Clinical Use of Probiotics in Pediatric Allergy (CUPPA): A World Allergy Organization Position Paper

In the absence of systematic reviews of treatment, meta-analyses of prevention studies were used to provide data in support of probiotic applications.Results: Despite the plethora of literature, probiotic research is still in its infancy. There is a need for basic microbiology research on the resident human microbiota. Mechanistic studies from biology, immunology, and genetics are needed before we can claim toharness the potential of immune modulatory effects of microbiota. Meanwhile, clinicians must take a step back and try to link disease state with alterations of the microbiota through well-controlled long term studies to identify clinical indications.Conclusions : Probiotics do not have an established role in the prevention or treatment of allergy. No single probiotic supplement or class of supplements has been demonstrated to efficiently influence the course of any allergic manifestation or long-termdisease or to be sufficient to do so. Further epidemiologic, immunologic, microbiologic, genetic, and clinical studies are necessary to determine whether probiotic supplements will be useful in preventing allergy. Until then, supplementation withprobiotics remains empirical in allergy medicine. In the future, basic research should focus on homoeostatic studies, and clinical research should focus on preventive medicine applications, not only in allergy. Collaborations between allergo-immunologistsand microbiologists in basic research and a multidisciplinary approach in clinical research are likely to be the most fruitful.