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Fiocchi A, Cabana MD, Mennini M. Reply to "Probiotics in managing pediatric asthma: Is this a viable road?". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3344-3345. [PMID: 36496221 DOI: 10.1016/j.jaip.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Alessandro Fiocchi
- Translational Research in Pediatric Specialities Area, Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Michael D Cabana
- Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, NY
| | - Maurizio Mennini
- Translational Research in Pediatric Specialities Area, Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Ruszkowski J, Majkutewicz K, Rybka E, Kutek M, Dębska-Ślizień A, Witkowski JM. The methodological quality and clinical applicability of meta-analyses on probiotics in 2020: A cross-sectional study. Biomed Pharmacother 2021; 142:112044. [PMID: 34399202 DOI: 10.1016/j.biopha.2021.112044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023] Open
Abstract
Systematic reviews with meta-analyses (SR/MA) are frequently conducted to investigate clinical efficacy of probiotics. However, only rigorously prepared analyses can serve as the highest level of evidence for a specified research question. We have aimed to determine (1) what is the methodological quality of recent SR/MA conducted to assess the efficacy of probiotics; (2) whether the results of SR/MA have a clinical application; and (3) what are factors associated with better quality and applicability of the SR/MA. We systematically searched 4 databases for SR/MA on the probiotics efficacy published in 2020 (PROSPERO CRD42020222716). The AMSTAR 2 tool and pre-defined authors' criteria were used to evaluate methodological quality and clinical applicability, respectively. A total of 114 SR/MA were appraised. In the case of 88 papers (77%), the overall confidence in the results was rated as "critically low". The most prevalent flaws were lack of list of excluded studies with justification (79.8%), lack of study protocol (60.5%), and problems with appropriate results combination(54.4%). A declaration of conduction a probiotic efficacy SR/MA could have been misleading in case of 18 studies that included also synbiotics, paraprobiotics, and prebiotics trials in analyses. Only 14 SR/MA provided results that can be apply in clinical practice. Higher journal impact factor and European affiliation of the 1st and corresponding authors were most consistently associated with higher odds of AMSTAR 2 items fulfillments. Based on our findings, SR/MA of probiotics trials cannot be treated as the highest level of evidence without a careful evaluation of their methodological validity.
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Affiliation(s)
- Jakub Ruszkowski
- Department of Pathophysiology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Poland.
| | - Katarzyna Majkutewicz
- Pathophysiology and Experimental Rheumatology Student Interest Club, Departments of Pathophysiology and Experimental Rheumatology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | | | - Marcin Kutek
- Department of Pathophysiology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Jacek M Witkowski
- Department of Pathophysiology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
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Vaghef-Mehrabany E, Maleki V, Behrooz M, Ranjbar F, Ebrahimi-Mameghani M. Can psychobiotics “mood” ify gut? An update systematic review of randomized controlled trials in healthy and clinical subjects, on anti-depressant effects of probiotics, prebiotics, and synbiotics. Clin Nutr 2020; 39:1395-1410. [DOI: 10.1016/j.clnu.2019.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
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4
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Plummer EL, Chebar Lozinsky A, Tobin JM, Uebergang JB, Axelrad C, Garland SM, Jacobs SE, Tang MLK. Postnatal probiotics and allergic disease in very preterm infants: Sub-study to the ProPrems randomized trial. Allergy 2020; 75:127-136. [PMID: 31608448 DOI: 10.1111/all.14088] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 09/09/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Probiotic supplementation to mothers and/or their term-born infants has been suggested to prevent allergic disease, in particular eczema; however, no studies have investigated probiotics for prevention of allergic diseases in very preterm infants. We evaluated the effect of a postnatal probiotic combination on development of allergic diseases in very preterm infants. METHODS This sub-study was an a priori secondary outcome of the ProPrems multi-center, double-blind, placebo-controlled randomized trial (ANZCTR:12607000144415). ProPrems randomized 1099 very preterm infants to receive a probiotic combination or placebo from soon after birth until discharge from hospital or term corrected age (CA), whichever was earlier. Allergic disease (eczema, atopic eczema, food allergy, wheeze, atopic sensitization) was assessed in a subgroup of ProPrems infants (n = 281) as close to 12 months CA as possible by questionnaire, clinical examination, and skin prick tests to common allergens. RESULTS There was no difference in eczema incidence between the probiotic and placebo groups (35[30%] of 118 infants vs 37[27%] of 137 infants, respectively, absolute difference 2.65%, 95% CI -8.45 to 13.75). Similarly, the incidence of atopic eczema (6[5%] of 118 vs 3[2%] of 137), food allergy (4[3%] of 124 vs 2[1%] of 154), wheeze (39[31%] of 127 vs 45[29%] of 154), and atopic sensitization (14[13%] of 106 vs 13[11%] of 123) were similar between the probiotic and placebo groups. CONCLUSION This study found no effect of postnatal administration of a probiotic combination on the incidence of allergic diseases or atopic sensitization in the first 2 years of life in children born very preterm. Evidence that probiotics are effective for prevention of allergic disease in premature infants remains lacking; adequately powered randomized controlled trials evaluating probiotic supplementation for allergy prevention in very preterm infants are needed.
