Archive for category Atopic allergies
J Nutr ’10: Controlled trial evaluating safety of maternal and infant feeding of 4 probiotic strains reports good results
Allen S, Jordan S, Storey M, et al. Dietary supplementation with lactobacilli and bifidobacteria is well tolerated and not associated with adverse events during late pregnancy and early infancy. J Nutr 2010;140(3):483-488.
Lactic acid bacteria and bifidobacteria are increasingly being administered to pregnant women and infants with the intention of improving health. Although these organisms have a long record of safe use, it is important to identify any adverse effects in potentially vulnerable populations.
In a randomized, double-blinded, placebo-controlled trial, we evaluated the safety of a bacterial dietary supplement for the prevention of atopy in infants. Two strains of lactobacilli (Lactobacillus salivarius CUL61 and Lactobacillus paracasei CUL08) and bifidobacteria (Bifidobacterium animalis subsp. lactis CUL34 and Bifidobacterium bifidum CUL20) with a total of 1 × 1010 colony-forming units were administered daily to women during the last month of pregnancy and to infants aged 0–6 mo. Adverse events (AE) were classified according to WHO International Statistical Classification of Diseases criteria. Common symptoms were recorded by regular questionnaires.
Baseline characteristics of 220 mother-infant dyads in the treatment and 234 in the placebo group were similar. Compliance with the trial interventions, loss to follow-up, symptoms, drug usage, infant growth, method of feeding, visits to the doctor, and mothers’ assessment of infant health were similar in the 2 groups. Fifteen (6.8%) mothers and 73 (33.2%) infants in the treatment group and 21 (9.0%) mothers and 75 (32.1%) infants in the placebo group reported AE (P = 0.49 and P = 0.84, respectively). Severe AE occurred in 18 mothers and 63 infants with a similar frequency in each group. None of the AE were attributed to the intervention.
Our findings support the safe use of this consortium of organisms during pregnancy and early infancy.
Br J Derm ’10: Maternal consumption of probiotic blend reduces atopic dermatitis in children at risk for allergies
Dotterud C, Storrø O, Johnsen R, et al. Probiotics in pregnant women to prevent allergic disease: A randomized, double-blind trial. Br J Dermatol 2010;163(3):616-623.
Previous reports have suggested that certain probiotics given to mothers and children at risk of atopy halves the incidence of atopic dermatitis (AD) at 2 years of age.
To examine if probiotics given to pregnant women in a nonselected population could prevent atopic sensitization or allergic diseases during the child’s first 2 years.
In a randomized, double-blind trial of children from a nonselected maternal population (ClinicalTrials.gov identifier: NCT00159523), women received probiotic milk or placebo from 36 weeks of gestation to 3 months postnatally during breastfeeding. The probiotic milk contained Lactobacillus rhamnosus GG, L. acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12. Children with an itchy rash for more than 4 weeks were assessed for AD. At 2 years of age, all children were assessed for atopic sensitization, AD, asthma and allergic rhinoconjunctivitis. The intention-to-treat (ITT) analysis was enabled by multiple imputations.
Four hundred and fifteen pregnant women were computer randomized. At 2 years, 138 and 140 children in the probiotic and the placebo groups, respectively, were assessed. In the ITT analysis, the odds ratio (OR) for the cumulative incidence of AD was 0·51 in the probiotic group compared with the placebo [95% confidence interval (CI) 0·30–0·87; P = 0·013]. There were no significant effects on asthma (OR 0·68, 95% CI 0·26–1·80; P = 0·437) or atopic sensitization (OR 1·52, 95% CI 0·74–3·14; P = 0·254).
Probiotics given to nonselected mothers reduced the cumulative incidence of AD, but had no effect on atopic sensitization.
Ped All Immun ’10: Maternal consumption of probiotic blend reduces eczema in infants at high risk of allergy during the first year of life
Kim J, Kwon J, Ahn S, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: A double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol 2010;21:e386-e393.
