Prebiotics
For prebiotics, Bozenky et al. 54 performed a randomized controlled trial in 6-8 weeks old high-risk infants (family history of allergy in first-grade relatives), who were given a hypoallergenic formula, either supplemented with or without 0.5g/100 ml of galacto-oligosaccharides. They noted a decreased, but not statistically significant, SCORAD score in both groups. Similarly, Boyle et al. 55 showed in an international multi-center study that in high-risk infants, partially-hydrolysed whey protein formula (pHF-OS) supplemented with neutral scGOS, lcFOS and pectin-derived acidic OS (pAOS) (vs the same formula without the prebiotics) did not prevent eczema in the first year of life. In the PIPA study (Prebiotics in the Prevention of Atopy), galacto-oligosaccharide/polydextrose (GOS/PDX)-supplemented formula showed no significant difference in the cumulative incidence of eczema in the first year of life in high-risk infants compared to standard formula and breastfeeding.56 Lastly, daily administration of kestose, the smallest FOS, for 6 weeks in 2- to 5-year-olds was significantly correlated with higher fecal F. prausnitzii levels and an improvement in SCORAD severity scores (rs =0.52, p = 0.04).57