title: World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics.
abstract: BACKGROUND
  The 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. Prebiotics - non-digestible oligosaccharides that stimulate growth of probiotic bacteria - 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 prebiotics in the prevention of allergy.
  
  
  METHODS
  The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy. We performed a systematic review of randomized controlled trials of prebiotics, and reviewed the evidence about patient values and preferences, and resource requirements (up to January 2015, with an update on July 29, 2015). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.
  
  
  RESULTS
  Based on GRADE evidence to decision frameworks, the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants. Both recommendations are conditional and based on very low certainty of the evidence. We found no experimental or observational study of prebiotic supplementation in pregnant women or in breastfeeding mothers. Thus, the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding, at this time.
  
  
  CONCLUSIONS
  WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy, term infants.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.|Tecnologico de Monterrey School of Medicine, Monterrey, Mexico.
authors.forename: Carlos A
authors.identifier: 0000-0002-1742-0242
authors.initials: CA
authors.lastname: Cuello-Garcia
authors.affiliation: Pediatric Hospital Bambino Gesù, Vatican City, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiocchi
authors.affiliation: Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
authors.forename: Ruby
authors.initials: R
authors.lastname: Pawankar
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.|University of Antioquia, School of Medicine, Medellín, Colombia.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Yepes-Nuñez
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Morgano
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kangmo
authors.initials: K
authors.lastname: Ahn
authors.affiliation: Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
authors.forename: Suleiman
authors.initials: S
authors.lastname: Al-Hammadi
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON Canada.
authors.forename: Arnav
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON Canada.
authors.forename: Shreyas
authors.initials: S
authors.lastname: Gandhi
authors.affiliation: Charité Klinik für Pädiatrie, Berlin, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
authors.affiliation: Department of Pediatrics, University of North Carolina, Chapel Hill, NC USA.
authors.forename: Wesley
authors.initials: W
authors.lastname: Burks
authors.affiliation: University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Giorgio W
authors.initials: GW
authors.lastname: Canonica
authors.affiliation: Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Ebisawa
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
authors.forename: Rose
authors.initials: R
authors.lastname: Kamenwa
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
authors.forename: Bee Wah
authors.initials: BW
authors.lastname: Lee
authors.affiliation: Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China.
authors.forename: Haiqi
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Immunology, Perth Children's Hospital, Telethon KIDS Institute, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Prescott
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.|Department of Family Medicine, McMaster University, Hamilton, ON Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: Riva
authors.affiliation: Allergy-Immunology Division, Children's Mercy Hospital & University of Missouri - Kansas City School of Medicine, Kansas City, MO USA.
authors.forename: Lanny
authors.initials: L
authors.lastname: Rosenwasser
authors.affiliation: Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Sampson
authors.affiliation: Food Allergy Research & Education (FARE), McLean, VA USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Spigler
authors.affiliation: Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Terracciano
authors.affiliation: Allergology Department, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vereda
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Waserman
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.|Department of Medicine, McMaster University, Hamilton, ON Canada.
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.|Department of Medicine, McMaster University, Hamilton, ON Canada.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Brożek