Single-Strain Probiotic Treatment Demonstrates Positive Effect on Pediatric AD

Single-strain probiotic treatment had a positive impact on atopic dermatitis (AD) in pediatric patients, according to a study published in Clinical and Translational Allergy.¹

The researchers noted that probiotics gained attention for AD treatment after a study found that they helped to reduce eczema in high-risk infants by half.²

“Probiotics may actively fight pathogenic bacteria by secreting antimicrobial factors,” the authors wrote. “They also regulate the immune system and direct it to attack pathogenic microorganisms or promote immune tolerance, thereby reducing inflammation. Strengthening intestinal homeostasis may improve AD, and probiotics are increasingly being used in dermatology.”¹

Previous studies have reported mixed conclusions about using probiotics to increase the scoring atopic dermatitis (SCORAD) value in children. Some studies suggest that probiotics can effectively improve AD in children, while others found no significant difference between experimental and placebo groups. Because of this, the researchers performed a systematic review and meta-analysis of randomized clinical trials (RCTs) that used probiotics to treat children with AD; they noted that this review aimed to provide evidence on probiotics’ effect on AD.

The researchers noted that eligible RCTs were published between 2010 and 2023 and evaluated probiotic efficacy in AD treatment among patients aged 18 years or younger taking probiotics orally; eligible studies needed recorded data on probiotic species, doses, and administration timing. Eligible RCTs also utilized control groups receiving a placebo and SCORAD value to help assess AD severity. The researchers found RCTS through various databases using keywords related to AD, probiotics, RCTs, and children.

Using these criteria, the researchers retrieved 1486 studies; 53 studies met the conditions for full-text review, and after reading each study, the researchers chose 9 for systematic review and meta-analysis. They noted that the studies spanned from 2010 to 2021, 5 of which used multistrain mixtures to treat AD, and the other 4, single-strain interventions. The participants included in these studies were aged 0 to 18 years. The most common intervention period was 12 weeks, but the doses used varied.

Ten outcomes from 9 RCTs were included, with the researchers using SCORAD as the evaluation for each. They noted that 1000 patients were included across all studies; 3 studies analyzed a combined 373 participants for dichotomous variables, and 7 studies analyzed a combined 627 children for continuous variables.

The researchers demonstrated through a meta-analysis of the random-effect model of dichotomous variables that there were no significant differences between the probiotic and control groups (odds ratio [OR], 1.75; 95% CI, 0.70, 4.35; P = .23; I2= 68%). Additionally, they demonstrated through a meta-analysis of the random-effect model of continuous variables significant differences between the probiotic and control groups (mean difference, –4.24; 95% CI, –7.78 to –0.71; P = .0007; I2 = 71%).

Because of the findings for continuous variables, the researchers performed subgroup analyses based on the number of strains, the children’s ages, and treatment duration. Through this, they found a statistically significant improvement in the SCORAD value with single-strain probiotics, but not for multistrain probiotics. Additionally, the researchers found that pediatric participants’ ages, treatment duration, and probiotic species were not statistically significant for the SCORAD value.

Overall, this study showed that single-strain probiotic treatment positively affected AD. However, the researchers noted that the quantity and quality of studies reviewed required the conclusions to be verified by more high-quality studies. Consequently, there were several limitations to the present findings, one being that the number of studies included, and their sample scales, were relatively small, affecting the conclusions’ reliability. The researchers highlighted that the main limitation was that they could not evaluate the therapeutic effect of specific probiotic strains on children with AD due to the lack of global consensus on the names and variety of strains.

The researchers explained that “future investigators should adopt large sample sizes and extend follow-up time to assess the mechanisms of action and long-term effects of probiotics.” They concluded by noting that future research on AD prevention should also explore data for improving children’s health.

References

1. Xue X, Yang X, Shi X, Deng Z. Efficacy of probiotics in pediatric atopic dermatitis: a systematic review and meta-analysis. Clin Transl Allergy. 2023;13(7):e12283. doi:10.1002/clt2.12283
2. Kalliomäki M, Antoine JM, Herz U, Rijkers GT, Wells JM, et al. Guidance for substantiating the evidence for beneficial effects of probiotics: prevention and management of allergic diseases by probiotics. J Nutr. 2010;140(3):713S-721S. doi:10.3945/jn.109.113761