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Affiliation(s)
| | | | - Jacinta M. Tobin
- Department of Paediatrics University of Melbourne Parkville Vic. Australia
| | - Jessica B. Uebergang
- Murdoch Children's Research Institute Parkville Vic. Australia
- Department of Paediatrics University of Melbourne Parkville Vic. Australia
| | | | - Suzanne M. Garland
- Murdoch Children's Research Institute Parkville Vic. Australia
- Department of Obstetrics and Gynaecology University of Melbourne Parkville Vic. Australia
- Centre for Women's Infectious Diseases The Royal Women's Hospital Parkville Vic. Australia
| | - Susan E. Jacobs
- Murdoch Children's Research Institute Parkville Vic. Australia
- Department of Obstetrics and Gynaecology University of Melbourne Parkville Vic. Australia
- Neonatal Services The Royal Women's Hospital Parkville Vic Australia
| | - Mimi L. K. Tang
- Murdoch Children's Research Institute Parkville Vic. Australia
- Department of Paediatrics University of Melbourne Parkville Vic. Australia
- Department of Allergy and Immunology The Royal Children's Hospital Melbourne Parkville Vic. Australia
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Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fox A, Bird JA, Fiocchi A, Knol J, Meyer R, Salminen S, Sitang G, Szajewska H, Papadopoulos N. The potential for pre-, pro- and synbiotics in the management of infants at risk of cow's milk allergy or with cow's milk allergy: An exploration of the rationale, available evidence and remaining questions. World Allergy Organ J 2019; 12:100034. [PMID: 31194186 PMCID: PMC6555906 DOI: 10.1016/j.waojou.2019.100034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/29/2019] [Accepted: 04/17/2019] [Indexed: 12/25/2022] Open
Abstract
Cow's milk allergy is one of the most commonly reported childhood food allergies, with increasing incidence, persistence and severity in many countries across the world. The World Allergy Organization Special Committee on Food Allergy has identified cow's milk allergy as an area in need of a rationale-based approach in order to make progress against what it considered an onerous problem, with worldwide public health impact. There is growing interest in the potential role of the gut microbiota in the early programming and development of immune responses and allergy. This discussion paper considers the rationale and available evidence for modulation of the gut microbiota and for the use of synbiotics in the management of infants at risk of, or living with cow's milk allergy and summarizes remaining research questions that need to be answered for the development of evidence-based recommendations.
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Affiliation(s)
- Adam Fox
- Dept of Paediatric Allergy, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, Westminster Bridge, London SE1 7EH, United Kingdom
| | - J. Andrew Bird
- University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Allergy and Immunology, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA
| | - Alessandro Fiocchi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Jan Knol
- Wageningen University, Stippeneng 4, 6708 WE Wageningen, the Netherlands
| | - Rosan Meyer
- Imperial College, Dept Paediatrics, London, UK
| | - Seppo Salminen
- Functional Foods Forum, Faculty of Medicine, Itäinen pitkäkatu 4A, 20014 Turku, Finland
| | - Gong Sitang
- Guangzhou Women and Children's Medical Center, Tianhe, Guangzhou, 510620, China
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, 02-091 Warsaw, Zwiriki i Wigury 63A, Poland
| | - Nikolaos Papadopoulos
- Professor of Allergy & Paediatric Allergy Division of Infection, Immunity & Respiratory Medicine, University of Manchester, 5th Floor (Research), Royal Manchester Childrens Hospital, Manchester M13 9WL, UK
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Wang HT, Anvari S, Anagnostou K. The Role of Probiotics in Preventing Allergic Disease. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E24. [PMID: 30764558 PMCID: PMC6406271 DOI: 10.3390/children6020024] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
The prevalence of allergic disorders has been increasing worldwide and significantly impacts the quality of life of the atopic individual. There has been an increased interest in the role of probiotics for the prevention and treatment of allergic disorders, given the recent evidence that atopy risk may be associated with a dysbiosis of the gut microbiome. Research in this area is ongoing with some studies showing possible benefits of probiotics, with seemingly little to no risk. While these studies suggest that there may be a promise in probiotic use for the prevention or treatment of allergy, further evidence is needed to determine its efficacy, optimal dosing, and strains needed for treatment. In this review, we discuss recently published studies examining the benefits, risks, and role of probiotics in preventing atopic dermatitis, asthma, allergic rhinitis, and food allergy.
