Airway inflammation in probiotic‐treated children at 5 years

Abstract

Early treatment of new-born high-risk children with certain probiotic strains has reduced the risk of atopic eczema. Whether probiotics reduce risk for airway inflammation in long term is not known. We aimed at studying the effect of probiotic treatment during the six first months of life on airway inflammation at age 5 yr. In a randomized double-blind allergy prevention trial between 2000 and 2007 in Helsinki, Finland, we gave a probiotic combination, plus pre-biotics, or placebo, to 1018 children during 6 months from birth. At age 5, we measured exhaled nitric oxide (FE(NO) ) in a randomized sub-population of 160 children. Allergic diseases and IgE-sensitization were assessed in all infants. FE(NO) did not differ between probiotic and placebo groups, median (interquartile range, IQR) 5.45 (4.3-7.3) vs. 5.70 (3.9-6.8) ppb, p = 0.22. FE(NO) was elevated among those suffering from asthma during the first 5 yr than in healthy non-sensitized children (p = 0.009). FE(NO) correlated positively with serum total and allergen-specific IgE concentrations. Early intervention with probiotics and pre-biotics does not affect airway inflammation later in childhood.

Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials

“…Table I includes only studies with direct evidence of the effect of probiotics administered to pregnant women, whereas Table II shows the summary of findings from studies in which probiotics were used by pregnant women directly and otherwise. Only one study 18 assessed the use of probiotics administered exclusively to pregnant women (Fig 2, box 1), whereas the remaining 20 studies 19,20,[22][23][24][25][26][28][29][30][31][32][33][34][35]37,39,40,45,46 evaluated the use of probiotics either in pregnant and then breast-feeding mothers, 19,20,22,23 in pregnant women and their infants, [24][25][26][33][34][35]37,39 or in all 3 groups (Fig 2, boxes 4, 5, and 7). [28][29][30][31][32]40,45,46 Overall, the final estimate from the meta-analysis of direct and indirect evidence showed a reduced risk of eczema in infants, as shown in...…”

The Role of Probiotics in Atopic Dermatitis Prevention and Therapy

“…However, a recent study was done by Kukkonen et al evaluating airway inflammation in probiotic-treated children at 5 years in 1018 children. Early intervention with probiotics and prebiotics did not affect airway inflammation later in childhood [108]. Furthermore, similarly certain probiotics are known to stimulate Th1 immunity, which has been suggested as one of the mechanisms by which they can suppress Th2-mediated allergic diseases.…”

“… Probiotics should not be considered as completely harmless, particularly in the immunodeficient host, and more safety studies are needed [100-110, 115,116].  Physiological use (normal route, normal dose, normal growth phase, specific strain or substrain/species) is studied in all cases, so as not to overwhelm (high dose) or circumvent natural immune processing [100][101][102][103][104][105][106][107][108][109][110].  Do probiotics really induce/exacerbate Th1 and / or Th2-mediated diseases?…”

“…Such as being reported an increased rate of recurrent wheezing episodes, an augmented rate of atopic disorders, increased sensitization to allergens as well as autoimmune disorders. Lactobacilli and Bifidobacteria have specific dose-and duration-dependent immunomodulatory effects on the proliferation of B-/T-lymphocytes [108][109][110].  The researchers ought to look for more appropriate and safe combinations of probiotic species (as with VSL#3 or Lacto-mix) or modified probiotics with/without prebiotic and test them in human/experimental AD models [112].…”

Gnotobiology and the Study of Complex Interactions between the Intestinal Microbiota, Probiotics, and the Host

“…Another study showed that even oral treatment of mothers with probiotic Lactobacillus rhamnosus GG reduces the incidence of atopic dermatitis (eczema) in their children (Kalliomaki et al, 2001b) and that this beneficial effect is transmitted from mother to child through breast-feeding (Rautava et al, 2002). Interestingly, while the decrease in eczema incidence is apparent even after several years, there is no decrease in allergic sensitization (Kalliomaki et al, 2001b;Wickens et al, 2008), and while quite effective in eczema prevention, early intervention with this probiotic microbe does not affect airway inflammation later in childhood (Kukkonen et al, 2011). This protective effect might require specific interaction between genes and environment, because a similarly designed study on a different population did not find any beneficial effect of L. rhamnosus on eczema incidence (Kopp et al, 2008).…”