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Role of Microbial Modulation in Management of Atopic Dermatitis in Children

Department of Paediatric Respiratory Medicine and Allergy, Emma Children’s Hospital Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
Department of Paediatric Immunology, University Medical Center Utrecht/Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
Nutricia Research, 3584 CT Utrecht, The Netherlands
Department of Paediatric Pulmonology and Paediatric Allergology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CG Utrecht, The Netherlands
Author to whom correspondence should be addressed.
These authors contributed equally to this paper.
Nutrients 2017, 9(8), 854;
Received: 31 May 2017 / Revised: 27 July 2017 / Accepted: 3 August 2017 / Published: 9 August 2017
(This article belongs to the Special Issue Nutrition and Allergic Diseases)
PDF [271 KB, uploaded 10 August 2017]


The pathophysiology of atopic dermatitis (AD) is multifactorial and is a complex interrelationship between skin barrier, genetic predisposition, immunologic development, skin microbiome, environmental, nutritional, pharmacological, and psychological factors. Several microbial modulations of the intestinal microbiome with pre- and/or probiotics have been used in AD management, with different clinical out-come (both positive, as well as null findings). This review provides an overview of the clinical evidence from trials in children from 2008 to 2017, aiming to evaluate the effect of dietary interventions with pre- and/or pro-biotics for the treatment of AD. By searching the PUBMED/MEDLINE, EMBADE, and COCHRANE databases 14 clinical studies were selected and included within this review. Data extraction was independently conducted by two authors. The primary outcome was an improvement in the clinical score of AD severity. Changes of serum immunological markers and/or gastrointestinal symptoms were explored if available. In these studies some dietary interventions with pre- and/or pro-biotics were beneficial compared to control diets in the management of AD in children, next to treatment with emollients, and/or local corticosteroids. However, heterogeneity between studies was high, making it clear that focused clinical randomized controlled trials are needed to understand the potential role and underlying mechanism of dietary interventions in children with AD. View Full-Text
Keywords: atopic dermatitis; children; mucosal immune development atopic dermatitis; children; mucosal immune development
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Hulshof, L.; Van’t Land, B.; Sprikkelman, A.B.; Garssen, J. Role of Microbial Modulation in Management of Atopic Dermatitis in Children. Nutrients 2017, 9, 854.

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