Nasal administration of a probiotic assemblage in allergic rhinitis: A randomised placebo‐controlled crossover trial

Abstract

Background Topical probiotics have been suggested as a treatment option for allergic rhinitis, as they may skew the immune response towards a beneficial type‐1 non‐allergic profile. So far observations in man have exclusively involved oral intake. The aim of this study was to examine whether a topical/nasal administration of a probiotic assemblage (PA) affects quality of life, symptoms and signs of allergic rhinitis in a nasal allergen challenge (NAC) model. Methods In a placebo‐controlled and crossover design, 24 patients with seasonal allergic rhinitis were randomised to topical/nasal administration with a PA of Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A or placebo for 3 weeks. Participants and investigators were blind to treatment allocation. The last week of each treatment period was combined with a NAC series. Efficacy variables were “Mini‐Rhinoconjunctivitis Quality of Life Questionnaire” (Mini‐RQLQ), “Total Nasal Symptom Score” (TNSS), “Peak Nasal Inspiratory Flow” (PNIF) and “Fractional Exhaled Nitric Oxide” (FeNO). In addition, to assess whether or not the PA produced any pro‐inflammatory effect per se, soluble analytes were monitored in nasal lavage fluids. Finally, bacterial cultures, sampled using swabs from the middle nasal meatus, were assessed for the presence of the PA by MALDI‐TOF analysis. Results Administration of the PA did not produce any nasal symptoms (cf. placebo). An innate immune response was discerned within the PA run (cf. baseline), but no change in nasal lavage fluid levels of cytokines/mediators was observed cf. placebo except for IL‐17/IL‐17A (a minor increase in the PA run). Administration of the PA did neither affect Mini‐RQLQ, TNSS, PNIF nor FeNO. No evidence of persistent colonization was observed. Conclusions Topical/nasal administration of a PA comprising Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A, while likely evoking a minor innate immune response yet being safe, does not affect quality of life, symptoms or signs of allergic rhinitis. Trial registration: not registered.

Research progress and future prospects of the mechanism of probiotics in the treatment of allergic rhinitis

“…The scores of the groups treated with Lactiplantibacillus plantarum, Lacticaseibacillus paracasei and Lacticaseibacillus rhamnosus strains were lower than those of the placebo group, with the MD of-5.19, -7.39 and -1.64, respectively. According to a meta-analysis, neither L. paracasei Lp33 nor L. rhamnosus GG had significant efficacy [17][18][19][20]. This may be due to the deviation caused by the lack of in-depth study of each strain.…”

“…This may be due to the deviation caused by the lack of in-depth study of each strain. In addition, researchers have suggested that in most cases, the combination of multiple strains is not more effective than a single strain [18][19][20][21]. This can remind clinicians that when treating patients with allergic rhinitis, they need to carefully consider the probiotic strains for treatment, and not blindly use multiple strains, otherwise it may not only fail to achieve a certain effect, but also bring new risks to patients.…”

“…At present, people use probiotics to treat allergic rhinitis mainly by oral administration, and there is little research on other routes of administration. Some articles have pointed out that the effect of oral administration of probiotics is not great, so it is indispensable to seek new methods of administration so as to improve the therapeutic effect and ensure its safety [20]. One study compared the effects of oral and nasal administration in the treatment of allergic diseases [21].…”

“…Researchers have also explored the safety of nasal administration. In a crossover study using placebo, two groups of 24 rhinitis sufferers were randomly assigned [20]. One group was given a probiotic assemblage (PA) comprising Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A locally/intranasally for 3 weeks, and the other group was given the same route of placebo for 3 weeks.…”

Epithelial Barrier in the Nasal Mucosa, Related Risk Factors and Diseases

“…Most studies investigated the effects of oral administration of probiotics on AR, whereas few studies investigated the topical/nasal administration of probiotics. The topical application of microbiota was focused on by a recent randomized, double-blind, placebo-controlled, and crossover-involved clinical trial [ 231 ]. By intranasal administration, they composed a probiotic combination (PA) consisting of Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37, and Lactococcus lactis L1A.…”