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Affiliation(s)
- Helen T Wang
- Department of Pediatrics, Section of Immunology, Allergy, Rheumatology, and Retrovirology, Texas Children's Hospital, Houston, TX 77030, USA.
- Baylor College of Medicine, Department of Pediatrics, Section of Immunology, Allergy, Rheumatology, and Retrovirology, Houston, TX 77030, USA.
| | - Sara Anvari
- Department of Pediatrics, Section of Immunology, Allergy, Rheumatology, and Retrovirology, Texas Children's Hospital, Houston, TX 77030, USA.
- Baylor College of Medicine, Department of Pediatrics, Section of Immunology, Allergy, Rheumatology, and Retrovirology, Houston, TX 77030, USA.
| | - Katherine Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy, Rheumatology, and Retrovirology, Texas Children's Hospital, Houston, TX 77030, USA.
- Baylor College of Medicine, Department of Pediatrics, Section of Immunology, Allergy, Rheumatology, and Retrovirology, Houston, TX 77030, USA.
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Lu T, Chen Y, Guo Y, Sun J, Shen W, Yuan M, Zhang S, He P, Jiao X. Altered Gut Microbiota Diversity and Composition in Chronic Urticaria. DISEASE MARKERS 2019; 2019:6417471. [PMID: 31827639 PMCID: PMC6881578 DOI: 10.1155/2019/6417471] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/23/2019] [Accepted: 10/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The pathogenesis of chronic urticaria (CU) is closely related to imbalances in immunity. The gastrointestinal microflora provides a vast and continuous stimulation for the immune system. However, the composition and diversity of gut microflora in CU patients are rarely reported. METHODS 10 CU patients and 10 healthy individuals were selected in this study, and their intestinal microbiome was detected by 16S rRNA sequencing. The data were analyzed using R language software. RESULTS 392 bacterial OTUs were common in the CU and healthy groups, but there were 159 OTUs particularly existing in the CU group, while 87 OTUs only were observed in healthy individuals. The bacterial diversity was reduced in CU patients compared with healthy individuals. The principal component analysis (PCA) and principal coordinate analysis (PCoA) revealed that the bacterial cluster in CU patients and the healthy controls were divided into different branches. Pathogenic strains including Escherichia coli were significantly higher in CU, while Faecalibacterium prausnitzii, Prevotella copri, and Bacteroides sp. were significantly lower in CU when compared with the healthy controls. CU patients with a high abundance of Escherichia coli had no ideal effect for probiotic therapy. CONCLUSION Our results demonstrated that the microbial composition was significantly different between CU patients and the healthy individual, which may be the reason leading to the various outcomes of probiotic treatment.
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Affiliation(s)
- Tao Lu
- The First Affiliated Hospital of Shantou University Medical College, China
| | - Yanxia Chen
- The First Affiliated Hospital of Shantou University Medical College, China
| | - Yangmin Guo
- The First Affiliated Hospital of Shantou University Medical College, China
| | - Jiayu Sun
- Biology and Genetic Department of Shantou University Medical College, China
| | - Weitao Shen
- The Second Affiliated Hospital of Shantou University Medical College, China
| | - Mengsi Yuan
- The First Affiliated Hospital of Shantou University Medical College, China
| | - Shuping Zhang
- The First Affiliated Hospital of Shantou University Medical College, China
| | - Ping He
- Biology and Genetic Department of Shantou University Medical College, China
| | - Xiaoyang Jiao
- Biology and Genetic Department of Shantou University Medical College, China
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Strus M, Helwich E, Lauterbach R, Rzepecka-Węglarz B, Nowicka K, Wilińska M, Szczapa J, Rudnicka M, Sławska H, Szczepański M, Waśko A, Mikołajczyk-Cichońska A, Tomusiak-Plebanek A, Heczko PB. Effects of oral probiotic supplementation on gut Lactobacillus and Bifidobacterium populations and the clinical status of low-birth-weight preterm neonates: a multicenter randomized, double-blind, placebo-controlled trial. Infect Drug Resist 2018; 11:1557-1571. [PMID: 30288066 PMCID: PMC6160268 DOI: 10.2147/idr.s166348] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Probiotic bacteria administered directly after birth to preterm neonates may improve gastrointestinal function and may reduce the incidence of late-onset sepsis, which is a frequent complication in this group. Purpose The main objective of this study was to evaluate whether a new probiotic bacterial mixture of Lactobacillus rhamnosus KL53A and Bifidobacterium breve PB04 given to preterm, low-birth-weight neonates would influence composition of their gut microbiota and sepsis rates. Patients and methods This study was a multicenter, randomized, double-blind, placebo-controlled trial conducted in clinical centers of neonatal care in Poland. A probiotic or placebo preparation was given twice daily to 181 preterm low-birth-weight neonates who were eligible for enteral feeding between July 2012 and July 2013. The probiotic was given to 90 neonates, while placebo was given to 91 neonates. The gut microbiota was monitored by microbiological analysis of stool samples. Sepsis episodes were detected on the basis of clinical and laboratory findings and confirmed by blood cultures. Results Tested probiotic administration resulted in continuous increase of the Lactobacillus and Bifidobacterium counts in the gut microbiota. The applied tested strains successfully colonized the neonates gut since they were present in over 90% of stool samples, which was confirmed by molecular analysis. Regardless of the study group (probiotic or placebo), B. breve colonization correlated with lower staphylococcal sepsis incidence, which was irrespective of whether probiotics were given. No sepsis case caused by strains included in study probiotic was recorded. Conclusion Appropriately selected and characterized probiotic bacteria may be safely given to preterm neonates to normalize their distorted gut microbiota and may contribute to lower staphylococcal sepsis rates.
