title: Probiotics: a novel approach in the management of food allergy. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. Probiotic effects on faecal inflammatory markers and on faecal IgA in food allergic atopic eczema/dermatitis syndrome infants. Development of allergen-specific T-cell memory in atopic and normal children Probiotics in the management of atopic eczema Pediatric atopic eczema: the impact of an educational intervention. Interleukin‐10 generation in atopic children following oral Lactobacillus rhamnosus GG A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. Developmental cytokine response profiles and the clinical and immunologic expression of atopy during the first year of life.
abstract: BACKGROUND The gastrointestinal microflora is an important constituent of the gut mucosal defense barrier . We have previously shown that a human intestinal floral strain , Lactobacillus GG ( ATCC 53103 ) , promotes local antigen-specific immune responses ( particularly in the IgA class ) , prevents permeability defects , and confers controlled antigen absorption . OBJECTIVE The aim of this study was to evaluate the clinical and immunologic effects of cow 's milk elimination without ( n = 14 ) and with ( n = 13 ) the addition of Lactobacillus GG ( 5 x 10(8 ) colony-forming units/gm formula ) in an extensively hydrolyzed whey formula in infants with atopic eczema and cow 's milk allergy . The second part of the study involved 10 breast-fed infants who had atopic eczema and cow 's milk allergy . In this group Lactobacillus GG was given to nursing mothers . METHODS The severity of atopic eczema was assessed by clinical scoring . The concentrations of fecal alpha 1- antitrypsin , tumor necrosis factor-alpha , and eosinophil cationic protein were determined as markers of intestinal inflammation before and after dietary intervention . RESULTS The clinical score of atopic dermatitis improved significantly during the 1-month study period in infants treated with the extensively hydrolyzed whey formula fortified with Lactobacillus GG . The concentration of alpha 1-antitrypsin decreased significantly in this group ( p = 0.03 ) but not in the group receiving the whey formula without Lactobacillus GG ( p = 0.68 ) . In parallel , the median ( lower quartile to upper quartile ) concentration of fecal tumor necrosis factor-alpha decreased significantly in this group , from 709 pg/gm ( 91 to 1131 pg/gm ) to 34 pg/gm ( 19 to 103 pg/gm ) ( p = 0.003 ) , but not in those receiving the extensively hydrolyzed whey formula only ( p = 0.38 ) . The concentration of fecal eosinophil cationic protein remained unaltered during therapy . CONCLUSION These results suggest that probiotic bacteria may promote endogenous barrier mechanisms in patients with atopic dermatitis and food allergy , and by alleviating intestinal inflammation , may act as a useful tool in the treatment of food allergy A mixture of neutral short-chain galactooligosaccharides ( scGOS ) and long-chain fructooligosaccharides ( lcFOS ) has been shown to reduce the incidence of atopic dermatitis ( AD ) and infectious episodes during the first 6 mo of life . This dual protection occurred through the intervention period . The present study evaluated if these protective effects were lasting beyond the intervention period . In a prospect i ve , r and omized , double-blind , placebo-controlled design , healthy term infants with a parental history of atopy were fed either a prebiotic-supplemented ( 8 g/L scGOS/lcFOS ) or placebo-supplemented ( 8 g/L maltodextrin ) hypoallergenic formula during the first 6 mo of life . Following this intervention period , blind follow-up continued until 2 y of life . Primary endpoints were cumulative incidence of allergic manifestations . Secondary endpoints were number of infectious episodes and growth .  Of 152 participants , 134 infants ( 68 in placebo , 66 in intervention group ) completed the follow-up . During this period , infants in the scGOS/lcFOS group had significantly lower incidence of allergic manifestations . Cumulative incidences for AD , recurrent wheezing , and allergic urticaria were higher in the placebo group , ( 27.9 , 20.6 , and 10.3 % , respectively ) than in the intervention group ( 13.6 , 7.6 , and 1.5 % ) ( P < 0.05 ) . Infants in the scGOS/lcFOS group had fewer episodes of physician-diagnosed overall and upper respiratory tract infections ( P < 0.01 ) , fever episodes ( P < 0.00001 ) , and fewer antibiotic prescriptions ( P < 0.05 ) . Growth was normal and similar in both groups . Early dietary intervention with oligosaccharide prebiotics has a protective effect against both allergic manifestations and infections . The observed dual protection lasting beyond the intervention period suggests that an immune modulating effect through the intestinal