Controversy exists regarding the preventive effect of probiotics on the development of eczema or atopic dermatitis. We investigated whether supplementation of probiotics prevents the development of eczema in infants at high risk.
In a randomized, double-blind, placebo-controlled trial, 112 pregnant women with a family history of allergic diseases received a once-daily supplement, either a mixture of Bifidobacterium bifidum BGN4, B. lactis AD011, and Lactobacillus acidophilus AD031, or placebo, starting at 4–8 wks before delivery and continuing until 6 months after delivery.
Infants were exclusively breast-fed during the first 3 months, and were subsequently fed with breastmilk or cow’s milk formula from 4 to 6 months of age.
Clinical symptoms of the infants were monitored until 1 yr of age, when the total and specific IgE against common food allergens were measured. A total of 68 infants completed the study.
The prevalence of eczema at 1 yr in the probiotic group was significantly lower than in the placebo group (18.2% vs. 40.0%, p = 0.048). The cumulative incidence of eczema during the first 12 months was reduced significantly in probiotic group (36.4% vs. 62.9%, p = 0.029); however, there was no difference in serum total IgE level or the sensitization against food allergens between the two groups.
Prenatal and postnatal supplementation with a mixture of B. bifidum BGN4, B. lactis AD011, and L. acidophilus AD031 is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life.
Lomax A, Calder P. Probiotics, Immune Function, Infection and Inflammation: A Review of the Evidence from Studies Conducted in Humans. Cur Pharma Des 2009;15(13):1428-1518.
A number of studies have been performed examining the influence of various probiotic organisms, either alone or in combination, on immune parameters, infectious outcomes, and inflammatory conditions in humans.
Some components of the immune response, including phagocytosis, natural killer cell activity and mucosal immunoglobulin A production (especially in children), can be improved by some probiotic bacteria. Other components, including lymphocyte proliferation, the production of cytokines and of antibodies other than immunoglobulin A appear less sensitive to probiotics.
Probiotics, including lactobacilli and bifidobacteria, administered to children can reduce incidence and duration of diarrhoea, but the precise effects depend upon the nature of the condition.
Probiotic supplementation can reduce the risk of travellers’ diarrhoea in adults, but does not affect duration. The effect of probiotics on other infectious outcomes is less clear.
Probiotics may benefit children and adults with irritable bowel syndrome and adults with ulcerative colitis; studies in Crohn’s Disease are less clear. Probiotics have little effect in rheumatoid arthritis.
Probiotic supplementation, especially with lactobacilli and bifidobacteria, can reduce risk and severity of allergic disease, particular atopic dermatitis; early supplementation appears to be effective.
Overall, the picture that emerges from studies of probiotics on immune, infectious and inflammatory outcomes in humans is mixed and there appear to be large species and strain differences in effects seen. Other reasons for differences in effects seen will include dose of probiotic organism used, duration of supplementation, characteristics of the subjects studied, sample size, and technical differences in how the measurements were made.
J All Clin Imm ’97: Study suggests probiotics benefit people with food allergies and atopic dermatitis
Majamaa H, Isolauri E. Probiotics: A novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179-185.
The gastrointestinal microflora is an important constituent of the gut mucosal defense barrier. We have previously shown that a human intestinal floral strain, Lactobacillus GG (ATCC 53103), promotes local antigen-specific immune responses (particularly in the IgA class), prevents permeability defects, and confers controlled antigen absorption.
The aim of this study was to evaluate the clinical and immunologic effects of cow’s milk elimination without (n = 14) and with (n = 13) the addition of Lactobacillus GG (5 x 10(8) colony-forming units/gm formula) in an extensively hydrolyzed whey formula in infants with atopic eczema and cow’s milk allergy. The second part of the study involved 10 breast-fed infants who had atopic eczema and cow’s milk allergy. In this group Lactobacillus GG was given to nursing mothers.
