Probiotics for the Prevention of Childhood Eczema

Abstract
The prevalence of eczema has increased during the past few decades and continues to rise. Furthermore, childhood eczema is associated with the development of allergy later in life. As a result, there is considerable interest in identifying effective treatments to prevent eczema and, possibly, halt the progression of allergic disease. One such preventive treatment option is probiotic therapy; however, the results from clinical trials have been inconsistent due, in part, to differences in probiotic strains. The Probiotics and Allergy (PandA) trial was the first study of a multistrain probiotic for the prevention of childhood eczema in which strains were selected based on in vitro cytokine production. The results of this trial are discussed in the context of other published clinical trials on probiotics for the prevention of childhood eczema, along with a discussion of the hygiene hypothesis and a review of Th1/Th2 immune balance.

Introduction
Eczema is a chronic, inflammatory skin condition characterized by varying degrees of erythema and pruritis, mainly affecting the face, neck, and flexural folds of the knees and elbows. The terms eczema and atopic dermatitis (AD) are often used interchangeably, although this lack of distinction is technically incorrect. A diagnosis of AD is more specific and excludes non-atopic pathologies, such as contact dermatitis.1 Atopy is distinguished by IgE sensitization or a positive skin test to environmental or food allergens, although these studies are not often utilized in the clinical setting. In practice, the distinction between eczema and AD is a predominately clinical one and is often based on symptoms, age of onset, and family history of allergic disease. For the purposes of this review, both terms will be utilized, and the choice of terms will be based on the preference of the primary reference.

Eczema is the most common inflammatory skin condition in children and contributes significantly to childhood morbidity. Eczema affects children throughout the world, although prevalence varies widely by region. In the United States, northern Europe, and Australia, up to 20% of children are affected.1,2 By contrast, only 2% to 5% of children in China and the Middle East are estimated to have eczema. The age of onset for more severe or chronic eczema is typically before 2 years and often within the first 6 months of life. Most children

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