey formula containing 8 g/l of the scGOS/lcFOS mixture ( n = 34 ) or maltodextrin as a placebo ( n=40 ) for 6 months . After intervention , plasma sample s were collected , and total plasma concentrations of lambda and kappa Ig-fLC were analyzed using ELISA . Total kappa and lambda Ig-fLC plasma concentrations were higher in infants suffering from AD when compared to infants without any sign of AD . In infants receiving the prebiotic mixture  , the Ig-fLC levels were significantly lower compared to the placebo-fed infants ( p<0.001 ) . Interestingly , lambda Ig-fLC concentrations were positively correlated with total IgE ( p<0.05 ) . These data demonstrate for the first time that the specific scGOS/lcFOS mixture lowered kappa and lambda Ig-fLC plasma concentrations in infants at high risk for allergies when compared to infants receiving placebo formula . Because Ig-fLC concentrations were increased in infants suffering from AD , this may have contributed , at least in part , to the reduced incidence in AD as described previously . This suggests a possible role for Ig-fLC in the pathophysiology of AD in infants at risk for allergy development Factors that influence immune regulation in early life may be implicated in the rise in allergic disease , including reduced microbial burden . The aim of the study was to examine the infant regulatory T-cell function in relation to ( a ) probiotic supplementation for the first 6 months of life and ( b ) the subsequent development of an early allergic phenotype . Two hundred and thirty-one allergic , pregnant women were recruited into a r and omized , controlled trial . The infants received either a probiotic or placebo daily for the first 6 months of life . One hundred and seventy-eight children completed the study , with blood sample s available from 118 ( 60 placebo ; 58 probiotic ) .  CD4(+)CD25(+)CTLA4(+)T-regulatory phenotype and allergen-induced FOXP3 mRNA expression were compared in relation to this intervention as well as according to evidence of early disease ( atopic dermatitis ) . The administration of probiotics was not associated with any significant differences in the proportion of circulating CD4(+)CD25(+)CTLA4(+)cells , or in the resting expression of FOXP3 . There were also no relationships between these parameters and patterns of gut colonization , and this probiotic did not reduce the risk of atopic dermatitis . Children who developed  atopic dermatitis ( n = 36/118 ) had significantly higher induced FOXP3 expression following stimulation with both house dust mite ( HDM ) ( p = 0.017 ) and ovalbumin ( OVA ) allergens ( p = 0.021 ) than those that did not develop atopic dermatitis . Although this relationship was seen in both the probiotic and placebo groups , it was more pronounced in the probiotic group . However , regression analysis demonstrated that higher allergen-induced FOXP3 expression was predicted by the presence of atopic dermatitis ( p = 0.018 ) rather than probiotics supplementation ( p = 0.217 ) . The higher levels of allergen-induced FOXP3 in atopic dermatitis suggest activation of these compensatory mechanisms rather than a primary defect in this pathway . Probiotic supplementation and gut colonization did not appear to substantially modify these regulatory pathways , or the risk of developing atopic dermatitis OBJECTIVES To describe the development of atopic dermatitis ( AD ) during the first 3 years of life and identify the localization of the early skin lesions that predicts the development of AD . DESIGN Prospect i ve , longitudinal , birth cohort study of children born to mothers with a history of asthma , followed up for 3 years with scheduled visits every 6 months as well as visits for onset or acute exacerbations of skin symptoms . SETTING The cohort was recruited from greater Copenhagen , Denmark , and followed up at a clinical research unit , which controlled all diagnoses and treatment of skin diseases . PARTICIPANTS A total of 411 infants were enrolled in the cohort ; 55 had incomplete follow-up and were excluded from certain analyses . MAIN OUTCOME MEASURES Atopic dermatitis was defined based on the criteria of Hanifin and Rajka , and severity was assessed by the SCORAD ( Scoring Atopic Dermatitis ) index . Predictive odds ratios of early skin lesions for those who developed AD vs those who did not were calculated . RESULTS The cumulative incidence of AD by age 3 years was 44 % ( 155/356 ) . The prevalence rate peaked at age 2 years for boys and at age 2.5 years for girls , but there were no other sex differences in the proportion of children developing AD . Skin involvement in infants with AD was found to begin at the scalp , forehead , ear , and neck in a balaclava-like pattern and continue to the extensor sides and trunk , finally affecting the flexor sides of the extremities . Early skin lesions of arms and joints best predicted AD at age 3 years . CONCLUSIONS Atopic dermatitis begins at the scalp , forehead , ear , and neck in a balaclava-like pattern . Eczema at the arms and joints provides the highest predictive value for the development of AD at age 3 years . This may be used for early prediction and intervention of AD BACKGROUND There have been considerable disagreements regarding the therapeutic effects of probiotics in atopic dermatitis ( AD ) . We performed this study to examine whether the oral administration