Prebiotics and probiotics for treatment of allergic disease
- Susan Prescott, MBBS, FRACP, PhD
Susan Prescott, MBBS, FRACP, PhD
- Winthrop Professor and Pediatric Allergist and Immunologist
- University of Western Australia
- Christina West, MD, PhD
Christina West, MD, PhD
- Department of Clinical Sciences
- Pediatrics Umeå University, Sweden
The rapid increase in immune-mediated disorders such as allergic disease is strongly linked to reduced early microbial exposure [1,2]. The gut microbiota represents the greatest microbial exposure by far and is central to the development of immune regulation. The specific composition of the gut microbiota may affect the risk of developing allergic disease . This finding provided the foundation for intervention studies designed to modify gut microbial composition for the treatment of allergic disease. The effects of beneficial bacteria (probiotics) or resistant starches or fiber (prebiotics) that selectively stimulate a limited number of beneficial bacteria have been evaluated in allergy treatment studies.
This review examines the evidence for prebiotics and probiotics in the treatment of allergic disease [4-8]. The evidence for prebiotics and probiotics in the prevention of allergic disease is presented separately. The definitions of prebiotics, probiotics, and synbiotics; proposed mechanisms of action; rationale for use in allergic disease; and side effects and safety are also discussed separately. (See "Prebiotics and probiotics for prevention of allergic disease".)
CLINICAL TREATMENT STUDIES USING PREBIOTICS
Randomized, controlled trials evaluating the effects of prebiotics for treatment of allergic disease are scarce, and further studies are needed before any conclusions can be drawn.
The effect of kestose, a fructo-fructooligosaccharide (FOS), was assessed in a trial that randomized 29 infants and children <3 years of age with eczema to daily ingestion of kestose or maltose (placebo) for 12 weeks . Median SCORAD (SCORing Atopic Dermatitis) scores were significantly lower at 6 and 12 weeks in the prebiotic group, compared with placebo.
CLINICAL TREATMENT STUDIES USING PROBIOTICS
Initial meta-analyses suggest no benefit of oral probiotics in the treatment of eczema or asthma. One meta-analysis reported a beneficial effect of probiotics in the treatment of allergic rhinitis, but it was not conclusive, and further studies are needed.
- Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 2002; 347:911.
- Wold AE. The hygiene hypothesis revised: is the rising frequency of allergy due to changes in the intestinal flora? Allergy 1998; 53:20.
- Penders J, Stobberingh EE, van den Brandt PA, Thijs C. The role of the intestinal microbiota in the development of atopic disorders. Allergy 2007; 62:1223.
- Johannsen H, Prescott SL. Practical prebiotics, probiotics and synbiotics for allergists: how useful are they? Clin Exp Allergy 2009; 39:1801.
- Ozdemir O. Various effects of different probiotic strains in allergic disorders: an update from laboratory and clinical data. Clin Exp Immunol 2010; 160:295.
- Tang ML, Lahtinen SJ, Boyle RJ. Probiotics and prebiotics: clinical effects in allergic disease. Curr Opin Pediatr 2010; 22:626.
- Thomas DW, Greer FR, American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Probiotics and prebiotics in pediatrics. Pediatrics 2010; 126:1217.
- Yao TC, Chang CJ, Hsu YH, Huang JL. Probiotics for allergic diseases: realities and myths. Pediatr Allergy Immunol 2010; 21:900.
- Shibata R, Kimura M, Takahashi H, et al. Clinical effects of kestose, a prebiotic oligosaccharide, on the treatment of atopic dermatitis in infants. Clin Exp Allergy 2009; 39:1397.
- Liong MT. Safety of probiotics: translocation and infection. Nutr Rev 2008; 66:192.
- Centers for Disease Control and Prevention. Health Alert Network. Fatal gastrointestinal mucormycosis in an infant following ingestion of contaminated dietary supplement – Connecticut, 2014. http://www.bt.cdc.gov/han/han00373.asp (Accessed on November 25, 2014).
- Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, et al. Probiotics for treating eczema. Cochrane Database Syst Rev 2008; :CD006135.
- Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol 2008; 121:116.
- Michail SK, Stolfi A, Johnson T, Onady GM. Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol 2008; 101:508.
- Gore C, Custovic A, Tannock GW, et al. Treatment and secondary prevention effects of the probiotics Lactobacillus paracasei or Bifidobacterium lactis on early infant eczema: randomized controlled trial with follow-up until age 3 years. Clin Exp Allergy 2012; 42:112.
- Drago L, Iemoli E, Rodighiero V, et al. Effects of Lactobacillus salivarius LS01 (DSM 22775) treatment on adult atopic dermatitis: a randomized placebo-controlled study. Int J Immunopathol Pharmacol 2011; 24:1037.
