Efficacy of probiotics in preventing atopic dermatitis in infants: A systematic review and meta-analysis.

Abstract

ObjectiveAlthough probiotic modulation of the gut microbiota in early life has been proposed to prevent atopic dermatitis, supportive evidence remains inconsistent. This systematic review and meta-analysis aimed to determine whether probiotic supplementation initiated during infancy (0-36 months) reduces the risk of atopic dermatitis and provide clinically relevant insights.MethodsThe PubMed, Web of Science, EMBASE, and Cochrane Library databases were searched up to 8 January 2026 for randomized controlled trials comparing probiotics with placebo or no intervention for the prevention of atopic dermatitis. To be eligible, studies needed to have enrolled infants aged 0-36 months. Risk of bias was assessed using the Cochrane risk of bias 2 tool, and a random-effects meta-analysis was performed.ResultsEighteen randomized controlled trials (10,195 participants) were included. Pooled analysis showed that there was no significant protective effect of probiotics against atopic dermatitis (risk ratio&#x2009;=&#x2009;0.94; 95% confidence interval: 0.72-1.25; <i>p</i>&#x2009;=&#x2009;0.66), with substantial heterogeneity (I²&#x2009;=&#x2009;72.8%). Sensitivity analyses confirmed robustness, and no publication bias was detected (Egger's test, <i>p</i>&#x2009;=&#x2009;0.15). Two studies featured a high risk of bias, predominantly due to missing outcome data.ConclusionsCurrent evidence does not support routine probiotic supplementation initiated only during infancy for the prevention of atopic dermatitis. Positive preventive effects reported in previous meta-analyses are largely driven by perinatal (maternal-plus-infant) regimens, whereas infant-only supplementation has failed to demonstrate consistent benefit.<b>INPLASY registration number:</b> INPLASY202650128.