Eczema in children: Can prebiotics or probiotics help prevent it?

Photo of a mother breastfeeding her baby
PantherMedia / Theresia Karanitsch

Studies have found weak that probiotic dietary supplements can prevent in children who have a higher genetic risk of developing it. There has hardly been any research on prebiotic dietary supplements.

Many children develop itchy rashes () in the first few years of life. Between 10 and 20% of all children have this kind of rash for some time. Eczema usually develops in the first two years of life.

Genes play a major role in the development of . But many parents still wonder if there is anything they can do to prevent their child from getting it. Sometimes mothers are advised to take probiotic or prebiotic supplements in the last few weeks of pregnancy and/or while breastfeeding. You can also buy baby formula with added probiotics or prebiotics.

How do probiotics and prebiotics work?

Probiotic products have living in them, such as lactic acid . It is thought that they have a positive effect on gut flora, and that this can prevent allergy-related diseases from developing later on. Prebiotics are mainly indigestible carbohydrates such as oligosaccharides, which stimulate the production of healthy in the digestive tract. Probiotic and prebiotic products are available in the form of tablets and drinks, and are sometimes found in dairy products such as yogurt.

An international group of researchers was commissioned by the World Allergy Organization (WAO) to analyze studies on the preventive effect of probiotic and prebiotic products on allergies and . The WAO is a global umbrella organization of nearly 90 national medical societies that deal with allergies.

The researchers wanted to find out whether a child's risk of developing or an is reduced if

  • the mother takes prebiotics or probiotics while pregnant,
  • the mother takes prebiotics or probiotics while breastfeeding, or
  • the child is given baby formula containing prebiotics or probiotics after birth.

Research on probiotics

The researchers analyzed a total of 29 studies that tested the effect of probiotics on and allergic diseases. It wasn't always possible to get separate answers to the questions they were looking into because the probiotics were used in combination in most of the studies: In other words, the mothers either took probiotics during pregnancy and while breastfeeding, or both the mothers and their babies received probiotics.

The studies that used the probiotics like this suggest that they can prevent . About 6 to 14 out of 100 fewer children developed by using probiotic dietary supplements.

But the studies left some questions unanswered: The different strains of were examined separately or in combination, for example Lactobacillus rhamnosus and different types of Bifidobacteria. Based on this data, it's not possible to tell whether the various types of have different effects or what the best dose would be.

Also, the studies mostly involved pregnant women, mothers and babies who had a higher risk of allergic disease because it runs in their family. There is hardly any research on whether probiotics can also protect people in families with a low risk of allergies.

The researchers also looked into possible side effects of probiotics, such as nausea, constipation, diarrhea and rashes. They didn't find that probiotics increased the risk of these types of side effects, but the studies didn't provide enough information on side effects overall.

Wold Allergy Organization recommendations on probiotics

Based on the study data, WAO has issued recommendations: The recommendation is for the prevention of in children who have a genetic predisposition. They are considered to have a predisposition if at least one parent or sibling has an allergic disease such as hay fever, , asthma or a food allergy. If a baby has this kind of increased risk, the WAO recommends that their mother uses probiotics in the final trimester of pregnancy and while breastfeeding, and that the baby should be given probiotics too.

According to the WAO, probiotics aren't likely to cause side effects. But the risk of side effects could be higher in women who have a chronically weak immune system, especially regarding infections that can be caused by the probiotic .

Every mother can ultimately decide for herself whether or not to take probiotics or give them to her child. This decision may be influenced by things like whether the possible benefit of using probiotics is worth the associated cost and effort. It also often depends on whether the mother has had herself, or whether her other children have had it.

Research on prebiotics

The researchers didn't find any good-quality studies on the possible benefits of taking prebiotic dietary supplements during pregnancy or while breastfeeding. As a result, the WAO does not recommend that women take prebiotics during pregnancy or while breastfeeding.

The researchers found 18 studies on the use of prebiotics in babies. These studies involved only babies and toddlers up to the age of three who were not breastfed. In some of the studies the children came from families with a higher risk of allergies, and in other studies they didn't. Most of the time the prebiotics that were tested in the studies were additives in baby formula.

The studies didn't find any clear proof that prebiotics prevent . The children who took the prebiotics only had a decreased risk of . Due to problems with the way the studies were done and the low number of participants, the researchers rated the quality of the studies as very low. More research is needed in order to be able to reach more reliable conclusions about the pros and cons of prebiotic baby formula. So the WAO makes only a very weak recommendation for the use of prebiotics in infants who are not breastfed.

Cuello-Garcia CA, Brożek JL, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Terracciano L et al. Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol 2015; 136(4): 952-961.

Cuello-Garcia CA, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Morgano GP, Zhang Y et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics. World Allergy Organ J 2016; 9: 10.

Fiocchi A, Pawankar R, Cuello-Garcia C, Ahn K, Al-Hammadi S, Agarwal A et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. World Allergy Organ J 2015; 8(1): 4.

Garcia-Larsen V, Ierodiakonou D, Jarrold K et al. Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLoS Med 2018; 15(2): e1002507.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on February 11, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.