Lactobacillus rhamnosus GG in the Primary Prevention of Eczema in Children: A Systematic Review and Meta-Analysis

Hania Szajewska, Andrea Horvath, Hania Szajewska, Andrea Horvath

Abstract

Current guidelines recommend the use of probiotics to reduce the risk of eczema. It remains unclear which strain(s) to use. We systematically evaluated data on the efficacy of Lactobacillus rhamnosus GG (LGG) supplementation prenatally and/or postnatally for the primary prevention of eczema. The Cochrane Library, MEDLINE, and EMBASE databases were searched up to August 2018, with no language restrictions, for systematic reviews of randomized controlled trials (RCTs) and RCTs published afterwards. The primary outcome was eczema. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). A random-effects model was used to pool data. Heterogeneity was explored using the I² statistics. The GRADE criteria were used to assess the overall quality of evidence supporting the primary outcome. Seven publications reporting 5 RCTs (889 participants) were included. High to moderate certainty in the body of evidence suggests that LGG supplementation (regardless of the timing of administration) did not reduce the risk of eczema. There was also no consistent effect on other allergic outcomes. This meta-analysis shows that LGG was ineffective in reducing eczema. It does not support the general recommendation to use probiotics for preventing eczema, unless specific strains would be indicated.

Keywords: allergy; infants; pediatrics; probiotics.

Conflict of interest statement

Declaration of personal interests: H.S. has served as a speaker for Dicofarm, Vitis Pharma, Bayer, i.e., the manufacturers and/or distributors of LGG. A.H. has served as a speaker for Nutricia, Mead Johnson, Vitis Pharma.

Figures

Figure 1
Figure 1
Risk of bias graph.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Primary outcome: Effect of LGG supplementation on eczema (data presented based on the timing of LGG administration and the timing of assessment).
Figure 4
Figure 4
Secondary outcome: Effect of LGG supplementation on wheezing/asthma (data presented based on the timing of LGG administration and the timing of assessment).
Figure 5
Figure 5
Secondary outcome: Effect of LGG supplementation on allergic rhinitis (data presented based on the timing of LGG administration and the timing of assessment).

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