Uso de probióticos e/ou prebióticos na prevenção de eczema em crianças com alto risco de atopia: uma revisão sistemática
Probiotics and/or prebiotics use on the prevention of eczema in children with high risk of atopy: a systematic review
Giovanna Delcole; Leonardo Lerro; Matheus Alves Alvares; Natália de Santana Pinto; Rodrigo Ferreira Rodrigues; Vera Esteves Vagnozzi Rullo
Resumo
O objetivo deste estudo foi encontrar a relação do uso de probióticos e/ou prebióticos na prevenção do desenvolvimento de eczema atópico em crianças com alto risco. Foram utilizadas para esta revisão as bases de dados MEDLINE, via PubMed, SciELO e LILACS, com os seguintes descritores “(probiotics OR prebiotics) AND (allergy) AND (eczema)”. Foram selecionados ensaios clínicos randomizados publicados até janeiro de 2020, sem restrição de idioma, em humanos, desde o nascimento até os 18 anos de idade. Foram recuperados 247 artigos, sendo cinco utilizados para análise. Quatro estudos não demonstraram relação entre o uso de probióticos e/ou prebióticos e a prevenção de eczema atópico em crianças de alto risco. Em contrapartida, um dos trabalhos obteve associação positiva, porém restrito a crianças com alergia à proteína do leite de vaca. Foi concluído nesta revisão que não existe relação entre o uso de probiótico e/ ou prebióticos em crianças de alto risco de atopia na prevenção de eczema, com possível exceção em crianças com alergia ao leite da vaca, com o desenvolvimento de eczema. É necessário a realização de mais estudos em longo prazo para a confirmação de real associação.
Palavras-chave
Abstract
The aim of this study was to assess the relationship between the use of probiotics and/or prebiotics and the onset of eczema in children with high risk of atopy. PubMed, SciELO, and LILACS databases were used with the following descriptors: “(probiotics OR prebiotics) AND (allergy) AND (eczema).” Randomized clinical trials published up to January 2020, with no language restriction, involving humans from birth to 18 years of age were included. In total, 247 articles were found, and five were included in the analysis. Four trials did not show a relationship between the use of probiotics and/or prebiotics and the prevention of atopic eczema in high-risk children. In contrast, one clinical trial reported a positive association, but restricted to children with cow’s milk allergy. In conclusion, there is no relationship between the use of probiotics and/or prebiotics and the onset of eczema in children with high risk of atopy, with a possible exception for children with cow’s milk allergy. Additional long-term studies are necessary to confirm whether this association is true.
Keywords
Referências
1. Antunes AA, Solé D, Carvalho VO, Bau AEK, Kuschnir FC, Mallozi MC, et al. Guia prático de atualização em dermatite atópica - Parte I: etiopatogenia, clínica e diagnóstico. Posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e da Sociedade Brasileira de Pediatria. Arq Asma Alerg Imunol. 2017;1(2):131‑56. Referências Probióticos e/ou prebióticos na prevenção de eczema – Delcole G et al.
2. Simão HL e Departamento de Alergia e Imunologia da SBP. Atualização em Dermatite Atópica. 2017 [Internet]. Disponível em:https://www.sbp.com.br/fileadmin/user_upload/pdfs/dermatite_ atopica.pdf
3. Ministério da Saúde. Dermatologia na Atenção Básica de Saúde: Cadernos de Atenção Básica Nº 9 - Eczema. Brasília; 2002 [Internet]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/guiafinal9.pdf. Acessado em: janeiro/2020.
4. Solé D, Wandalsen GF, Camelo-Nunes IC, Naspitz CK; ISAAC - Brazilian Group. Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC) - Phase 3. J Pediatr (Rio J). 2006;82(5):341‑6.
5. Soh SE, Aw M, Gerez I, Chong YS, Rauff M, Ng YPM, et al. Probiotic supplementation in the first 6 months of life in at risk Asian infants – effects on eczema and atopic sensitization at the age of 1 year. Clinical & Experimental Allergy, 39:571‑8. Disponível em: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2222.2008.03133.x. Acessado em: janeiro/2020.
6. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996 Feb;17(1):1‑12.
7. Boyle RJ, Tang ML, Chiang WC, Chua MC, Ismail I, Nauta A, et al.; PATCH study investigators. Prebiotic-supplemented partially hydrolysed cow’s milk formula for the prevention of eczema in high-risk infants: a randomized controlled trial. Allergy. 2016;71(5):701‑10.
8. Cabana MD, McKean M, Caughey AB, Fong L, Lynch S, Wong A, et al. Early probiotic supplementation for eczema and asthma prevention: a randomized controlled trial. Pediatrics. 2017;140(3):e20163000.
9. Boženský J, Hill M, Zelenka R, Skýba T. Prebiotics do not influence the severity of atopic dermatitis in infants: a randomised controlled trial. PLoS One. 2015;10(11):e0142897.
10. Berni Canani R, Sangwan N, Stefka AT, Nocerino R, Paparo L, Aitoro R, et al. Lactobacillus rhamnosus GG-supplemented formula expands butyrate-producing bacterial strains in food allergic infants. ISME J. 2016 Mar;10(3):742‑50.
