Synbiotics could not Reduce the Scoring of Childhood Atopic Dermatitis (SCORAD): A Randomized Double Blind Placebo-Controlled Trial
Abstract
Despite preliminary evidence, the role of probiotic and synbiotic in treatment of the atopic dermatitis has shown varying results. We aimed to evaluate whether synbiotic supplementation decrease severity of atopic dermatitis (AD) in childhood. In a randomized double blind-placebo controlled trial, we evaluated the synbiotic supplementation efficiency on the treatment of atopic dermatitis.
Infants aged 1–36 months with moderate to severe atopic dermatitis were randomized (n=41) and received either synbiotic (probiotic plus prebiotic) (n=20) or placebo (n=21) daily as a powder for two months. Emollient (Eucerin) and topical corticosteroid (Hydrocortisone) were permitted.
Children were scored for severity of atopic dermatitis (SCORAD). Also allergen Skin Prick Tests (SPT), IgE blood level and eosinophil count were measured at first visit. Patients’ SCORAD were reevaluated at the end of intervention. We followed 36 out of 41 subjects for two months (drop out rate = 9%).
In the whole group, the mean Total SCORAD (at base line 40.93) decreased by 56% (p=0.00). The mean Objective SCORAD (at base line 31.29) decreased by 53% (p=0.00). There was no significant difference in the mean decrease of total SCORAD between placebo (22.3) and synbiotic groups (24.2). There was also no difference between two intervention groups in the mean decrease of total SCORAD regarding to different demographic, clinical and para clinical subgroups.
This study could not confirm synbiotic as an effective treatment for childhood atopic dermatitis and further studies are needed. These findings challenge the role of synbiotics in the treatment of childhood atopic dermatitis.
- Beattie PE, Lewis-Jones MS. A comparative study of impairment of Quality Of Life (QOL) in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 2006; 155:145-5.
- Boguniewicz M, Abramovits W, Paller A, Whitaker- Worth DL, Prendergast M, Cheng JW, et al. A multiple- domain framework of clinical, economic, and patient- reported outcomes for evaluating benefits of intervention in atopic dermatitis. J Drugs Dermatol 2007; 6(4):416-3.
- Mancini AJ, Kaulback K, Chamlin SL. The socioeconomic impact of atopic dermatitis in the United States: a systematic review. Pediatr Dermatol 2008;25(1):1-6.
- Mozaffari H, Pourpak Z, Pourseyed S, Farhoodi A, Aghamohammadi A, Movahadi M, et al. Quality of life in atopic dermatitis patients. J Microbiol Immunol Infect 2007; 40(3):260-4.
- Bergmann RL, Edenharter G, Bergmann KE, Forster J, Bauer CP, Wahn V, et al. Atopic dermatitis in early infancy predicts allergic airway disease at 5 years. Clin Exp Allergy1998; 28(8):965-70.
- Pourpak Z, Mozaffari H, Gharagozlou M, Daneshmandi Z, Moin M. Asthma in patients with atopic dermatitis. Indian J Pediatr 2008; 75(2):139-41.
- ISAAC Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhino conjunctivitis and atopic eczema: ISAAC. Lancet 1998;351:1225-32.
- Sonia M. The role of Probiotics in allergic diseases.Allergy Asthma Clin Immunol 2009; 5(1):5. Ji GE. Probiotics in primary prevention of atopic dermatitis. Forum Nutr 2009; 61:117-28.
- Strachan DP, Hay fever, hygiene, and household size,BMJ 1989; 299:1259-60.
- Holt PG. Postnatal maturation of immune competence during infancy and childhood. Pediatr Allergy Immunol 1995; 6(2):59-70.
- Bloomfield SF, Stanwell-Smith R, Crevel RW, Pickup J.Too clean, or not too clean: the hygiene hypothesis and home hygiene. Clin Exper Allergy 2006; 36(4):402-25.
- Schaub B, Lauener R, Von Mutius E. The many faces of the hygiene hypothesis. J Allergy Clin Immunol 2006;117(5):969-77.
