Probiotics in Treatment of Allergic Rhinitis
Probiotics in Treatment of Allergic Rhinitis
Probiotics in Treatment of Allergic Rhinitis
views shows that probiotics are beneficial for treating infectious diarrhea, preventing antibiotic-associated diarrhea, and
treating vaginal infections in pregnancy.35 They have been
formally investigated in a number of clinical trials for the
treatment of seasonal and perennial AR with variable results.
The aim of the present paper is to find whether probiotics are
effective in treatment of AR or not.
METHOD
Criteria for Considering Studies for This Review
Types of Studies
Randomized double-blind placebo-controlled trials
(RCTs).
Types of Participants
Participants in trials were of either sex and of any age.
Types of Interventions
Interventions consisted of daily treatment with probiotics or placebo (no probiotic bacteria), used for 2 weeks,
as an additive to standard antiallergic medications. All formulations of probiotics (irrespective of the type, strain, and
concentration) were considered.
WAO Journal
September 2010
A. Primary outcome
Quality of life score at the end of treatment
B. Secondary outcomes
Time (months) free from episodes.
Mean duration of an episode.
Number of episodes per year.
Changes in blood parameters/immunologic markers.
Time or duration was defined was defined as number of days to
resolution of specific outcome from initiation of treatment.
Change in symptom score was defined as the change in total
score over days per week. If the data were not available in the
required format, the authors were contacted for the information.
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Data Collection
Two review authors independently reviewed the results
for inclusion in the analysis. Design of the trial, comparator,
characteristics of study participants, number of participants,
type of intervention (dose, duration), and major outcomes
evaluated. Differences about study quality were resolved
through discussion. We recorded data on a prestructured data
extraction form. We assessed publication bias using the
Cochrane Collaborations Risk of bias tool.
Study Descriptions
Information in relation to methodological quality, characteristics of participants, interventions and outcome measures of each trial is provided in Table 1.
Data Synthesis
Continuous data were expressed as mean (SD) and
standardized mean difference (SMD) was obtained. The data
from various studies were pooled and expressed as pooled
SMD with 95% confidence interval (CI). Dichotomous data
were expressed as odds ratio (OR) with 95% CI. P value 0.05
was considered significant. A fixed effects model was initially
conducted. If significant heterogeneity existed between trials,
potential sources of heterogeneity were considered and where
appropriate a random effects model was used. Inverted funnel
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RESULTS
There were 53 hits obtained when the combined MeSH
terms were used (Fig. 1). From the initial search, 11 studies
were considered as potentially eligible. These studies were
further evaluated for eligibility. Seven studies were found to
be eligible for inclusion in this review (Table 1),713 and 4
studies were excluded.20 23 The quality of studies were good
with Jadad score varying from 3 to 5. Though most studies
had adequate randomization and blinded intervention, allocation concealment was not clear in all but one study.9 Not all
studies assessed all the out comes. For the studies in which
the results were expressed as mean (95% CI) or mean SE,
the SD was derived from the available data. Seven included
studies enrolled a total of 616 participants (342 for treatment
and 274 as control subjects, which totaled 610 after losses to
follow-up) involving all age groups and both sexes. In 3 trials,
participants were administered probiotics on/before the onset of
pollen season and was continued until the completion of the
pollen season.10 12 Two studies provided data on the assessment
of quality of life7,8 and 3 about adverse-events.7,8,10
1) Bifidobacterium longum536
(BB536);
3.5 2.4 108 cfu/100 g
2) 200 g/d
3) Total duration 14 weeks
1) BB536 powder
5 1010 cfu/2 g
2) Twice daily
3) Total duration 13 weeks
1) Lactobacillus bulgaricus,
107cfu/ml, Streptococcus
thermophilus, 108 cfu/ml
and L. casei 108 cfu/ml
2) 100 mL/d
3) Total duration 12 months
1) Lactobacillus casei shirota
(4 1010 cfu/80 mL)
2) 80 mL/d
3) Total duration 8 weeks
1) Lactobacillus paracasei-33
(2 109 cfu/200 ml)
2) 200400 mL/d
3) Total duration 30 days
1) Lactobacillus paracasei
(5 109 cfu/capsule)
2) 2 capsules/d of live, heat
killed, and placebo capsules
in 3 groups
3) Total duration 30 days
Intervention
Outcomes
Notes
Jadad
Score
RCT, Randomized double-blind placebo controlled trials; FU, follow-up, cfu, colony forming unit; SMS, symptom-medication score; JCP, Japanese cedar pollinosis; PRQLQ, Pediatric Rhinoconjunctivitis Quality of Life
Questionnaire; LFU, lost to follow up.
Ishida 200513
Xiao 2006b12
Xiao 2006a11
Tamura 200710
Giovannini 20079
1) 90 subjects
(probiotics 60, placebo 30) in 3 groups
2) Age (yrs) 16.07 2.11 (live), 14.50 1.78
(heat-killed),
16.60 2.02 (placebo)
3) Allergic rhinitis symptoms for 1 year and
sensitization to house dust mites
1) 80 children (probiotics 60, placebo 20)
2) Age (yrs) 15.87 1.53 (intervention) and 14.00
1.90 (placebo)
3) Allergic rhinitis symptoms for 1 year and
sensitization to house dust mites
1) 187 children
(probiotics 92, placebo 95)
2) Age 25 years
3) Global Initiative for Asthma (GINA) and Allergic
Rhinitis and its guidelines used
Peng 20057
Wang 20048
Participants
Study/Year
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Publication Bias
To assess whether there was a bias in the published
literature, funnel plot was constructed using the SMD and
DISCUSSION
In the present review, treatment with probiotic was
shown to improve the quality of life score of patients with AR
at the end of treatment. Other outcome showing improvement
with probiotic treatment was decrease in the number of
episodes of rhinitis per year. Pooling could not be undertaken
for many of the outcomes, as studies did not follow a
standard format for reporting of clinical trials. Many
reasons could account for the different outcomes among
studies wherever pooling was done in these trials and these
are: varied dose and intake period, the type and severity of
the symptoms involved were different, seasonal variation
of allergic symptoms and most importantly, the species
and strains of the probiotics differ.
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19.
20.
21.
22.
23.
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