- Isolauri E, Arvola T, Sütas Y, et al. Probiotics in the management of atopic eczema. Clin Exp Allergy 2000; 30:1604.
- Brouwer ML, Wolt-Plompen SA, Dubois AE, et al. No effects of probiotics on atopic dermatitis in infancy: a randomized placebo-controlled trial. Clin Exp Allergy 2006; 36:899.
- Fölster-Holst R, Müller F, Schnopp N, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol 2006; 155:1256.
- Grüber C, Wendt M, Sulser C, et al. Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy 2007; 62:1270.
- Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy 2005; 60:494.
- Sistek D, Kelly R, Wickens K, et al. Is the effect of probiotics on atopic dermatitis confined to food sensitized children? Clin Exp Allergy 2006; 36:629.
- Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997; 99:179.
- Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005; 90:892.
- Woo SI, Kim JY, Lee YJ, et al. Effect of Lactobacillus sakei supplementation in children with atopic eczema-dermatitis syndrome. Ann Allergy Asthma Immunol 2010; 104:343.
- Han Y, Kim B, Ban J, et al. A randomized trial of Lactobacillus plantarum CJLP133 for the treatment of atopic dermatitis. Pediatr Allergy Immunol 2012; 23:667.
- Adams CA. The probiotic paradox: live and dead cells are biological response modifiers. Nutr Res Rev 2010; 23:37.
- Torii S, Torii A, Itoh K, et al. Effects of oral administration of Lactobacillus acidophilus L-92 on the symptoms and serum markers of atopic dermatitis in children. Int Arch Allergy Immunol 2011; 154:236.
- Gueniche A, Knaudt B, Schuck E, et al. Effects of nonpathogenic gram-negative bacterium Vitreoscilla filiformis lysate on atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled clinical study. Br J Dermatol 2008; 159:1357.
- Kirjavainen PV, Salminen SJ, Isolauri E. Probiotic bacteria in the management of atopic disease: underscoring the importance of viability. J Pediatr Gastroenterol Nutr 2003; 36:223.
- Xiao JZ, Kondo S, Yanagisawa N, et al. Probiotics in the treatment of Japanese cedar pollinosis: a double-blind placebo-controlled trial. Clin Exp Allergy 2006; 36:1425.
- Wang MF, Lin HC, Wang YY, Hsu CH. Treatment of perennial allergic rhinitis with lactic acid bacteria. Pediatr Allergy Immunol 2004; 15:152.
- Ishida Y, Nakamura F, Kanzato H, et al. Clinical effects of Lactobacillus acidophilus strain L-92 on perennial allergic rhinitis: a double-blind, placebo-controlled study. J Dairy Sci 2005; 88:527.
- Helin T, Haahtela S, Haahtela T. No effect of oral treatment with an intestinal bacterial strain, Lactobacillus rhamnosus (ATCC 53103), on birch-pollen allergy: a placebo-controlled double-blind study. Allergy 2002; 57:243.
- Tamura M, Shikina T, Morihana T, et al. Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized double-blind, placebo-controlled clinical trial. Int Arch Allergy Immunol 2007; 143:75.
- Vliagoftis H, Kouranos VD, Betsi GI, Falagas ME. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol 2008; 101:570.
- Zajac AE, Adams AS, Turner JH. A systematic review and meta-analysis of probiotics for the treatment of allergic rhinitis. Int Forum Allergy Rhinol 2015; 5:524.
- Lue KH, Sun HL, Lu KH, et al. A trial of adding Lactobacillus johnsonii EM1 to levocetirizine for treatment of perennial allergic rhinitis in children aged 7-12 years. Int J Pediatr Otorhinolaryngol 2012; 76:994.
- Chen YS, Jan RL, Lin YL, et al. Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis. Pediatr Pulmonol 2010; 45:1111.
- Giovannini M, Agostoni C, Riva E, et al. A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res 2007; 62:215.
- Gerasimov SV, Vasjuta VV, Myhovych OO, Bondarchuk LI. Probiotic supplement reduces atopic dermatitis in preschool children: a randomized, double-blind, placebo-controlled, clinical trial. Am J Clin Dermatol 2010; 11:351.
- van der Aa LB, Heymans HS, van Aalderen WM, et al. Effect of a new synbiotic mixture on atopic dermatitis in infants: a randomized-controlled trial. Clin Exp Allergy 2010; 40:795.
- Wu KG, Li TH, Peng HJ. Lactobacillus salivarius plus fructo-oligosaccharide is superior to fructo-oligosaccharide alone for treating children with moderate to severe atopic dermatitis: a double-blind, randomized, clinical trial of efficacy and safety. Br J Dermatol 2012; 166:129.
- van de Pol MA, Lutter R, Smids BS, et al. Synbiotics reduce allergen-induced T-helper 2 response and improve peak expiratory flow in allergic asthmatics. Allergy 2011; 66:39.