Probiotik dalam kalangan bayi untuk pencegahan penyakit alahan dan hipersensitiviti makanan
Abstract
Background
The composition of the intestinal microflora may be different in individuals with atopic eczema from those without this condition, and such differences may precede the development of eczema. Probiotics are live bacteria that colonize the gastrointestinal tract and provide a health benefit to the host. Probiotics added to infant feeds have the potential to prevent sensitisation of infants to dietary allergens.
Objectives
To determine the effect of probiotics given to infants for the prevention of allergic disease or food hypersensitivity.
Search methods
This included searches of the Cochrane Central Register of Controlled Trials (Issue 1, 2007), MEDLINE (1966 ‐ February 2007), EMBASE, PREMEDLINE, abstracts of conference proceedings and citations of published articles, and expert informants.
Selection criteria
Randomised and quasi‐randomised controlled trials that compare the use of a probiotic to no probiotic; or the use a specific probiotic compared to a different probiotic; or a probiotic with added prebiotic to control.
Data collection and analysis
Assessment of trial quality, data extraction and synthesis of data were performed using standard methods of the Cochrane Neonatal Review Group.
Main results
Twelve studies were eligible for inclusion. Allergic disease and / or food hypersensitivity outcomes were assessed by 6 studies enrolling 2080 infants, but outcomes for only 1549 infants were reported. Studies generally had adequate randomisation, allocation concealment and blinding of treatment. However, the findings of this review should be treated with caution due to excess losses in patient follow‐up (17% to 61%). Meta‐analysis of five studies reporting the outcomes of 1477 infants found a significant reduction in infant eczema (typical RR 0.82, 95% CI 0.70, 0.95). However, there was significant and substantial heterogeneity between studies. 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 (typical 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.
Authors' conclusions
There is insufficient evidence to recommend the addition of probiotics to infant feeds for prevention of allergic disease or food hypersensitivity. Although there was a reduction in clinical eczema in infants, this effect was not consistent between studies and caution is advised in view of methodological concerns regarding included studies. Further studies are required to determine whether the findings are reproducible.
PICO
Plain language summary
Probiotik dalam kalangan bayi untuk pencegahan penyakit alahan dan hipersensitiviti makanan
Tidak ada bukti yang mencukupi untuk mengesyorkan penambahan probiotik ke dalam makanan bayi untuk pencegahan penyakit alahan atau reaksi kepada makanan. Reaksi kepada makanan dan alahan (termasuk asma, ekzema dan demam alergi) adalah biasa dan ia mungkin akan meningkat di negara maju. Kebanyakkan bayi menjadi peka kepada makanan, termasuk rumusan bayi, melalui saluran gastrousus mereka, satu proses yang mungkin dijejaskan oleh komposisi bakteria usus. Percubaan untuk menggalakkan pertumbuhan bakteria gastrousus yang normal dan mencegah pemekaan kepada makanan juga merangkumi penggunaan probiotik. Probiotik adalah bakteria hidup yang menjajah saluran gastrousus dan memberi manfaat kesihatan kepada perumah. Ulasan ini mendapati bahawa probiotik yang ditambah ke dalam makanan bayi dapat membantu mencegah ekzema dalam kalangan bayi, dengan satu kajian mencadangkan manfaat mungkin akan berterusan hingga usianya empat tahun. Walau bagaimanapun, kebimbangan mengenai kualiti kajian, tidak kekonsistenan dapatan antara kajian, dan hakikat bahawa faedah tidak berterusan jika terhad kepada bayi dengan bukti pemekaan kepada alergen, mencadangkan bahawa kajian lanjut diperlukan untuk mengesahkan keputusan ini.