The severity of atopic eczema was assessed by clinical scoring. The concentrations of fecal alpha 1- antitrypsin, tumor necrosis factor-alpha, and eosinophil cationic protein were determined as markers of intestinal inflammation before and after dietary intervention.
The clinical score of atopic dermatitis improved significantly during the 1-month study period in infants treated with the extensively hydrolyzed whey formula fortified with Lactobacillus GG. The concentration of alpha 1-antitrypsin decreased significantly in this group (p = 0.03) but not in the group receiving the whey formula without Lactobacillus GG (p = 0.68). In parallel, the median (lower quartile to upper quartile) concentration of fecal tumor necrosis factor-alpha decreased significantly in this group, from 709 pg/gm (91 to 1131 pg/gm) to 34 pg/gm (19 to 103 pg/gm) (p = 0.003), but not in those receiving the extensively hydrolyzed whey formula only (p = 0.38). The concentration of fecal eosinophil cationic protein remained unaltered during therapy.
These results suggest that probiotic bacteria may promote endogenous barrier mechanisms in patients with atopic dermatitis and food allergy, and by alleviating intestinal inflammation, may act as a useful tool in the treatment of food allergy.
Kalliomäki M, et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 2001;357(9262):1076–1079.
BACKGROUND: Reversal of the progressive increase in frequency of atopic disease would be an important breakthrough for health care and wellbeing in western societies. In the hygiene hypothesis this increase is attributed to reduced microbial exposure in early life. Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora. We assessed the effect on atopic disease of Lactobacillus GG (which is safe at an early age and effective in treatment of allergic inflammation and food allergy).
METHODS: In a double-blind, randomised placebo-controlled trial we gave Lactobacillus GG prenatally to mothers who had at least one first-degree relative (or partner) with atopic eczema, allergic rhinitis, or asthma, and postnatally for 6 months to their infants. Chronic recurring atopic eczema, which is the main sign of atopic disease in the first years of life, was the primary endpoint.
FINDINGS: Atopic eczema was diagnosed in 46 of 132 (35%) children aged 2 years. Asthma was diagnosed in six of these children and allergic rhinitis in one. The frequency of atopic eczema in the probiotic group was half that of the placebo group (15/64 [23%] vs 31/68 [46%]; relative risk 0.51 [95% CI 0.32-0.84]). The number needed to treat was 4.5 (95% CI 2.6-15.6).
INTERPRETATIONS: Lactobacillus GG was effective in prevention of early atopic disease in children at high risk. Thus, gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics, for prevention of atopic disease.
J All Clin Imm ’02: RCT shows protective effect of probiotics in children of women with atopic disease
Rautava S, et al. Probiotics during pregnancy and breast-feeding might confer immuno modulatory protection against atopic disease in the infant. J Allergy Clin Immunol 2002;109:119–121.
The prevalence of atopic diseases is increasing throughout the Western world, and means of primary prevention are needed to reverse this trend. The role of breast-feeding, the best source of infant nutrition, in protection against atopic disease remains elusive.
In this double-blinded, placebo-controlled study of 62 mother-infant pairs, it is shown that administering probiotics to the pregnant and lactating mother increased the immunoprotective potential of breast milk, as assessed by the amount of anti-inflammatory transforming growth factor beta2 (TGF-beta2) in the milk (2885 pg/mL [95% CI, 1624-4146] in mothers receiving probiotics vs 1340 pg/mL [95% CI, 978-1702] in mothers receiving placebo; P =.018).
The risk of developing atopic eczema during the first 2 years of life in infants whose mothers received probiotics was significantly reduced in comparison with that in infants whose mothers received placebo (15% and 47%, respectively; relative risk, 0.32 [95% CI, 0.12-0.85]; P =.0098). Maternal atopy was a clear risk factor for atopic eczema in the infant. The infants most likely to benefit from maternal probiotic supplementation were those with an elevated cord blood IgE concentration.
Administering probiotics during pregnancy and breast-feeding thus offers a safe and effective mode of promoting the immunoprotective potential of breast-feeding and provides protection against atopic eczema during the first 2 years of life.
