Atopic dermatitis and skin disease
Reduced occurrence of early atopic dermatitis because of immunoactive prebiotics among low-atopy-risk infants

https://doi.org/10.1016/j.jaci.2010.07.022Get rights and content

Background

Most infants developing atopic dermatitis have a low risk for atopy. Primary prevention of atopic dermatitis is difficult.

Objective

To assess the effect of supplementation of an infant and follow-on formula with prebiotic and immunoactive oligosaccharides on the occurrence of atopic dermatitis in the first year of life.

Methods

Healthy term infants from 5 European countries with low atopy risk were recruited before the age of 8 weeks, either having started with formula feeding or being on full breast-feeding (breast-feeding group). Formula-fed infants were randomized to feeding with a regular formula containing a specific mixture of neutral oligosaccharides and pectin-derived acidic oligosaccharides (prebiotic formula group) or regular formula without oligosaccharides (control formula group).

Results

A total of 414 infants were randomized to the prebiotic group and 416 infants to the control group. A total of 300 infants were followed in the breast-feeding group. Up to the first birthday, atopic dermatitis occurred in significantly fewer infants from the prebiotic group (5.7%) than from the control group (9.7%; P = .04). The cumulative incidence of atopic dermatitis in the prebiotic group was in the low range of the breast-feeding group (7.3%). In a Cox regression model, the rate of atopic dermatitis was significantly lower by 44% in the prebiotic group versus the control group (P = .04). The number needed to prevent 1 case of atopic dermatitis by supplementation of prebiotics was 25 infants.

Conclusion

Formula supplementation with a specific mixture of oligosaccharides was effective as primary prevention of atopic dermatitis in low atopy risk infants.

Section snippets

Study design

The study was performed as a double-blind, placebo-controlled, randomized prospective nutritional intervention study. As reported elsewhere, the primary endpoint of the study was to elucidate whether formula feeding supplemented with a specific mixture of neutral and acidic oligosaccharides reduces the incidence of fever episodes in healthy term-born infants during the first year of life (Multicentric Infection Prevention Study (MIPS); Margriet van Stuivenberg, June 2010, unpublished data).

The

Study population

From July 2005 to December 2006, a total of 1187 infants were screened. Fifty-seven of these infants were not enrolled. A total of 1130 infants participated and were randomized into 1 of the 2 study groups or were fully breast-fed and in the BG. The intention-to-treat population was composed of 414 infants in the PG, 416 infants in the CG, and 300 infants in the BG. The trial profile is shown in Fig 1. During the observation period, 129 patients (11%) dropped out (PG, n = 53; CG, n = 42; BG,

Discussion

This trial shows that supplementation of infant formula/follow-on formula with a specific prebiotic mixture of scGOS/lcFOS/pAOS reduces the incidence of AD up to the first birthday in infants at low risk for atopy by 44% compared with the control group and down to a level similar to that of fully breast-fed infants. The severity of AD, however, was not affected significantly.

A novelty of our study is the low atopy risk strata as the target population. Primary prevention in infants at low AD

References (30)

  • M. Kalliomäki et al.

    Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial

    Lancet

    (2003)
  • A.P. Vos et al.

    Specific prebiotic oligosaccharides modulate the early phase of a murine vaccination response

    Int Immunopharmacol

    (2010)
  • H. Williams et al.

    International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide?

    J Allergy Clin Immunol

    (2008)
  • J.A. Odhiambo et al.

    ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three

    J Allergy Clin Immunol

    (2009)
  • C. Söderhäll et al.

    Variants in a novel epidermal collagen gene (COL29A1) are associated with atopic dermatitis

    PLoS Biol

    (2007)
  • Cited by (222)

    • Current Use of Probiotics and Prebiotics in Allergy

      2022, Journal of Allergy and Clinical Immunology: In Practice
      Citation Excerpt :

      The use of prebiotics was addressed in a systematic way for the preparation of the guidelines of the World Allergy Organization on the prevention of allergic diseases using prebiotics.68 In 2017, a half dozen studies assessing the use of prebiotics for the prevention of AEDS in infants were available.64,110-114 Prebiotics (GOS-FOS) were either added to a cereal, used as an oral capsule, or typically added in milk formula composition.

    View all citing articles on Scopus

    Supported by Danone Research, Friedrichsdorf, Germany. The role of the funder has been to supply the study formulas and facilitate the data collection and data analysis.

    Disclosure of potential conflict of interest: C. Grüber receives honoraria from Danone. F. Mosca receives research support from Danone/Numico. C. P. Braegger has consultant arrangements and receives research support from Danone. J. Riedler is on the advisory board for Numico and receives research support from MIPS. U. Wahn receives research support from Danone. The rest of the authors have declared that they have no conflict of interest.

    View full text