flora modification may be the principal mechanism of action Probiotic bacteria are proposed to alleviate intestinal inflammation in infants with atopic eczema/dermatitis syndrome ( AEDS ) and food allergy . In such infants we investigated effects of probiotic bacteria on faecal IgA , and on the intestinal inflammation markers tumour necrosis factor-alpha ( TNF-alpha ) , alpha1-antitrypsin ( AT ) , and eosinophil cationic protein ( ECP ) . A total of 230 infants with AEDS and suspected cow 's milk allergy ( CMA ) received in a r and omized double-blinded manner , concomitant with elimination diet , Lactobacillus GG ( LGG ) , a mixture of four probiotic strains ( MIX ) , or placebo for 4 wk . Four weeks after treatment , CMA was diagnosed with a double-blind placebo-controlled milk challenge . Faecal sample s of 102 infants , r and omly chosen for analysis , were collected before treatment , after 4-wk treatment , and on the first day of milk challenge . After treatment , IgA levels tended to be higher in probiotic groups than in the placebo group ( LGG vs. placebo , p=0.064 ; MIX vs. placebo , p=0.064 ) , and AT decreased in the LGG group , but not in other treatment groups . After challenge in IgE-associated CMA infants , faecal IgA was higher for LGG than for placebo ( p=0.014 ) , and TNF-alpha was lower for LGG than for placebo , but non-significantly ( p=0.111 ) . In conclusion , 4-wk treatment with LGG may alleviate intestinal inflammation in infants with AEDS and CMA BACKGROUND In the past 20 - 30 years , there has been an increase in prevalence of allergic respiratory diseases , particularly amongst children . This study is a prospect i ve analysis of the postnatal maturation of T-helper cell ( Th ) responses to aeroallergens in atopic and non-atopic infants . METHODS We measured mononuclear-cell proliferative and cytokine responses to specific allergens and tetanus toxoid in blood sample s from atopic and non-atopic infants every 6 months from birth to 2 years of age . Cytokine analyses of responses to housedust-mite allergen used ELISA and reverse-transcriptase PCR . We also measured responses to Fel d1 ( cat allergen ) and tetanus toxoid . FINDINGS Sample s from 18 atopic and 13 non-atopic infants showed low-level Th2-skewed allergen-specific responses at birth , with little accompanying specific interferon-gamma production . Neonatal Th2 responses were lower in the atopic group than in the non-atopic group ; the differences were significant for interleukin-4 ( mRNA : beta-actin ratio 0.48 [ SE 0.15 ] vs 0.15 [ 0.06 ] , p=0.049 ) , interleukin-6 ( 4750 [ 48 ] vs 1352 [ 51 ] pg/mL culture fluid , p=0.003 ) , interleukin-10 ( 1162 [ 228 ] vs 485 [ 89 ] , p=0.015 ) , and interleukin-13 ( 7.1 [ 0.9 ] vs 0.9 [ 0.3 ] , p=0.008 ) . There was rapid suppression of Th2 responses during the first year of life in non-atopic children , but there was consolidation of responses in atopic children , associated with defective neonatal interferon-gamma production . INTERPRETATION The continuation of fetal allergen-specific Th2 responses during infancy is a defining feature of the inductive phase of atopic disease , and is associated with decreased capacity for production of the Th1 cytokine interferon y by atopic neonates . These findings provide a plausible mechanism for persistence of the fetal Th2 responses during early childhood in atopic individuals and subsequent expression of disease Over the last two decades the incidence of allergic diseases has increased in industrialized countries , and consequently new approaches have to be explored Patient education has been regarded as having a key role in the self-management of atopic eczema . However , the relationship between the educational interventions and clinical outcomes including severity of eczema , quality of life , and family impact has not been rigorously examined . The purpose of this longitudinal r and omized controlled study was to evaluate the impact of an intensive education program with a focus on dermatology and immunology design ed for parents and children diagnosed with atopic eczema . The intention of this study was not to change treatment regimes prescribed by the patient 's physician . The Scoring Atopic Dermatitis rating system was used for assessment of disease impact , and the impact on quality of life was quantified by using the Children 's Dermatology Life Quality Index , Infants ' Dermatology Quality of Life Index , and Dermatitis Family Impact .  