Probiotics in the prevention of eczema: a randomised controlled trial

Abstract

ObjectiveTo evaluate a multistrain, high-dose probiotic in the prevention of eczema.DesignA randomised, double-blind, placebo-controlled, parallel group trial.SettingsAntenatal clinics, research clinic, children at home.PatientsPregnant women and their infants.InterventionsWomen from 36 weeks gestation and their infants to age 6 months received daily either the probiotic (Lactobacillus salivarius CUL61, Lactobacillus paracasei CUL08, Bifidobacterium animalis subspecies lactis CUL34 and Bifidobacterium bifidum CUL20; total of 1010 organisms/day) or matching placebo.Main outcome measureDiagnosed eczema at age 2 years. Infants were followed up by questionnaire. Clinical examination and skin prick tests to common allergens were done at 6 months and 2 years.ResultsThe cumulative frequency of diagnosed eczema at 2 years was similar in the probiotic (73/214, 34.1%) and placebo arms (72/222, 32.4%; OR 1.07, 95% CI 0.72 to 1.6). Among the secondary outcomes, the cumulative frequency of skin prick sensitivity at 2 years was reduced in the probiotic (18/171; 10.5%) compared with the placebo arm (32/173; 18.5%; OR 0.52, 95% CI 0.28 to 0.98). The statistically significant differences between the arms were mainly in sensitisation to cow's milk and hen's egg proteins at 6 months. Atopic eczema occurred in 9/171 (5.3%) children in the probiotic arm and 21/173 (12.1%) in the placebo arm (OR 0.40, 95% CI 0.18 to 0.91).ConclusionsThe study did not provide evidence that the probiotic either prevented eczema during the study or reduced its severity. However, the probiotic seemed to prevent atopic sensitisation to common food allergens and so reduce the incidence of atopic eczema in early childhood.Trial registration NumberISRCTN26287422.

Food for thought

“…At present, it is unclear whether faecal microbial diversity is related to differential dietary patterns, or whether these effects may interact in a manner that compounds disease risk. Results of intervention trials using probiotics to prevent allergy have been inconsistent, although a recent trial demonstrated a reduction in food sensitization with a multi-strain high-dose probiotic [37].…”

Probiotic use in the prevention and therapy of atopic dermatitis

“…Ostaje nedo voljno razjašnjeno što dovodi do takve predominacije Th2 limfocita 9 . Smatra se kako je poboljšanje higijenskih uvjeta, koje je dovelo do smanjene izloženosti mikroorganizmima tijekom ranog djetinjstva, zaslužno za ovakav trend porasta prevalencije 10,11 . Ova teorija poznata je kao higijenska hipoteza koju je 1989. godine postavio Strachan.…”

“…10 Danas je ona modificirana saznanjima o ulozi crijevne mikrobiote u sazrijevanju imunološkog sustava 12 . Komenzalne crijevne bakterije predstavljaju prvi i najveći izvor mikrobnog opterećenja i time inicijalni poticaj za uspostavu Th1/Th2 ravnoteže 4,9,11 .…”

“…Navedeni rezultati bili su prisutni u studijama u kojima se koristio isključivo Lactobacillus rod i u onima u kojima se koristila kombinacija različitih sojeva probiotskih bakterija koje pripadaju rodovima Lactobacillus i Bifidobacterium 22 . Rezultati nekih studija ukazuju na to kako primjena probiotika smanjuje kumulativnu incidenciju atopijskog ekcema isključivo ako je on udružen s IgE senzitizacijom 11,13,24 . Takav učinak vjerojatno ostvaruju sprječavanjem nastanka senzitizacije na uobičajene alimentarne alergene, u prvom redu proteine kravljeg mlijeka i jajeta, i time kasnije manifestacije atopijskog ekcema.…”

“…Takav učinak vjerojatno ostvaruju sprječavanjem nastanka senzitizacije na uobičajene alimentarne alergene, u prvom redu proteine kravljeg mlijeka i jajeta, i time kasnije manifestacije atopijskog ekcema. Učinak na senzitizaciju inhalacijskim alergenima nije dokazan 11 . Iako se to još ne može sa sigurnošću potvrditi, čini se kako bi probiotici mogli imati prolongirani preventivni učinak koji se nastavlja sve do školske dobi.…”