PROBIOTICS
Place in Therapy
According to the primary literature and the Cochrane review, the use of probiotics, specifically Lactobacillus, provides no significant difference in the treatment of atopic dermatitis. However, one should take into consideration the quality of the literature. One should also consider the strains of Lactobacillus studied. In the Cochrane review, subgroup analysis demonstrated that in 7 of the 12 studies which used Lactobacillus GG showed no beneficial effect on SCORAD score. However other Lactobacillus strains were used in 5 of the 12 studies which demonstrated improvement in SCORAD score. This warrants for future studies to look at the newer probiotic strains to better understand their effects. In addition, one of the studies demonstrated that the use of Lactobacillus appears to be more effective in allergic patients with a positive skin prick test response and increased IgE levels. 1-3
There are other pharmacologic options with more robust evidence demonstrating their safety and efficacy, hence this should be one of the last line of agents used. However, with this being one of the few natural remedies available as a potential treatment option for patients, for those who wish to use probiotics practitioners may accept the option due to low risk of adverse events but not recommend due to the lack of supporting evidence.
References
1. Boyle J, Bath0Hextall FJ, Leonardi-Bee J, Murrell DF, Tang MLK. Probiotics for treating eczema (Review). The Cochrane Collaboration. 2008. Accessed June 25, 2012 http://www.cfah.org/hbns/archives/viewSupportDoc.cfm?supportingDocID=674
2. Haahtela T, Juntunen-Backman K, Korpela R et al. Probiotics in the treatment of atopic eczema / dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy. 2005; 60(4):494-500.
3. Natural Medicines Comprehensive Database. Lactobacillus. http://naturaldatabase.therapeuticresearch.com.proxy.lib.uwaterloo.ca/nd/printversion.aspx?id=790&referer=542160ap