title: World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics.
abstract: BACKGROUND
  Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.
  
  
  OBJECTIVE
  The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.
  
  
  METHODS
  We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations.
  
  
  RESULTS
  Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence.
  
  
  CONCLUSIONS
  WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.
authors: Pediatric Hospital Bambino Gesù, Vatican City, Italy.
authors: Alessandro
authors: A
authors: Fiocchi
authors: Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
authors: Ruby
authors: R
authors: Pawankar
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.|Tecnologico de Monterrey School of Medicine and Health Sciences, Monterrey, Mexico.
authors: Carlos
authors: C
authors: Cuello-Garcia
authors: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Kangmo
authors: K
authors: Ahn
authors: Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
authors: Suleiman
authors: S
authors: Al-Hammadi
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.|Faculty of Medicine, University of Toronto, Toronto, ON Canada.
authors: Arnav
authors: A
authors: Agarwal
authors: Charité Klinik für Pädiatrie, Berlin, Germany.
authors: Kirsten
authors: K
authors: Beyer
authors: Department of Pediatrics, University of North Carolina, Chapel Hill, NC USA.
authors: Wesley
authors: W
authors: Burks
authors: University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors: Giorgio W
authors: GW
authors: Canonica
authors: Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
authors: Motohiro
authors: M
authors: Ebisawa
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.|Faculty of Medicine, University of Toronto, Toronto, ON Canada.
authors: Shreyas
authors: S
authors: Gandhi
authors: Department of Pediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
authors: Rose
authors: R
authors: Kamenwa
authors: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors: Bee Wah
authors: BW
authors: Lee
authors: Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China.
authors: Haiqi
authors: H
authors: Li
authors: Department of Immunology, Perth Children's Hospital, Telethon KIDS Institute, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
authors: Susan
authors: S
authors: Prescott
authors: Department of Family Medicine, McMaster University, Hamilton, ON Canada.
authors: John J
authors: JJ
authors: Riva
authors: Allergy-Immunology Division, Children's Mercy Hospital & University of Missouri - Kansas City School of Medicine, Kansas City, MO USA.
authors: Lanny
authors: L
authors: Rosenwasser
authors: Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY USA.
authors: Hugh
authors: H
authors: Sampson
authors: Food Allergy Research & Education (FARE), McLean, VA USA.
authors: Michael
authors: M
authors: Spigler
authors: Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy.
authors: Luigi
authors: L
authors: Terracciano
authors: Allergology Department, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
authors: Andrea
authors: A
authors: Vereda-Ortiz
authors: Department of Medicine, McMaster University, Hamilton, ON Canada.
authors: Susan
authors: S
authors: Waserman
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.
authors: Juan José
authors: JJ
authors: Yepes-Nuñez
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.|Department of Medicine, McMaster University, Hamilton, ON Canada.
authors: Jan L
authors: JL
authors: Brożek
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.|Department of Medicine, McMaster University, Hamilton, ON Canada.
authors: Holger J
authors: HJ
authors: Schünemann
keywords: Allergy; GRADE; Practice guidelines; Prevention; Probiotics
references: J Clin Epidemiol. 2011 Apr;64(4):395-400
references: 21194891
references: Lancet. 2001 Apr 7;357(9262):1076-9
references: 11297958
references: Allergy. 2009 Sep;64(9):1349-58
