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October 10, 2016

Probiotics in the Treatment of Atopic Dermatitis

Question

Are probiotics helpful in the treatment and the prevention of atopic dermatitis?

Answers

From the Editor: A new feature of Ask the World Experts is involving WAO Junior Members in this endeavor.  Professors Manuel Rial Prado and Denica Zheleva both address the question of the role of probiotics in the treatment of atopic dermatitis.  While it appears probiotics may indeed prevent the development of atopic dermatitis, the role in treatment is uncertain.

By Professor Manuel Rial Prado

Atopic dermatitis is the point of attachment between allergic diseases and autoimmune diseases. Probiotics and synbiotics favor the expression of anti-inflammatory Th1 cytokines which produces therapeutic benefits in patients with atopic dermatitis as revealed by recent meta-analysis.

On the other hand, the McMaster University with The WAO guideline panel suggests using probiotics in pregnant women and in breastfeed women at high risk for allergy in their children because considering all critical outcomes, there is a net benefit resulting primarily from prevention of eczema, they make the same recommendation in infants at high risk of developing allergies.

References:

1- World Allergy Organization Journal 2015; 8:4. DOI: 10.1186/s40413-015-0055-2.

2- JAMA Pediatr. 2016 Mar;170(3):236-42. doi: 10.1001/jamapediatrics.2015.3943

Manuel Rial Prado, MD
Allergist
Complexo Hospitalario Universitario A Coruña
A Coruña, Spain

 

By Professor Denica Zheleva

Atopic dermatitis is one of the epidemically expanding non-infectious diseases in the 21 century. It poses immense challenges to both patients and physicians. With a steady growth in its incidence and prevalence, the disease carries a heavy social and economic burden.

Atopic dermatitis (AD, syn. ‘atopic eczema’) is the commonest inflammatory skin disorder in children and represents a serious problem for the providers of health care all over the world (1-4) with an impressive effect on patients' quality of life (1),(5-9). In 40–60% of paediatric patients with AD persist having symptoms later on in life (10, 11). Although AD often starts in early infancy, there are adult onset forms  which start in adolescence or adulthood (11). Most of the patients with AD can control their skin disease with topical therapy and emollient skin care. There is a considerable group of patients with severe AD who do not respond to the prescribed treatment with moisturizers, topical corticosteroids (TCS), and/or topical calcineurin inhibitors (TCI) or experience immediate flare-ups after tapering topical anti-inflammatory therapy.

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