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Affiliation(s)
- Magdalena Strus
- Department of Microbiology, Jagiellonian University Medical College, Kraków, Poland,
| | - Ewa Helwich
- Department of Neonatology, Institute of Mother and Child, Warszawa, Poland
| | | | | | - Katarzyna Nowicka
- Department of Neonatology, Institute of Mother and Child, Warszawa, Poland
| | - Maria Wilińska
- Clinical Department of Neonatology, Independent Public Clinical Hospital CMKP, Warszawa, Poland
| | - Jerzy Szczapa
- Department of Neonatology, Gynecology and Obstetrics Clinical Hospital, Poznań, Poland
| | | | - Helena Sławska
- Department of Neonatology, Specialist Hospital No. 2, Bytom, Poland
| | - Marek Szczepański
- Clinic Department of Neonatology and Neonatal Intensive Care, University Clinical Hospital, Białystok, Poland
| | - Aneta Waśko
- Medical Department, IBSS BIOMED S.A., Kraków, Poland
| | | | | | - Piotr B Heczko
- Department of Microbiology, Jagiellonian University Medical College, Kraków, Poland,
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Szajewska H, Horvath A. Lactobacillus rhamnosus GG in the Primary Prevention of Eczema in Children: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10091319. [PMID: 30231505 PMCID: PMC6163317 DOI: 10.3390/nu10091319] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/04/2018] [Accepted: 09/14/2018] [Indexed: 11/16/2022] Open
Abstract
Current guidelines recommend the use of probiotics to reduce the risk of eczema. It remains unclear which strain(s) to use. We systematically evaluated data on the efficacy of Lactobacillus rhamnosus GG (LGG) supplementation prenatally and/or postnatally for the primary prevention of eczema. The Cochrane Library, MEDLINE, and EMBASE databases were searched up to August 2018, with no language restrictions, for systematic reviews of randomized controlled trials (RCTs) and RCTs published afterwards. The primary outcome was eczema. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). A random-effects model was used to pool data. Heterogeneity was explored using the I² statistics. The GRADE criteria were used to assess the overall quality of evidence supporting the primary outcome. Seven publications reporting 5 RCTs (889 participants) were included. High to moderate certainty in the body of evidence suggests that LGG supplementation (regardless of the timing of administration) did not reduce the risk of eczema. There was also no consistent effect on other allergic outcomes. This meta-analysis shows that LGG was ineffective in reducing eczema. It does not support the general recommendation to use probiotics for preventing eczema, unless specific strains would be indicated.
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Affiliation(s)
- Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland.
| | - Andrea Horvath
- Department of Paediatrics, The Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland.