Huurre A, et al. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: A double-blind placebo-controlled study. Clin Exp Allergy 2008;38(8):1342–1348
The effects of breastfeeding and probiotics on infant sensitization still remain discrepant.
To explore probable explanatory factors in infant sensitization and the protective effect of probiotics.
Altogether 171 mother-infant pairs from an ongoing placebo-controlled double-blind study with nutrition modulation by dietary counselling and probiotic supplementation were studied. Skin prick testing was done in infants at 6 and 12 months and in mothers at third trimester of pregnancy. The breast milk concentrations of cytokines TGF-beta2, soluble CD14, IFN-gamma, TNF-alpha, IL-10, IL-6, IL-4 and IL-2 were measured.
The risk of sensitization increased in infants with allergic mothers breastfeeding over 6 months [odds ratio (OR=4.83, P=0.005)], or exclusively breastfeeding over 2.5 months (OR=3.4, P=0.018). Probiotic supplementation had a protective effect against sensitization in infants with a high hereditary risk due to maternal sensitization (OR=0.3, P=0.023). The concentration of TGF-beta2 tended to be higher in the colostrum of the mothers in the probiotic group as compared with those on placebo (probiotic/placebo ratio=1.50, P=0.073). A similar result was obtained in the subgroup of allergic mothers (probiotic/placebo ratio=1.56, P=0.094).
Infants of atopic mothers, specifically when breastfed exclusively over 2.5 months or totally over 6 months, had a higher risk of sensitization at the age of 12 months. This risk could be reduced by the use of probiotics during pregnancy and lactation, partly by resulting in a beneficial composition of the breast milk.
Lancet ’03: Study suggests probiotic effect on reducing risk of atopic sensitivity in children extends beyond infancy
Kalliomäki M, et al. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003;361(9372):1869–1871.
Perinatal administration of the probiotic Lactobacillus rhamnosus strain GG (ATCC 53103), reduces incidence of atopic eczema in at-risk children during the first 2 years of life (infancy). We have therefore assessed persistence of the potential to prevent atopic eczema at 4 years.
Atopic disease was diagnosed on the basis of a questionnaire and a clinical examination. 14 of 53 children receiving lactobacillus had developed atopic
eczema, compared with 25 of 54 receiving placebo (relative risk 0.57, 95% CI 0.33-0.97). Skin prick test reactivity was the same in both groups: ten of 50 children previously given lactobacillus compared with nine of 50 given placebo tested positive.
Our results suggest that the preventive effect of lactobacillus GG on atopic eczema extends beyond infancy.
Saavedra JM. Use of Probiotics in Pediatrics: Rationale, Mechanisms of Action, and Practical Aspects. Nutrition in Clinical Practice, 2007;22(3):351-365.
The use of probiotics (ingested microbes that can modify intestinal microbial populations in a way that benefit the host) has moved from concept to actual demonstration of specific benefits by specific microorganisms for specific populations.
It is increasingly clear that these benefits to the host are mostly mediated by the profound effect that intestinal microflora (microbiota) have on gut barrier function and host immune response.
Intestinal bacteria are more numerous than the human cells of the host that harbors them. Despite having many potential pathogens in this microflora, humans do not routinely get infected. It is no coincidence that gut-associated immune tissue constitutes approximately 80% of all immunologically active cells in the human host.
The gut interacts with intestinal bacteria, both resident and ingested, to develop protective mechanisms (via improving gut barrier function and immune stimulation for defense) and appropriate, nonexaggerated responses (via immune modulation and immune tolerance) to support host health.
The mechanisms of this interaction between host and bacteria are increasingly being unraveled and in great part explain the clinical benefits that have been reported with specific probiotic bacteria by enhancing host defense mechanisms (such as for treatment and prevention of viral diarrhea and reducing risk of necrotizing enterocolitis), mitigating antibiotic-associated diarrhea, and modulating host immune response (such as in allergic disease).