title: Clinical Use of Probiotics in Pediatric Allergy (CUPPA):  A World Allergy Organization Position Paper.
abstract: BACKGROUND
  : Probiotic administration has been proposed for the prevention and treatment of specific allergic manifestations such as eczema, rhinitis, gastrointestinal allergy, food allergy, and asthma. However, published statements and scientific opinions disagree about the clinical usefulness.
  
  
  OBJECTIVE
  : A World Allergy Organization Special Committee on Food Allergy and Nutrition review of the evidence regarding the use of probiotics for the prevention and treatment of allergy.
  
  
  METHODS
  : A qualitative and narrative review of the literature on probiotic treatment of allergic disease was carried out to address the diversity and variable quality of relevant studies. This variability precluded systematization, and an expert panel group discussion method was used to evaluate the literature. In the absence of systematic reviews of treatment, meta-analyses of prevention studies were used to provide data in support of probiotic applications.
  
  
  RESULTS
  : Despite the plethora of literature, probiotic research is still in its infancy. There is a need for basic microbiology research on the resident human microbiota. Mechanistic studies from biology, immunology, and genetics are needed before we can claim to harness the potential of immune modulatory effects of microbiota. Meanwhile, clinicians must take a step back and try to link disease state with alterations of the microbiota through well-controlled long-term studies to identify clinical indications.
  
  
  CONCLUSIONS
  : Probiotics do not have an established role in the prevention or treatment of allergy. No single probiotic supplement or class of supplements has been demonstrated to efficiently influence the course of any allergic manifestation or long-term disease or to be sufficient to do so. Further epidemiologic, immunologic, microbiologic, genetic, and clinical studies are necessary to determine whether probiotic supplements will be useful in preventing allergy. Until then, supplementation with probiotics remains empirical in allergy medicine. In the future, basic research should focus on homoeostatic studies, and clinical research should focus on preventive medicine applications, not only in allergy. Collaborations between allergo-immunologists and microbiologists in basic research and a multidisciplinary approach in clinical research are likely to be the most fruitful.
authors.affiliation: 1Department of Pediatrics - Division of Allergy - Pediatric Hospital Bambino Gesù - Rome, Vatican City 2Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA 3Department of Pediatrics and Medicine, Section of Allergy and Immunology, Louisiana State University Health Sciences Center, Shreveport, LA 4Department of Medicine, University of Medicine and Dentistry of New Jersey Medical School, Newark, NJ 5Department of Paediatrics, Imperial College London, London, United Kingdom 6Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil 7Department of Pediatric Allergology, Women's and Children's Health, University of Uppsala, Uppsala, Sweden 8Department of Food Science & Technology University of Nebraska, Lincoln, NE, USA 9Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland 10Department of Allergy and Immunology, Royal Children's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Australia 11King's College London, Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Paediatric Allergy, St Thomas' Hospital, London, United Kingdom 12Sydney Medical School, University of Sydney, New South Wales, Australia 13Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY 14Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand 15Department of Paediatrics, National University of Singapore, Singapore.
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