1. By Jacqueline Wivinus and Kristina Hegarty

2.  Objective: To study the effects of the use of probiotics in pediatric patients that suffer from atopic dermatitis. Clinical Significance:  Intestinal permeability and dysbiosis influence gut immune function  GI permeability is thought to be greatest in early infancy and to decline with intestinal maturation. GI permeability and microbiota are thought to be critical influences in allergic disease. 1  Probiotics compete with pathogens  Probiotics alleviate immunogenicity of potential allergens

3.  Double-blind randomized, placebo-controlled study  Pediatric patients: 1-13 yo  Probiotic complex  Bifidobacterium bifidum  Lactobacillus acidophilus  Lactobacillus casei  Lactobacillus salivarius  Placebo control group  Skim milk powder  dextrose

6.  Strengths  Randomized, double-blind, controlled trial  Statistically significant results  Measuring multiple inflammatory markers  Weaknesses  Skim milk placebo  Small sample size  Limited to pediatric patients  Duration  SCORAD subjectivity

7.  The Cochrane Database  12 randomized controlled trials reviewed  No significant improvement with probiotics  Up to Date Database  Meta-analyses of using probiotics for eczema treatment  Problems of quality with some studies and heterogeneity  Probiotics benefit IgE sensitized individuals

8.  Natural Standard  Probiotics for children is promising  Infants benefit from mothers probiotics use  May reduce cow’s milk allergy and other allergic reactions  Stabilize intestinal barrier function

9.  Probiotic supplementation  Limit/avoid stress  Skin or serum testing  Elimination diet

10.  Mahan L, Escott-Stump S, Raymond J. Krause’s Food and the Nutrition Care Process. St. Louis, Missouri: Elsevier Inc; 2012.  Yesilova Y, Calka O, Akdeniz N, Berktas M. Effect of Probiotics on the Treatment of Children with Atopic Dermatitis. Ann Dermatol. 2012; 24: 189-193.  Boyle, RJ, Bath-Hextall, FJ, Leonardi-Bee, J, Murrell, DF, Tang, MLK. Probiotics for treating eczema (Review). Wiley [serial online]. 2008; 4: 1-57. Available from: The Cochrane Library. Accessed June 1, 2012.  West, C, Prescott, S. Prebiotics and probiotics for treatment of allergic disease. Wolters Kluwer Health [serial online]. 2011. Available from: UpToDate. Accessed June 1, 2012.  Natural Standard. Probiotics (Bifidobacterium, Lactobacillus, Saccharomyces boulardii) page. Available at: http://www.naturalstandard.com/databases/ herbssupplements/patient-probiotics.asp#. Accessed May 30, 2012.