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Jarde A, Lewis-Mikhael AM, Moayyedi P, Stearns JC, Collins SM, Beyene J, McDonald SD. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:14. [PMID: 29310610 PMCID: PMC5759212 DOI: 10.1186/s12884-017-1629-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/14/2017] [Indexed: 12/15/2022] Open
Abstract
Background Probiotics are living microorganisms that, when administered in adequate amounts, confer a health benefit. It has been speculated that probiotics might help prevent preterm birth, but in two previous systematic reviews possible major increases in this risk have been suggested. Our objective was to perform a systematic review and meta-analysis of the risk of preterm birth and other adverse pregnancy outcomes in pregnant women taking probiotics, prebiotics or synbiotics. Methods We searched six electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science’s Core collection and BIOSIS Preview) up to September 2016 and contacted authors for additional data. We included randomized controlled trials in which women with a singleton pregnancy received a probiotic, prebiotic or synbiotic intervention. Two independent reviewers extracted data using a piloted form and assessed the risk of bias using the Cochrane risk of bias tool. We used random-effects meta-analyses to pool the results. Results We identified 2574 publications, screened 1449 non-duplicate titles and abstracts and read 160 full text articles. The 49 publications that met our inclusion criteria represented 27 studies. No study used synbiotics, one used prebiotics and the rest used probiotics. Being randomized to take probiotics during pregnancy neither increased nor decreased the risk of preterm birth < 34 weeks (RR 1.03, 95% CI 0.29–3.64, I2 0%, 1017 women in 5 studies), preterm birth < 37 weeks (RR 1.08, 95% CI 0.71–1.63, I2 0%, 2484 women in 11 studies), or most of our secondary outcomes, including gestational diabetes mellitus. Conclusions We found no evidence that taking probiotics or prebiotics during pregnancy either increases or decreases the risk of preterm birth or other infant and maternal adverse pregnancy outcomes. Trial registration We prospectively published the protocol for this study in the PROSPERO database (CRD42016048129). Electronic supplementary material The online version of this article (10.1186/s12884-017-1629-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Jarde
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Anne-Mary Lewis-Mikhael
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Paul Moayyedi
- Department of Medicine, Gastroenterology Division, McMaster University, Hamilton, ON, Canada
| | - Jennifer C Stearns
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Stephen M Collins
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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12
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Vuillermin PJ, Macia L, Nanan R, Tang ML, Collier F, Brix S. The maternal microbiome during pregnancy and allergic disease in the offspring. Semin Immunopathol 2017; 39:669-675. [PMID: 29038841 PMCID: PMC5711986 DOI: 10.1007/s00281-017-0652-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022]
Abstract
There is substantial epidemiological and mechanistic evidence that the increase in allergic disease and asthma in many parts of the world in part relates to changes in microbial exposures and diet acting via the composition and metabolic products of the intestinal microbiome. The majority of research in this field has focused on the gut microbiome during infancy, but it is increasingly clear that the maternal microbiome during pregnancy also has a key role in preventing an allergy-prone immune phenotype in the offspring. The mechanisms by which the maternal microbiome influences the developing fetal immune system include alignment between the maternal and infant regulatory immune status and transplacental passage of microbial metabolites and IgG. Interplay between microbial stimulatory factors such as lipopolysaccharides and regulatory factors such as short-chain fatty acids may also influence on fetal immune development. However, our understanding of these pathways is at an early stage and further mechanistic studies are needed. There are also no data from human studies relating the composition and metabolic activity of the maternal microbiome during pregnancy to the offspring's immune status at birth and risk of allergic disease. Improved knowledge of these pathways may inform novel strategies for tackling the increase in allergic disorders in the modern world.
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Affiliation(s)
- Peter J Vuillermin
- Deakin University, Geelong, Australia. .,Barwon Health, Geelong, Australia. .,Murdoch Childrens Research Institute, Parkville, Australia. .,Centre for Food and Allergy Research, Parkville, Australia.
| | - Laurence Macia
- Charles Perkins Centre, Discipline of Pathology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Ralph Nanan
- Charles Perkins Centre, Discipline of Pathology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mimi Lk Tang
- Murdoch Childrens Research Institute, Parkville, Australia.,The Royal Children's Hospital, Melbourne, Parkville, Australia
| | - Fiona Collier
- Deakin University, Geelong, Australia.,Barwon Health, Geelong, Australia.,Murdoch Childrens Research Institute, Parkville, Australia
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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Huang R, Ning H, Shen M, Li J, Zhang J, Chen X. Probiotics for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Cell Infect Microbiol 2017; 7:392. [PMID: 28932705 PMCID: PMC5592329 DOI: 10.3389/fcimb.2017.00392] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/22/2017] [Indexed: 01/18/2023] Open
Abstract
Objective: Atopic dermatitis (AD) is a prevalent, burdensome, and psychologically important pediatric concern. Probiotics have been suggested as a treatment for AD. Some reports have explored this topic; however, the utility of probiotics for AD remains to be firmly established. Methods: To assess the effects of probiotics on AD in children, the PubMed/Medline, Cochrane Library Scopus, and OVID databases were searched for reports published in the English language. Results: Thirteen studies were identified. Significantly higher SCORAD values favoring probiotics over controls were observed (mean difference [MD], −3.07; 95% confidence interval [CI], −6.12 to −0.03; P < 0.001). The reported efficacy of probiotics in children < 1 year old was −1.03 (95%CI, −7.05 to 4.99) and that in children 1–18 years old was −4.50 (95%CI, −7.45 to −1.54; P < 0.001). Subgroup analyses showed that in Europe, SCORAD revealed no effect of probiotics, whereas significantly lower SCORAD values were reported in Asia (MD, −5.39; 95%CI, −8.91 to −1.87). Lactobacillus rhamnosus GG (MD, 3.29; 95%CI, −0.30 to 6.88; P = 0.07) and Lactobacillus plantarum (MD, −0.70; 95%CI, −2.30 to 0.90; P = 0.39) showed no significant effect on SCORAD values in children with AD. However, Lactobacillus fermentum (MD, −11.42; 95%CI, −13.81 to −9.04), Lactobacillus salivarius (MD, −7.21; 95%CI, −9.63 to −4.78), and a mixture of different strains (MD, −3.52; 95%CI, −5.61 to −1.44) showed significant effects on SCORAD values in children with AD. Conclusions: Our meta-analysis indicated that the research to date has not robustly shown that probiotics are beneficial for children with AD. However, caution is needed when generalizing our results, as the populations evaluated were heterogeneous. Randomized controlled trials with larger samples and greater power are necessary to identify the species, dose, and treatment duration of probiotics that are most efficacious for treating AD in children.
