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World Allergy Organ J. 2016 Mar 1;9:10. doi: 10.1186/s40413-016-0102-7. eCollection 2016.

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

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Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.
Tecnologico de Monterrey School of Medicine, Monterrey, Mexico.
Pediatric Hospital Bambino Gesù, Vatican City, Italy.
Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
University of Antioquia, School of Medicine, Medellín, Colombia.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 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, Republic of 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, Crawley, 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, Icahn School of Medicine at Mount Sinai, 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



The 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. Prebiotics - non-digestible oligosaccharides that stimulate growth of probiotic bacteria - 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 prebiotics in the prevention of allergy.


The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy. We performed a systematic review of randomized controlled trials of prebiotics, and reviewed the evidence about patient values and preferences, and resource requirements (up to January 2015, with an update on July 29, 2015). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.


Based on GRADE evidence to decision frameworks, the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants. Both recommendations are conditional and based on very low certainty of the evidence. We found no experimental or observational study of prebiotic supplementation in pregnant women or in breastfeeding mothers. Thus, the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding, at this time.


WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy, term infants.

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