Specific probiotics alleviate allergic rhinitis during the birch pollen season

Abstract

AIM:To investigate whether birch pollen allergy symptoms are linked with gut microbiota changes and whether probiotics have an effect on these. METHODS:Forty seven children with confirmed birch pollen allergy were randomized to receive either a probiotic combination of Lactobacillus acidophilus (L . a c i d o p h i l u s ) N C F M T M ( ATC C 7 0 0 3 9 6 ) a n dBifidobacterium lactis (B. lactis ) Bl-04 (ATCC SD5219) or placebo in a double-blind manner for 4 mo, starting prior to onset of the birch pollen season. Symptoms were recorded in a diary. Blood samples were taken for analysis of cytokines and eosinophils. Fecal samples were analysed for microbiota components, calprotectin and IgA. Nasal swabs were taken for analysis of eosinophils. RESULTS:The pollen season induced a reduction in Bifidobacterium , Clostridium and Bacteroides which could not be prevented by the probiotic intervention. During the intervention, significantly higher numbers of B. lactis 11.2 × 10 7 ± 4.2 × 10 7 vs 0.1 × 10 7 ± 0.1 × 10 7 bacteria/g feces (P < 0.0001) and L. acidophilus NCFM TM 3.5 × 10 6 ± 1.3 × 10 6 vs 0.2 × 10 6 ± 0.1 × 10 6 bacteria/g feces (P < 0.0001) were observed in the probiotic group compared to the placebo group. During May, there was a tendency for fewer subjects, (76.2% vs 95.2%, P = 0.078) to report runny nose, while during June, fewer subjects, 11.1% vs 33.3%, reported nasal blocking in the probiotics group (P = 0.101). Concomitantly, fewer subjects in the probiotic group had infiltration of eosinophils in the nasal mucosa compared to the placebo group, 57.1% vs 95% (P = 0.013). Eye symptoms tended to be slightly more frequent in the probiotic group, 12.5 d[interquartile range (IQR) 6-18] vs 7.5 d (IQR 0-11.5) (P = 0.066) during May. Fecal IgA was increased in the placebo group during the pollen season; this increase was prevented by the probiotics (P = 0.028). CONCLUSION:Birch pollen allergy was shown to be associated with changes in fecal microbiota composition. The specific combination of probiotics used was shown to prevent the pollen-induced infiltration of eosinophils into the nasal mucosa, and indicated a trend for reduced nasal symptoms.

Simulating colonic survival of probiotics in single-strain products compared to multi-strain products

“…The strains were included either as single freeze-dried cultures at a dose of 2.5 × 10 9 colony-forming units (cfu), or in a combination of two strains ( L. acidophilus NCFM + B. lactis Bl-04, 5 × 10 9 cfu [6]) or as all four strains combined (HOWARU Restore, 10 10 cfu [7]). The dose of the strains used in the simulations was similar to the daily doses used in two human intervention studies, of 5 × 10 9 and 1.7 × 10 10 cfu, respectively [6,7]. Counts of the single strains were controlled by flow cytometry of the bulk material [8], and the multi-strain products were composed accordingly.…”

Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial

“…A few published studies in the field of probiotics and AR are in line with our observations in this clinical trial and have showed a beneficial effect of the probiotic strains only after a 44-week administration. 16,19,21,30,31 We implemented the whole-blood assay and the basophil activation test in the current setting to correlate immune parameters to allergic symptoms and to be in alignment with recent recommendations suggested for probiotic-focused clinical trials. 32,33 It is well known that in allergic individuals, significant cytokine levels are induced upon ex vivo stimulation 28,34 and such increases in cytokine levels can be modulated by administration of mainstream treatments such as corticosteroids.…”

Microbiota and Allergy: From Dysbiosis to Probiotics

“…From the available evidence, it seems that probiotics have no impact on microbiota. In the treatment of rhinitis with L. acidophilus NCFMTM, fecal probiotic cell counts correlated positively with fecal acetic, propionic and butyric acid concentrations (Ouwehand et al, 2009), suggesting that the presence of L. acidophilus NCFMTM increases microbial fermentation in the colon. However, the colonization pattern did not differ between groups that consumed the probiotic strains and placebo.…”

“…Treatment with LGG resulted in a trend towards elevated fecal IgA levels, and this effect was significant in IgE-associated cow-milk allergy infants, suggesting maturation of intestinal immunity and triggering of a mechanism to protect the gut from the offending food (Viljanen et al, 2005a). In older subjects with a mature immune system and suffering from allergic rhinitis, fecal IgA concentrations increased in the placebo group during the pollen season; this increase was prevented by L. acidophilus NCFMTM (Ouwehand et al, 2009). Probiotics have also been reported to decrease the levels of fecal inflammatory markers, but this is controversial: findings differ between studies and strains used.…”

“…The degree of eosinophil infiltration into the respiratory mucosa correlates directly with the intensity of allergic rhinitis and can be used as an objective marker of the disease. A mixture of L. acidophilus NCFMTM and B. lactis Bl-04 reduced nasal eosinophil infiltration (Ouwehand et al, 2009) as did Bacillus clausii which also reduced the number of days on which antihistamine was used in children with allergic rhinitis due to pollen sensitization (Ciprandi et al, 2005a). However, L. rhamnosus ATCC53103 was not beneficial to teenagers and young adults allergic to birch pollen or ingested apple and who had intermittent symptoms of atopic allergy and/or mild asthma (Helin et al, 2002).…”