11. Berni Canani R, Nocerino R, Terrin G, Coruzzo A, Cosenza L, Leone L, et al. Effect of Lactobacillus GG on tolerance acquisition in infants with cow’s milk allergy: a randomized trial. J Allergy Clin Immunol. 2012 Feb;129(2):580‑2.
12. Fiocchi A, Pawankar R, Cuello-Garcia C, Ahn K, Al-Hammadi S, Agarwal A, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. World Allergy Organ J. 2015 Jan 27;8(1):4. doi: 10.1186/s40413-015-0055-2. eCollection 201.
13. Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol. 2015 Feb;29(2):232-42.
14. Zuccotti G, Meneghin F, Aceti A, Barone G, Callegari ML, Di Mauro A, et al. Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy. 2015 Nov;70(11):1356-71. doi: 10.1111/all.12700. Epub 2015 Aug 13.
15. Azad MB, Coneys JG, Kozyrskyj AL, Field CJ, Ramsey CD, Becker AB, et al. Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and meta-analysis. BMJ. 2013 Dec 4;347:f6471. doi: 10.1136/bmj.f6471.
16. Sun D, Ong PY. Infectious Complications in Atopic Dermatitis. Immunol Allergy Clin North Am. 2017;37(1):75‑93.
17. Kido-Nakahara M, Furue M, Ulzii D, Nakahara T. Itch in Atopic Dermatitis. Immunol Allergy Clin North Am. 2017;37(1):113‑22.
18. Ehlayel MS, Bener A, Sabbah A. Montelukast treatment in children with moderately severe atopic dermatitis. Eur Ann Allergy Clin Immunol. 20039(7):232‑6.
19. Porto AC, Simão HM. Dermatite Atópica. In: Lopez FA, Campos Jr. D. Tratado de Pediatria: Sociedade Brasileira de Pediatria. 2ª ed. Barueri: Manole; 2010. p. 577-89.
20. Roxo Jr. P. Dermatite atópica. In: Roxo Jr. P (ed.). Alergia e Imunodeficiências em Pediatria – Abordagem Prática. 1ª ed. Ribeirão Preto: Tecmed; 2006. p. 23-41.
21. Ellwood P, Asher MI, Beasley R, Clayton TO, Stewart AW; ISAAC Steering Committee. The international study of asthma and allergies in childhood (ISAAC): phase three rationale and methods. Int J Tuberc Lung Dis. 2005;9(1):10‑6.
22. Fernández-Mayoralas DM, Caballero JM, Alvarez LG. Prevalencia de la dermatitis atópica en escolares de Cartagena y su relación con el sexo y la contaminación. An Pediatr (Barc). 2004;60(6):555‑60.
23. Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008;121:116-21, e11.
24. Moro G, Arslanoglu S, Stahl B, Jelinek J, Wahn U, Boehm G. A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age. Arch Dis Child. 2006;91(10):814‑9.
25. Infant and young child feeding; 2019. Infant and young child feeding [site na Internet]. Disponível em: http://www.data.unicef.org/nutrition/iycf. Acessado em: janeiro/2020.
26. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818‑23.
27. de Silva D, Geromi M, Halken S, Host A, Panesar SS, Muraro A, et al. Primary prevention of food allergy in children and adults: systematic review. Allergy. 2014;69:581-9.
28. Arslanoglu S, Moro GE, Boehm G, Wienz F, Stahl B, Bertino E. Early neutral prebiotic oligosaccharide supplementation reduces the incidence of some allergic manifestations in the first 5 years of life. J Biol Regul Homeost Agents. 2012;26(3 Suppl):49‑59.
29. Kunz B, Oranje AP, Labrèze L, Stalder JF, Ring J, Taïeb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology. 1997;195(1):10‑9.
30. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-14.
31. Martin JA, Hamilton BE, Osterman MJ. Births in the United States, 2014. NCHS Data Brief. 2015 Sep;(216):1-8.
32. Sun W, Svendsen ER, Karmaus WJ, Kuehr J, Forster J. Earlylife antibiotic use is associated with wheezing among children with high atopic risk: a prospective European study. J Asthma. 2015;52(7):647‑52.
33. Engorn B, Flerlage J. The Harriet Lane Handbook. Table 23.4. 20ª ed. Philadelphia: Elsevier, Saunders; 2015.
34. Kalliomäki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007 Apr;119(4):1019‑21.
35. Cabana MD, McKean M, Wong AR, Chao C, Caughey AB. Examining the hygiene hypothesis: the trial of infant probiotic supplementation. Paediatr Perinat Epidemiol. 2007;21(Suppl 3):23‑8.
36. Arslanoglu S, Piemontese P, Eisses A, Macheiner M, et al. Prevention of early atopic dermatitis by an infant formula supplemented with immunoactive prebiotics in low atopy risk infants. Allergy. 2008;63:615.
Submetido em:
02/04/2020
Aceito em:
22/06/2020
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