Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial.
BACKGROUND
Probiotic supplementation in early life may be effective for preventing eczema. Previous studies have suggested that prenatal administration may be particularly important for beneficial effects.


OBJECTIVE
We examined whether prenatal treatment with the probiotic Lactobacillus rhamnosus GG (LGG) can influence the risk of eczema during infancy.


METHODS
We recruited 250 pregnant women carrying infants at high risk of allergic disease to a randomized controlled trial of probiotic supplementation (LGG 1.8 × 10(10) cfu/day) from 36 weeks gestation until delivery. Infants were assessed during their first year for eczema or allergic sensitization. Immunological investigations were performed in a subgroup. Umbilical cord blood was examined for dendritic cell and regulatory T cell numbers and production of TGFβ, IL-10, IL-12, IL-13, IFN-γ and TNFα. Maternal breast milk was examined for total IgA, soluble CD14 and TGFβ.


RESULTS
Prenatal probiotic treatment was not associated with reduced risk of eczema (34% probiotic, 39% placebo; RR 0.88; 95% CI 0.63, 1.22) or IgE-associated eczema (18% probiotic, 19% placebo; RR 0.94; 95% CI 0.53, 1.68). Prenatal probiotic treatment was not associated with any change in cord blood immune markers, but was associated with decreased breast milk soluble CD14 and IgA levels.


CONCLUSIONS
Prenatal treatment with Lactobacillus rhamnosus GG was not sufficient for preventing eczema. If probiotics are effective for preventing eczema, then a postnatal component to treatment or possibly an alternative probiotic strain is necessary.
Allergy and Immune Disorders, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.
R J
RJ
Boyle
I H
IH
Ismail
S
S
Kivivuori
P V
PV
Licciardi
R M
RM
Robins-Browne
L-J
LJ
Mah
C
C
Axelrad
S
S
Moore
S
S
Donath
J B
JB
Carlin
S J
SJ
Lahtinen
M L K
ML
Tang
D000328:Adult; D004485:Eczema / Q000453:epidemiology / Q000517:prevention & control*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005312:Fetal Blood / Q000737:chemistry / Q000276:immunology; D006801:Humans; D007223:Infant; D052201:Lacticaseibacillus rhamnosus / Q000276:immunology*; D008875:Middle Aged; D008895:Milk, Human / Q000737:chemistry / Q000276:immunology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000276:immunology*; D019936:Probiotics / Q000627:therapeutic use*; D055815:Young Adult