Single-Strain Probiotic Has Positive Effect on Atopic Dermatitis in Pediatric Patients

In a recent systematic review and meta-analysis,¹ researchers found that single-strain probiotic treatment demonstrated a positive effect on atopic dermatitis (AD) among pediatric patients with the condition.

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Researchers sought to evaluate the validity of probiotic use in a pediatric population with AD, noting the condition’s prevalence in childhood coupled with existing studies assessing probiotics as a potential AD treatment strategy. In fact, Kalliomäki et al conducted a study in 2003 wherein they found that perinatal probiotic consumption reduced the risk of infantile eczema by half, specifically with regard to the probiotic Lactobacillus rhamnosus.² This study helped propel probiotics forward as a potential consideration for AD treatment.

However, researchers note that there have been numerous conflicting studies wherein few or no significant differences were observed between groups of patients receiving probiotics versus those receiving a placebo. This is compounded by the controversy of probiotic use in a pediatric population, according to Xue et al.

Through a systematic search of PubMed/MEDLINE, Embase, EBSCO, Web of Science, and Cochrane databases, researchers searched for relevant studies and journals ranging in publication date from January 1, 2010, to January 1, 2023. Relevant key words used in the search process included, “clinical trial,” “dermatitis atopic,” “dermatitides,” “neurodermatitis atopic,” “probiotics,” “randomized,” and “randomly.”

Studies and journals included in the analysis were required to meet specific criteria, including:

• Control groups involving placebo treatment
• Oral probiotic use described with species, dose, and administration method
• Participants diagnosed with AD in accordance with the American Academy of Dermatology Diagnostic Criteria
• Participants equal to or less than 18 years of age
• Primary endpoints described in detail
• Use of SCORing Atopic Dermatitis (SCORAD) to assess AD severity

Upon data extraction, 1,486 studies were retrieved. After removing duplicate content and screening criteria, a total of 53 articles underwent full-text review, after which 9 were included in the subsequent meta-analysis.

Five of the 9 studies involved multi-strain probiotic mixtures, while 4 utilized single-strain interventions. Additionally, 7 of the 9 studies involved a total of 627 children and were analyzed with continuous variables, while 3 studies involved a total of 373 children and were analyzed with dichotomous variables.

Among the 7 studies with continuous variables, 4 involved patients (n=320) using single-strain probiotics, and 3 involved patients (n=307) using multi-strain probiotics. In a subgroup analysis, researchers found that the difference between use of single-strain probiotics and the placebo treatment was statistically significant. Furthermore, they found that use of probiotics increased the SCORAD value of patients, with a notable and significant difference in improvement between patients taking a single-strain probiotic versus patients taking a multi-strain probiotic.

According to researchers, potential limitations of the review and meta-analysis included limited sample sizes featuring limited numbers of patients and studies, as well as a lack of reported allocation concealment in some studies and potential clinical heterogeneity.

“This study showed that single-strain probiotic treatment exerts a positive effect on the AD. Few studies focused on the improvement of probiotics with AD in children, and future investigators should adopt large sample sizes and extend follow-up time to assess the mechanisms of action and long-term effects of probiotics,” wrote Xue et al. “Research on AD prevention in children should also be increased to explore data for improving children's health. Defined by the quantity and quality of the included studies, the conclusions of the present work warrant further verification by high-quality studies.”

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). doi:10.1002/clt2.12283
2. Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. 2003;361(9372):1869-1871. doi:10.1016/S0140-6736(03)13490-3