Probiotics may be unsafe in infants allergic to cow's milk

Moneret‐Vautrin, D.A.; Morisset, M.; Cordebar, V.; Codréanu, F.; Kanny, G.

doi:10.1111/j.1398-9995.2006.01050.x

Cited by 31 publications

(16 citation statements)

References 7 publications

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“…95 Cow's milk has thus far been subject to cautionary labeling both in Europe and the United States, 96 but the similar labeling of milk as an ingredient of pharmaceutical preparations has not been required, and several cases of anaphylaxis caused by milk in medicinal fillers, such as lactose, have been reported. [97][98][99] Goat's and ewe's milks have also been implicated in anaphylactic reactions. 100,101 Unusual clinical presentations of CMA Unusual clinical presentations are as much a feature of CMA as one might expect from such a ubiquitous allergen source in food and the environment as milk (Box 1).…”

Section: Epidemiology Of Cmamentioning

confidence: 98%

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA): A summary report

Fiocchi¹,

Schünemann

Brožek

et al. 2010

Journal of Allergy and Clinical Immunology

243

220

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Section: Epidemiology Of Cmamentioning

confidence: 98%

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA): A summary report

Fiocchi¹,

Schünemann

Brožek

et al. 2010

Journal of Allergy and Clinical Immunology

243

220

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“…For instance, some children receiving probiotics have developed anaphylactic reactions from cow's milk protein allergens present in the probiotic product. 156,157 There are culture methods to grow lactic acid bacteria that effectively eliminate residual cow milk protein allergens. While it is unclear whether such methods are sufficient to exempt products from food allergen labeling requirements, unless the probiotic product specifically states that it is allergen-free, allergic individuals who want to use probiotic products should actively seek assurance from manufacturers that a given product does not contain an offending allergen.…”

Section: Microbiological and Metabolic Issues Related To Safetymentioning

confidence: 99%

Safety assessment of probiotics for human use

et al. 2010

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The safety of probiotics is tied to their intended use, which includes consideration of potential vulnerability of the consumer or patient, dose and duration of consumption, and both the manner and frequency of administration. Unique to probiotics is that they are alive when administered, and unlike other food or drug ingredients, possess the potential for infectivity or in situ toxin production. Since numerous types of microbes are used as probiotics, safety is also intricately tied to the nature of the specific microbe being used. The presence of transferable antibiotic resistance genes, which comprises a theoretical risk of transfer to a less innocuous member of the gut microbial community, must also be considered. Genetic stability of the probiotic over time, deleterious metabolic activities, and the potential for pathogenicity or toxicogenicity must be assessed depending on the characteristics of the genus and species of the microbe being used. Immunological effects must be considered, especially in certain vulnerable populations, including infants with undeveloped immune function. A few reports about negative probiotic effects have surfaced, the significance of which would be better understood with more complete understanding of the mechanisms of probiotic interaction with the host and colonizing microbes. Use of readily available and low cost genomic sequencing technologies to assure the absence of genes of concern is advisable for candidate probiotic strains. The field of probiotic safety is characterized by the scarcity of studies specifically designed to assess safety contrasted with the long history of safe use of many of these microbes in foods.

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“…Even the immune safety of probiotics should not be taken for granted, as reports of sensitization and anaphylaxis to probiotic supplements have begun to appear, and 3 articles have reported a total of 99 cases [167-169]. …”

Section: Some Safety Aspects Of Probiotics For Allergy Treatmentmentioning

confidence: 99%

Clinical Use of Probiotics in Pediatric Allergy (cuppa): A World Allergy Organization Position Paper

Fiocchi

Burks

Bahna

et al. 2012

World Allergy Organization Journal

124

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BackgroundProbiotic administration has been proposed for the prevention and treatment of specific allergic manifestations such as eczema, rhinitis, gastrointestinal allergy, food allergy, and asthma. However, published statements and scientific opinions disagree about the clinical usefulness.ObjectiveA World Allergy Organization Special Committee on Food Allergy and Nutrition review of the evidence regarding the use of probiotics for the prevention and treatment of allergy.MethodsA qualitative and narrative review of the literature on probiotic treatment of allergic disease was carried out to address the diversity and variable quality of relevant studies. This variability precluded systematization, and an expert panel group discussion method was used to evaluate the literature. In the absence of systematic reviews of treatment, meta-analyses of prevention studies were used to provide data in support of probiotic applications.ResultsDespite the plethora of literature, probiotic research is still in its infancy. There is a need for basic microbiology research on the resident human microbiota. Mechanistic studies from biology, immunology, and genetics are needed before we can claim to harness the potential of immune modulatory effects of microbiota. Meanwhile, clinicians must take a step back and try to link disease state with alterations of the microbiota through well-controlled long-term studies to identify clinical indications.ConclusionsProbiotics do not have an established role in the prevention or treatment of allergy. No single probiotic supplement or class of supplements has been demonstrated to efficiently influence the course of any allergic manifestation or long-term disease or to be sufficient to do so. Further epidemiologic, immunologic, microbiologic, genetic, and clinical studies are necessary to determine whether probiotic supplements will be useful in preventing allergy. Until then, supplementation with probiotics remains empirical in allergy medicine. In the future, basic research should focus on homoeostatic studies, and clinical research should focus on preventive medicine applications, not only in allergy. Collaborations between allergo-immunologists and microbiologists in basic research and a multidisciplinary approach in clinical research are likely to be the most fruitful.

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Probiotics may be unsafe in infants allergic to cow's milk

Cited by 31 publications

References 7 publications

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA): A summary report

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA): A summary report

Safety assessment of probiotics for human use

Clinical Use of Probiotics in Pediatric Allergy (cuppa): A World Allergy Organization Position Paper

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