- Simon GL, Gorbach SL. Intestinal flora in health and disease. Gastroenterology 1984; 86(1):174-93. Björkstén B. Genetic and environmental risk factors for the development of food allergy, Curr Opin Allergy Clin Immunol 5 (2005), pp. 249-53.
- Björkstén B, Naaber P, Sepp E, Mikelsaar M. The intestinal microflora in allergic Estonian and Swedish 2- year-old children. Clin Exp Allergy 1999; 29(3):342-6.
- Kalliomäki M, Kirjavainen PV, Eerola E, Kero P, Salminen SJ, Isolauri E. Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing, J Allergy Clin Immunol 2001; 107(1):129-34.
- Sepp E, Julge K, Vasar M, Naaber P, Björkstén B, Mikelsaar M. Intestinal microflora of Estonian and Swedish infants, Acta Paediatr 1997; 86(9):956-61.
- Adlerberth I, Carlsson B, de Man P, Jalil F, Khan SR, Larsson P, et al. Intestinal colonization with Enterobacteriaceae in Pakistani and Swedish hospital delivered infants, Acta Paediatr 1991; 80(6-7):602-10.
- (WHO), FaAOFotUNaWHO: Guidelines for the Evaluation of Probiotics in Food. Report of a Joint FAO/WHO Working Group on Drafting Guidelines for the Evaluation of Probiotics in Food. Accessed on December 7, 2006.
- Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4- year follow-up of a randomized placebo-controlled trial, Lancet 2003; 361(9372):1869-71.
- Viljanen M, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial, Allergy 2005;60(4):494-500.
- Sistek D, Kelly R, Wickens K, Stanley T, Fitzharris P, Crane J. Is the effect of probiotics on atopic dermatitis confined to food sensitized children? Clin Exp Allergy 2006; 36(5):629-33.
- Bjorksten B, Sepp E, Julge K, Voor T, Mikelsaar M.Allergy development and the intestinal microflora during the first year of life, J Allergy Clin Immunol 2001;108(4):516-20.
- Kunz B, Oranje AP, Labre´ze L, Staldor JF, Ring J, Taiieb A. Clinical validation and guidelines for the SCORAD Index: Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1997;195(1):10-9.
- Kailasapathy K, Chin J. Survival and therapeutic potential of probiotic organisms with reference to Lactobacillus acidophilus and Bifidobacterium spp. Immunol C ell Biol 2000; 78:80-8.
- Michail S, Onady G, Stolfi A, Johnson T. Efficacy of probiotics in treatment ofpediatric atopic dermatitis a meta-analysis of randomized, controlled trials 2008;101(5):508-16.
- Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997; 99(2):179-85.
- Kirjavainen PV, Arvola T, Salminen SJ, Isolauri E.Aberrant composition of gut microbiota of allergic infants. a target of bifidobacterial therapy at weaning? Gut 2002; 51(1):51-5.
- Passeron T, Lacour JP, Fontas E, Ortonne JP. Prebiotics and synbiotics. two promising approaches for the treatment of atopic dermatitis in children above 2 years. Allergy 2006; 61(4):431-7.
- Rosenfeldt V, Benfeldt E, Nielsen SD, Michaelsen KF, Jeppesen DL, Valerius NH, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol 2003; 111(2):389-95.
- Brouwer ML, Wolt-Plompen SA, Dubois AE, van der Heide S, Jansen DF, Hoijer MA, et al. No effects of probiotics on atopic dermatitis in infancy. a randomized placebo-controlled trial. Clin Exp Allergy 2006;36(7):899-906.
- Fölster-Holst R, Müller F, Schnopp N, Abeck D, Kreiselmaier I, Lenz T, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol 2006; 155(6):1256-61.
- Farid R, Jabbari F, Ahanchian H, Moghiman T. Clinical and immunogical Effect of Probiotic in childhood Atopic Dermatitis. J Allergy Clin Immunol 2010; 125(2 ,suppl 1):AB93.
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Issue | Vol 10, No 1 (2011) | |
Section | Articles | |
Keywords | ||
Atopy Dermatitis Infants Prebiotics |
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