of Lactobacillus plantarum CJLP133 improves pediatric AD . METHODS In a r and omized , double-blind , placebo-controlled study , either L. plantarum CJLP133 at a dosage of 0.5 × 10(10 ) colony-forming units or placebo in children aged 12 months to 13 yr was given twice a day for 12 wk . SCOring of Atopic Dermatitis ( SCORAD ) scores , eosinophil counts , serum total IgE , and cytokines were evaluated . RESULTS Forty-four of 58 patients in the probiotic group and 39 of 60 patients in the placebo group completed the study . The SCORAD score at week 14 was lower in the probiotic group than in the placebo group ( p = 0.044 ) . The mean change in the SCORAD score from weeks 2 to 14 was 9.1 in the probiotic group , which was greater than the mean change of 1.8 in the placebo group ( p = 0.004 ) . No statistical differences in the total use of topical corticosteroids were found between two groups ( p = 0.815 ) . In the probiotic group , the total eosinophil count was significantly lower at the end of the intervention compared to the baseline measurements ( p = 0.023 ) . Logarithmic IFN-γ and IL-4 were significantly decreased by the end of the intervention compared to baseline measurements in the probiotic group ( p < 0.001 and 0.049 ) . CONCLUSIONS Our results suggest that supplementation with probiotic L. plantarum CJLP133 is beneficial in the treatment of pediatric AD BACKGROUND AND DESIGN The aim of the study was to define the natural history of sensitization in atopic dermatitis ( AD ) through cross-sectional ( comparison of three age classes ) and longitudinal study : 250 children with minor ( 32.5 % ) , moderate ( 32.5 % ) , and severe ( 35 % ) AD were examined for aeroallergen and food hypersensitivity ( skin tests , clinical scoring after allergen elimination , and food challenges ) . RESULTS The allergic screening was negative in minor AD and positive in 33 % of cases of moderate AD that were concerned with aeroallergen sensitizations with only limited respiratory involvement . This suggests that nonspecific cutaneous hyperreactivity remains an almost exclusive precipitating factor in moderate or minor AD . Severe AD was characterized by a positive allergologic assessment in 100 % of patients : food allergens were incriminated as flare factors in 96 % of patients , with associated aeroallergen sensitization in 36 % . Even at a young age ( less than or equal to 2 years ) , the severe AD group is marked by an extreme frequency of food sensitization ( 93 % ) that persists in 73 % of children younger than 7 years and 67 % younger than 16 years . From the comparison of three age classes , the sequence of food and respiratory sensitization seems to be part of the natural course of AD . Prospect i ve study in 29 children of group 1 ( less than 2 years ) with a 3-year follow-up confirms the data of the cross-sectional study since 27 had development of aeroallergen sensitization , with respiratory symptoms as early as age 3 years in 23 of these children . CONCLUSION The detection of food allergy in a child presenting with AD is likely to indicate a prognosis of severe AD and should be considered by dermatologists as a potentially important predictor of further respiratory symptoms OBJECTIVE To determine whether probiotic lactobacilli may alleviate small intestinal inflammation and strengthen the intestinal barrier function in children with atopic dermatitis . STUDY DESIGN In a double-blinded , placebo-controlled , cross-over study , probiotic lactobacilli ( Lactobacillus rhamnosus 19070 - 2 and L reuteri DSM 12246 ) were administered for 6 weeks to 41 children with moderate and severe atopic dermatitis . Gastrointestinal symptoms were registered before and during treatment and small intestinal permeability was measured by the lactulose-mannitol test . RESULTS During Lactobacillus supplementation , there was a significant decrease in the frequency of gastrointestinal symptoms ( 39 % during the placebo period versus 10 % during active treatment , P=.002 ) . There was a positive association between the lactulose to mannitol ratio and the severity of the eczema ( r=0.61 , P=.02 after placebo and r=0.53 , P=.05 after active treatment ) . After probiotic treatment , the lactulose to mannitol ratio was lower ( 0.073 ) than after placebo ( 0.110 , P=.001 ) . CONCLUSIONS Impairment of the intestinal mucosal barrier appears to be involved in the pathogenesis of atopic dermatitis . The study suggests that probiotic supplementation may stabilize the intestinal barrier function and decrease gastrointestinal symptoms in children with atopic dermatitis
The best evidence lies with probiotics supplementation in mothers and infants in preventing development and reducing severity of AD .
Specifically , Lactobacillus rhamnosus GG was effective in long-term prevention of AD development .
γ-Linolenic acid reduced severity of AD .
Supplementation with prebiotics and black currant seed oil ( γ-linolenic acid and ω-3 combination ) was effective in reducing the development of AD .
Certain types of nutrient supplementation are beneficial in preventing AD development and reducing its severity .
OBJECTIVE To identify whether nutrient supplementation with probiotics , prebiotics , formula , or fatty acids prevents the development of  atopic dermatitis ( AD ) or reduces the severity of AD in newborns to children younger than 3 years .