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Affiliation(s)
- Ruixue Huang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South UniversityChangsha, China
| | - Huacheng Ning
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South UniversityChangsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South UniversityChangsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South UniversityChangsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South UniversityChangsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South UniversityChangsha, China
| | - Jianglin Zhang
- Department of Dermatology, Xiangya Hospital, Central South UniversityChangsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South UniversityChangsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South UniversityChangsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South UniversityChangsha, China
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14
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Liu MY, Yang ZY, Dai WK, Huang JQ, Li YH, Zhang J, Qiu CZ, Wei C, Zhou Q, Sun X, Feng X, Li DF, Wang HP, Zheng YJ. Protective effect of Bifidobacterium infantis CGMCC313-2 on ovalbumin-induced airway asthma and β-lactoglobulin-induced intestinal food allergy mouse models. World J Gastroenterol 2017; 23:2149-2158. [PMID: 28405142 PMCID: PMC5374126 DOI: 10.3748/wjg.v23.i12.2149] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/17/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether oral administration of Bifidobacterium infantis CGMCC313-2 (B. infantis CGMCC313-2) inhibits allergen-induced airway inflammation and food allergies in a mouse model.
METHODS Ovalbumin (OVA)-induced allergic asthma and β-lactoglobulin-induced food allergy mouse models were used in this study. Following oral administration of B. infantis CGMCC313-2 during or after allergen sensitization, histopathologic changes in the lung and intestine were evaluated by hematoxylin and eosin (HE) staining. In the allergic asthma mouse model, we evaluated the proportion of lung-infiltrating inflammatory cells. OVA-specific IgE and IgG1 levels in serum and cytokine levels in bronchoalveolar lavage fluid (BALF) were also assessed. In the food allergy mouse model, the levels of total IgE and cytokines in serum were measured.
RESULTS Oral administration of B. infantis CGMCC313-2 during or after allergen sensitization suppressed allergic inflammation in lung and intestinal tissues, while the proportion of infiltrating inflammatory cells was significantly decreased in the BALF of allergic asthma mice. Moreover, B. infantis CGMCC313-2 decreased the serum levels of total IgE in food allergy mice, and reductions in IgE and IgG1 were also observed in OVA-induced allergic asthma mice. The expression of interleukin-4 (IL-4) and IL-13 in both serum and BALF was suppressed following the administration of B. infantis CGMCC313-2, while an effect on serum IL-10 levels was not observed.
CONCLUSION B. infantis CGMCC313-2 inhibits the secretion of allergen-induced IgE, IL-4 and IL-13, and attenuates allergic inflammation.
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15
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16
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Mennini M, Dahdah L, Artesani MC, Fiocchi A, Martelli A. Probiotics in Asthma and Allergy Prevention. Front Pediatr 2017; 5:165. [PMID: 28824889 PMCID: PMC5534455 DOI: 10.3389/fped.2017.00165] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/13/2017] [Indexed: 12/16/2022] Open
Abstract
Interest in probiotic research and its potential benefits in infant foods are relatively recent but significantly increasing. The evolution of the knowledge in the last 20 years demonstrated that alterations in the microbiome may be a consequence of events occurring during infancy or childhood, including prematurity, cesarean section, and nosocomial infections. Several pieces of evidence prove that a "healthy" intestinal microbiota facilitates the development of immune tolerance. Interventional studies suggest that probiotics could be protective against the development of many diseases. Nevertheless, many factors complicate the analysis of dysbiosis in subjects with food allergy. Comparison in-between studies are difficult, because of considerable heterogeneity in study design, sample size, age at fecal collection, methods of analysis of gut microbiome, and geographic location. Currently, there is no positive recommendation from scientific societies to use pre- or probiotics for treatment of food allergy or other allergic manifestations, while their use in prevention is being custom-cleared. However, the recommendation is still based on little evidence. Although there is valid scientific evidence in vitro, there is no sufficient information to suggest the use of specific probiotics in allergy and asthma prevention.
