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World Allergy Organ J. 2015 Jan 27;8(1):4. doi: 10.1186/s40413-015-0055-2. eCollection 2015.

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics.

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Pediatric Hospital Bambino Gesù, Vatican City, Italy.
Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 2C19, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada.
Tecnologico de Monterrey School of Medicine and Health Sciences, Monterrey, Mexico.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
Faculty of Medicine, University of Toronto, Toronto, ON Canada.
Charité Klinik für Pädiatrie, Berlin, Germany.
Department of Pediatrics, University of North Carolina, Chapel Hill, NC USA.
University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
Department of Pediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China.
Department of Immunology, Perth Children's Hospital, Telethon KIDS Institute, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
Department of Family Medicine, McMaster University, Hamilton, ON Canada.
Allergy-Immunology Division, Children's Mercy Hospital & University of Missouri - Kansas City School of Medicine, Kansas City, MO USA.
Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY USA.
Food Allergy Research & Education (FARE), McLean, VA USA.
Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy.
Allergology Department, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
Department of Medicine, McMaster University, Hamilton, ON Canada.
Contributed equally



Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention.


The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy.


We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations.


Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence.


WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.


Allergy; GRADE; Practice guidelines; Prevention; Probiotics

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