A Cochrane review [Abstract] 1 included 12 studies with a total of 2080 infants. Meta-analysis of 5 studies found a significant reduction in infant eczema (RR 0.82, 95% CI 0.70 to 0.95, n=1477). However, significant (p = 0.03) and substantial (I2 = 63.6%) heterogeneity was found. One study reported that the difference in eczema between groups persisted to 4 years age. When the analysis was restricted to studies reporting atopic eczema (confirmed by skin prick test or specific IgE), the findings were no longer significant (RR 0.80, 95% CI 0.62, 1.02). All studies reporting significant benefits used probiotic supplements containing L. rhamnosus and enrolled infants at high risk of allergy. No other benefits were reported for any other allergic disease or food hypersensitivity outcome (all allergic disease; asthma; allergic rhinitis; urticaria; overall for gastrointestinal manifestations of food allergy, cow's milk protein hypersensitivity, cow's milk protein allergy). To date, treatment with probiotic bacteria appears to be safe, although the studies included in this review have insufficient power to detect uncommon outcomes including sepsis with probiotic bacteria.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and excess losses in patient follow-up in some studies), and by inconsistency (heterogeneity in results across studies and in interventions and outcomes).
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