references: 19392993
references: J Allergy Clin Immunol. 2008 Oct;122(4):788-794
references: 18762327
references: Am J Clin Dermatol. 2008;9(2):93-103
references: 18284263
references: BMJ. 2013 Dec 04;347:f6471
references: 24304677
references: Pediatrics. 2013 Sep;132(3):e666-76
references: 23958764
references: JAMA Dermatol. 2013 Mar;149(3):350-5
references: 23682371
references: JAMA. 2012 May 9;307(18):1959-69
references: 22570464
references: J Chemother. 2013 Aug;25(4):193-212
references: 23906073
references: J Allergy Clin Immunol. 2012 Dec;130(6):1355-60
references: 23083673
references: World Allergy Organ J. 2012 Nov;5(11):148-67
references: 23282383
references: CMAJ. 2014 Feb 18;186(3):E123-42
references: 24344144
references: Br J Nutr. 2008 Oct;100(4):834-45
references: 18341756
references: Allergy. 2014 May;69(5):590-601
references: 24697491
references: Clin Exp Allergy. 2009 Apr;39(4):571-8
references: 19134020
references: J Pediatr Gastroenterol Nutr. 2008 Jan;46(1):99-110
references: 18162844
references: Clin Exp Allergy. 2012 Jul;42(7):1071-9
references: 22702506
references: Pediatr Allergy Immunol. 2010 Mar;21(2 Pt 2):e386-93
references: 19840300
references: Pediatrics. 2008 Apr;121(4):e850-6
references: 18332075
references: Allergy. 2011 Apr;66(4):509-16
references: 21121927
references: J Obstet Gynaecol Can. 2009 Jun;31(6):542-552
references: 19646321
references: J Allergy Clin Immunol. 2010 Dec;126(6 Suppl):S1-58
references: 21134576
references: J Clin Gastroenterol. 2012 Jul;46(6):468-81
references: 22688142
references: J Allergy Clin Immunol. 2007 Apr;119(4):1019-21
references: 17289135
references: Clin Exp Allergy. 2005 Dec;35(12):1557-64
references: 16393321
references: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006474
references: 17943911
references: Pediatr Allergy Immunol. 2007 Feb;18(1):10-9
references: 17295794
references: Br J Nutr. 2012 Jan;107(1):1-6
references: 21787448
references: Chest. 2005 Feb;127(2):502-8
references: 15705988
references: Adv Exp Med Biol. 2008;635:113-34
references: 18841708
references: J Nutr. 2010 Mar;140(3):483-8
references: 20089774
references: J Allergy Clin Immunol. 2002 Jan;109(1):119-21
references: 11799376
references: Nutr J. 2012 Oct 04;11:81
references: 23035863
references: J Pediatr Gastroenterol Nutr. 2011 Jun;52(6):756-62
references: 21593648
references: Allergy. 2008 Jun;63(6):634-45
references: 18445181
references: J Clin Gastroenterol. 2012 Oct;46 Suppl:S1-2
references: 22955349
references: Pediatr Allergy Immunol. 2011 Mar;22(2):249-51
references: 21332798
references: Clin Exp Allergy. 2012 Sep;42(9):1386-96
references: 22925325
references: Eur J Clin Nutr. 2011 Feb;65(2):175-83
references: 21081959
references: Pediatr Allergy Immunol. 2009 Aug;20(5):430-7
references: 19298231
references: J Allergy Clin Immunol. 2008 Jan;121(1):116-121.e11
references: 18206506
references: Clin Exp Allergy. 2008 Apr;38(4):611-8
references: 18266878
references: J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):238-50
references: 21150647
references: Br J Dermatol. 2010 Sep;163(3):616-23
references: 20545688
references: Allergy. 2008 Nov;63(11):1481-90
references: 18925885
references: Int Arch Allergy Immunol. 2010;153(2):201-6
references: 20413988
references: Am J Clin Nutr. 2001 Feb;73(2 Suppl):444S-450S
references: 11157355
references: Lancet. 2003 May 31;361(9372):1869-71
references: 12788576
references: Epidemiology. 2012 May;23(3):402-14
references: 22441545
references: Clin Exp Allergy. 2008 Aug;38(8):1342-8
references: 18477013
references: Evid Based Child Health. 2011 Sep;6(5):1322-1339
references: 22822349
references: J Allergy Clin Immunol. 2009 Feb;123(2):335-41
references: 19135235
references: J Pediatr Gastroenterol Nutr. 2004 Nov;39(5):465-73
references: 15572882
references: J Allergy Clin Immunol. 2007 May;119(5):1174-80
references: 17349686
references: J Allergy Clin Immunol. 2007 Jan;119(1):192-8
references: 17208601