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Affiliation(s)
- Maurizio Mennini
- Division of Allergy, Bambino Gesù Children's Hospital, Vatican City, Vatican City
| | - Lamia Dahdah
- Division of Allergy, Bambino Gesù Children's Hospital, Vatican City, Vatican City
| | | | - Alessandro Fiocchi
- Division of Allergy, Bambino Gesù Children's Hospital, Vatican City, Vatican City
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17
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Fiocchi A, Fierro V, La Marra F, Dahdah LA. The custom clearance of pro- and prebiotics in allergy prevention. Ann Allergy Asthma Immunol 2016; 117:465-467. [PMID: 27788872 DOI: 10.1016/j.anai.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Alessandro Fiocchi
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Rome, Italy.
| | - Vincenzo Fierro
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Fabiola La Marra
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Lamia Antanios Dahdah
- Division of Allergy, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Rome, Italy
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18
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Kepert I, Fonseca J, Müller C, Milger K, Hochwind K, Kostric M, Fedoseeva M, Ohnmacht C, Dehmel S, Nathan P, Bartel S, Eickelberg O, Schloter M, Hartmann A, Schmitt-Kopplin P, Krauss-Etschmann S. D-tryptophan from probiotic bacteria influences the gut microbiome and allergic airway disease. J Allergy Clin Immunol 2016; 139:1525-1535. [PMID: 27670239 DOI: 10.1016/j.jaci.2016.09.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 05/13/2016] [Accepted: 09/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic immune diseases, such as asthma, are highly prevalent. Currently available pharmaceuticals improve symptoms but cannot cure the disease. This prompted demands for alternatives to pharmaceuticals, such as probiotics, for the prevention of allergic disease. However, clinical trials have produced inconsistent results. This is at least partly explained by the highly complex crosstalk among probiotic bacteria, the host's microbiota, and immune cells. The identification of a bioactive substance from probiotic bacteria could circumvent this difficulty. OBJECTIVE We sought to identify and characterize a bioactive probiotic metabolite for potential prevention of allergic airway disease. METHODS Probiotic supernatants were screened for their ability to concordantly decrease the constitutive CCL17 secretion of a human Hodgkin lymphoma cell line and prevent upregulation of costimulatory molecules of LPS-stimulated human dendritic cells. RESULTS Supernatants from 13 of 37 tested probiotic strains showed immunoactivity. Bioassay-guided chromatographic fractionation of 2 supernatants according to polarity, followed by total ion chromatography and mass spectrometry, yielded C11H12N2O2 as the molecular formula of a bioactive substance. Proton nuclear magnetic resonance and enantiomeric separation identified D-tryptophan. In contrast, L-tryptophan and 11 other D-amino acids were inactive. Feeding D-tryptophan to mice before experimental asthma induction increased numbers of lung and gut regulatory T cells, decreased lung TH2 responses, and ameliorated allergic airway inflammation and hyperresponsiveness. Allergic airway inflammation reduced gut microbial diversity, which was increased by D-tryptophan. CONCLUSIONS D-tryptophan is a newly identified product from probiotic bacteria. Our findings support the concept that defined bacterial products can be exploited in novel preventative strategies for chronic immune diseases.
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Affiliation(s)
- Inge Kepert
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany
| | - Juliano Fonseca
- Research Unit Analytical BioGeoChemistry (BGC), Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Constanze Müller
- Research Unit Analytical BioGeoChemistry (BGC), Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Katrin Milger
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany
| | - Kerstin Hochwind
- Research Unit Microbe-Plant Interactions, Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Matea Kostric
- Research Unit Environmental Genomics, Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Maria Fedoseeva
- Center of Allergy and Environment (ZAUM), Technische Universität and Helmholtz Zentrum München, Member of the German Center for Lung research (DZL), Oberschleissheim, Germany
| | - Caspar Ohnmacht
- Center of Allergy and Environment (ZAUM), Technische Universität and Helmholtz Zentrum München, Member of the German Center for Lung research (DZL), Oberschleissheim, Germany
| | - Stefan Dehmel
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany
| | - Petra Nathan
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany
| | - Sabine Bartel
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany; Division of Experimental Asthma Research, Research Center Borstel, Leibniz Center for Medicine and Biosciences, Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Oliver Eickelberg
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany
| | - Michael Schloter
- Research Unit Environmental Genomics, Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Anton Hartmann
- Research Unit Microbe-Plant Interactions, Helmholtz Zentrum München, Oberschleissheim, Germany
| | - Philippe Schmitt-Kopplin
- Research Unit Analytical BioGeoChemistry (BGC), Helmholtz Zentrum München, Oberschleissheim, Germany; Analytical Food Chemistry, Technische Universität Muenchen, Freising, Germany
| | - Susanne Krauss-Etschmann
- Comprehensive Pneumology Center, Ludwig Maximilians University Hospital, Member of the German Center for Lung Research (DZL), and Helmholtz Zentrum München, Munich, Germany; Division of Experimental Asthma Research, Research Center Borstel, Leibniz Center for Medicine and Biosciences, Member of the German Center for Lung Research (DZL), Borstel, Germany; Institute for Experimental Medicine, Christian-Albrechts-Universitaet zu Kiel, Kiel, Germany.
