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

Position article and guidelines

Alessandro Fiocchi^1†, Ruby Pawankar^2†, Carlos Cuello-Garcia³⁴, Kangmo Ahn⁵, Suleiman Al-Hammadi⁶, Arnav Agarwal³⁷, Kirsten Beyer⁸, Wesley Burks⁹, Giorgio W Canonica¹⁰,Motohiro Ebisawa¹¹, Shreyas Gandhi³⁷, Rose Kamenwa¹², Bee Wah Lee¹³, Haiqi Li¹⁴,Susan Prescott¹⁵, John J Riva¹⁶, Lanny Rosenwasser¹⁷, Hugh Sampson¹⁸, Michael Spigler¹⁹, Luigi Terracciano²⁰, Andrea Vereda-Ortiz²², Susan Waserman²¹, Juan José Yepes-Nuñez³, Jan L Brożek^213* and Holger J Schünemann²¹³

World Allergy Organization Journal 2015, 8:4  doi:10.1186/s40413-015-0055-2

Published: 27 January 2015

Abstract

Background

Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.

Objective

The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.

Methods

We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations.

Results

Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence.

Conclusions

WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.

Keywords: 
Allergy; Prevention; Probiotics; Practice guidelines; GRADE 

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