A Cochrane review [Abstract] 1 included 12 studies with a total of 781 subjects. All studies evaluated probiotics in children, and a majority (8 of 12) evaluated their effects in children under 18 months age. There was no significant difference in participant or parent-rated symptom scores at the end of the study treatments; symptom severity on a scale from 0 to 20 was 0.90 points lower after probiotic treatment than after placebo (95% CI -1.04 to 2.84; 5 studies, n=313). There was also no significant difference in participant or parent-rated overall eczema severity in favour of probiotic treatment (OR 0.40, 95% CI 0.14 to 1.15; 3 studies, n=150). There was no significant difference in investigator rated eczema severity between probiotic and placebo treatments; on a scale from 0 to 102 investigator rated eczema severity was 2.46 points lower after probiotic treatment than after placebo treatment (95% CI -2.53 to 7.45; 7 studies, n=588). Significant heterogeneity was noted between the results of individual studies, which may be explained by the use of different probiotic strains.
Subgroup analysis by age of participant, severity of eczema, presence of atopy or presence of food allergy did not identify a population with different treatment outcomes to the population as a whole. The adverse events search identified some case reports of infections and bowel ischaemia caused by probiotics.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by inconsistency (heterogeneity in interventions and outcomes and variability in results across studies).
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