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Original articles: G Moro, S Arslanoglu, B Stahl, J Jelinek, U Wahn, and G Boehm A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age Arch Dis Child 2006; 91: 814-819 [Abstract] [Full text] [PDF]

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Lowering the burden of atopic dermatitis

Matthias Wjst   (13 October 2006)

Lowering the burden of atopic dermatitis 13 October 2006
Matthias Wjst Send letter to journal: Re: Lowering the burden of atopic dermatitis m{at}wjst.de Matthias Wjst	Dear Editor, The study of Moro et al. (Ref.1) deals with the interesting question if there is any treatment that may prevent the development of allergy. Their main outcome is atopic dermatitis where a group comparison between maltodextrin (placebo) and galacto-/fructo- oligosaccharides (verum) showed an exact p of 0.014 as reported in Figure 2. I assume that they used a two sided test for the cumulative incidence of AD, where a single sided test may be more appropriate, leading eventually to a p of 0.0082. Showing also the distribution of the SCORAD index in both treatment groups would nevertheless be interesting as there is a high chance of confounding by inappropriate block randomization by genetic risk. As we have shown earlier in this journal (Ref.2) the risk by parental history of various allergic disease is not interchangeable; in other words a few more parents with atopic dermatitis (and/or the filaggrin gene variants) in the placebo group could also explain the observed effect. The authors have also not controlled for vitamin D supplementation that has been found now in four independent studies to be associated with later allergy (Ref.3) Aside from that, the study raises some ethical questions. According to current law in Germany advertisement of bottle feeding is prohibited without showing the alternative of breast feeding. In my opinion also a scientific study report needs to clearly state that the investigators have (1) promoted benefit and advantage of breast-feeding, (2) facilitated breastfeeding, (3) explained potential negative consequences of bottle feeding and (4) detailed the difficulty to reverse any decision against breast feeding. As the mean age of first bottle feeding is only 11 days in this study, the authors need to show (for example from preceding year when they obtained the data for the power calculation) that this study has not prevented breast feeding and even induced more AD cases than expected under non observing conditions. References: 1) Moro G, Arslanoglu S, Stahl B. et al. A mixture of prebiotic oligosaccharided reduced the incidence of atopic dermatitis during the first six months of age. Arch Dis Child 2006; 91: 814-819 2) Dold S, Wjst M, von Mutius E, et al. Genetic risk for asthma, allergic rhinitis, and atopic dermatitis. Arch Dis Child 1992;67(8):1018- 22 3) Wjst M. The vitamin D slant on allergy. Pediatr Allergy Immunol 2006 Nov;17:477-783