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Prebiotics and probiotics for treatment of allergic disease

Susan Prescott, MBBS, FRACP, PhD
Christina West, MD, PhD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


The rapid increase in immune-mediated disorders such as allergic disease is strongly linked to reduced early microbial exposure [1,2]. The gut microbiota represents the greatest microbial exposure by far and is central to the development of immune regulation. The specific composition of the gut microbiota may affect the risk of developing allergic disease [3]. This finding provided the foundation for intervention studies designed to modify gut microbial composition for the treatment of allergic disease. The effects of beneficial bacteria (probiotics) or resistant starches or fiber (prebiotics) that selectively stimulate a limited number of beneficial bacteria have been evaluated in allergy treatment studies.

This review examines the evidence for prebiotics and probiotics in the treatment of allergic disease [4-8]. The evidence for prebiotics and probiotics in the prevention of allergic disease is presented separately. The definitions of prebiotics, probiotics, and synbiotics; proposed mechanisms of action; rationale for use in allergic disease; and side effects and safety are also discussed separately. (See "Prebiotics and probiotics for prevention of allergic disease".)


Randomized, controlled trials evaluating the effects of prebiotics for treatment of allergic disease are scarce, and further studies are needed before any conclusions can be drawn.

The effect of kestose, a fructo-fructooligosaccharide (FOS), was assessed in a trial that randomized 29 infants and children <3 years of age with eczema to daily ingestion of kestose or maltose (placebo) for 12 weeks [9]. Median SCORAD (SCORing Atopic Dermatitis) scores were significantly lower at 6 and 12 weeks in the prebiotic group, compared with placebo.


Initial meta-analyses suggest no benefit of oral probiotics in the treatment of eczema or asthma. One meta-analysis reported a beneficial effect of probiotics in the treatment of allergic rhinitis, but it was not conclusive, and further studies are needed.

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Literature review current through: Nov 2017. | This topic last updated: Jun 10, 2016.
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