A total of 61 pediatric patients ( 0 - 16 years ) diagnosed with atopic eczema from the metropolitan area of Adelaide were r and omized to either the control or intervention group . Results of the study showed that the intervention group had a significant improvement in the scoring atopic dermatitis measure when compared to the control group at week 4 and week 12 . Quality of life measures did not significantly improve with decreased severity of eczema except in the group of children aged 5 - 16 years which , despite small numbers , showed a significant improvement in quality of life scores . These findings suggest that education provides an important role in decreasing the severity of eczema Oral  Lactobacillus rhamnosus GG ingestion for 5 days to 4 weeks has been shown to alleviate clinical symptoms of gastrointestinal inflammation and atopic dermatitis BACKGROUND The role of probiotics in prevention of allergic disease is still not clearly established , although early reports suggested Lactobacillus GG halved the risk of eczema at 2 years . OBJECTIVE To determine whether probiotic supplementation in early life could prevent development of eczema and atopy at 2 years . METHODS Double-blind , r and omized placebo-controlled trial of infants at risk of allergic disease . Pregnant women were r and omized to take Lactobacillus rhamnosus HN001 ( L rhamnosus ) , Bifidobacterium animalis subsp lactis strain HN019 or placebo daily from 35 weeks gestation until 6 months if breast-feeding , and their infants were r and omized to receive the same treatment from birth to 2 years ( n = 474 ) . The infant 's cumulative prevalence of eczema and point prevalence of atopy , using skin prick tests to common allergens , was assessed at 2 years . RESULTS Infants receiving L rhamnosus had a significantly ( P = .01 ) reduced risk of eczema ( hazard ratio [ HR ] , 0.51 ; 95 % CI , 0.30 - 0.85 ) compared with placebo , but this was not the case for B animalis subsp lactis ( HR , 0.90 ; 95 % CI , 0.58 - 1.41 ) . There was no significant effect of L rhamnosus ( HR , 0.74 ; 95 % CI , 0.46 - 1.18 ) or B animalis subsp lactis ( HR , 0.82 ; 95 % CI , 0.52 - 1.28 ) on atopy . L rhamnosus ( 71.5 % ) was more likely than B animalis subsp lactis ( 22.6 % ) to be present in the feces at 3 months , although detection rates were similar by 24 months . CONCLUSION We found that supplementation with L rhamnosus , but not B animalis subsp lactis , substantially reduced the cumulative prevalence of eczema , but not atopy , by 2 years . Underst and ing how Lactobacilli act to prevent eczema requires further investigation BACKGROUND Allergic diseases have been linked to abnormal patterns of immune development , and this has stimulated efforts to define the precise patterns of cytokine dysregulation that are associated with specific atopic phenotypes . OBJECTIVE Cytokine-response profiles were prospect ively analyzed over the first year of life and compared with the clinical and immunologic expressions of atopy . METHODS Umbilical cord and 1-year P BMC s were obtained from 285 subjects from allergic families .  PHA-stimulated cytokine-response profiles ( IL-5 , IL-10 , IL-13 , and IFN-gamma ) were compared with blood eosinophil counts and total and specific IgE levels ( dust mites , cat , egg , Alternaria species , peanut , milk , and dog ) at age 1 year and at the development of atopic dermatitis and food allergy . RESULTS For the cohort as a whole , cytokine responses did not evolve according to a strict TH1 or TH2 polarization pattern . PHA-stimulated cord blood cells secreted low levels of IL-5 ( 2.1 pg/mL ) , moderate levels of IFN-gamma ( 57.4 pg/mL ) , and greater amounts of IL-13 ( 281.8 pg/mL ) . From birth to 1 year , IL-5 responses dramatically increased , whereas IL-13 and IFN-gamma responses significantly decreased . Reduced cord blood secretion of IL-10 and IFN-gamma was associated with subsequent sensitization to egg . In addition , there was evidence of TH2 polarization ( increased IL-5 and IL-13 levels ) associated with blood eosinophilia and increased total IgE levels by age 1 year . CONCLUSION These findings demonstrate that cytokine responses change markedly during the first year of life and provide further evidence of a close relationship between TH2 skewing of immune responses and the incidence of atopic manifestations in children
target: Conclusion : The administration of a probiotic mixture containing L. acidophilus DDS-1 , B. lactis UABLA- 12 , and fructo-oligosaccharide was associated with significant clinical improvement in children with AD , with corresponding lymphocyte subset changes in peripheral blood .
background: Abstract Background : The role of probiotics in the treatment of atopic dermatitis ( AD ) remains controversial .
  A recent systematic review of the available evidence called for further clinical trials with new probiotic formulations .
  Objective : To assess the clinical efficacy and impact of Lactobacillus acidophilus DDS-1 , Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide on peripheral blood lymphocyte subsets in preschool children with moderate-to-severe AD .