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19
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Pirbaglou M, Katz J, de Souza RJ, Stearns JC, Motamed M, Ritvo P. Probiotic supplementation can positively affect anxiety and depressive symptoms: a systematic review of randomized controlled trials. Nutr Res 2016; 36:889-898. [PMID: 27632908 DOI: 10.1016/j.nutres.2016.06.009] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
Gastrointestinal microbiota, consisting of microbial communities in the gastrointestinal tract, play an important role in digestive, metabolic, and immune functioning. Preclinical studies on rodents have linked behavioral and neurochemical changes in the central nervous system with deficits or alterations in these bacterial communities. Moreover, probiotic supplementation in rodents has been shown to markedly change behavior, with correlated changes in central neurochemistry. While such studies have documented behavioral and mood-related supplementation effects, the significance of these effects in humans, especially in relation to anxiety and depression symptoms, are relatively unknown. Thus, the purpose of this paper was to systematically evaluate current literature on the impact of probiotic supplementation on anxiety and depression symptoms in humans. To this end, multiple databases, including Medline, PsycINFO, PubMed, Scopus, and Web of Science were searched for randomized controlled trials published between January 1990 and January 2016. Search results led to a total of 10 randomized controlled trials (4 in clinically diagnosed and 6 in non-clinical samples) that provided limited support for the use of some probiotics in reducing human anxiety and depression. Despite methodological limitations of the included trials and the complex nature of gut-brain interactions, results suggest the detection of apparent psychological benefits from probiotic supplementation. Nevertheless a better understanding of developmental, modulatory, and metagenomic influences on the GI microbiota, specifically as they relate to mood and mental health, represent strong priorities for future research in this area.
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Affiliation(s)
- Meysam Pirbaglou
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Joel Katz
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Mehras Motamed
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada; University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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20
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Ricci G, Cipriani F, Cuello-Garcia CA, Brożek JL, Fiocchi A, Pawankar R, Yepes-Nuñes JJ, Terraciano L, Gandhi S, Agarwal A, Zhang Y, Schünemann HJ. A clinical reading on "World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics". World Allergy Organ J 2016; 9:9. [PMID: 26998191 PMCID: PMC4785738 DOI: 10.1186/s40413-016-0101-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 01/26/2023] Open
Affiliation(s)
- Giampaolo Ricci
- />Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Pad 16, via Massarenti 11, 40138 Bologna, Italy
| | - Francesca Cipriani
- />Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Pad 16, via Massarenti 11, 40138 Bologna, Italy
| | - Carlos A. Cuello-Garcia
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Tecnologico de Monterrey School of Medicine, Monterrey, Mexico
| | - Jan L. Brożek
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | | | - Ruby Pawankar
- />Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Juan José Yepes-Nuñes
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
| | - Luigi Terraciano
- />Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy
| | - Shreyas Gandhi
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Arnav Agarwal
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Yuan Zhang
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
| | - Holger J. Schünemann
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario Canada
- />Department of Medicine, McMaster University, Hamilton, Ontario Canada
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Cuello-Garcia CA, Brożek JL, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Terracciano L, Gandhi S, Agarwal A, Zhang Y, Schünemann HJ. Reply: To PMID 26044853. J Allergy Clin Immunol 2015; 136:1423-5. [PMID: 26329512 DOI: 10.1016/j.jaci.2015.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Carlos A Cuello-Garcia
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Tecnologico de Monterrey School of Medicine, Monterrey, Mexico
| | - Jan L Brożek
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | | | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Juan José Yepes-Nuñez
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; School of Medicine, University of Antioquia, Medellín, Colombia
| | - Luigi Terracciano
- Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy
| | - Shreyas Gandhi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuan Zhang
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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