Effect of probiotic Lactobacillus strains in children with atopic dermatitis.
J Allergy Clin Immunol 2003 Feb;111(2):389-95
Rosenfeldt V, Benfeldt E, Nielsen SD, Michaelsen KF, Jeppesen DL, Valerius NH, Paerregaard A. Research Department of Human Nutrition and the LMC Center for Advanced Food Studies, The Royal Veterinary and Agricultural University, Copenhagen, Denmark.
Summary and comments by Mary Ellen Sanders
The incidence of allergy in industrialized countries has been on the rise in recent decades. This rise is hypothesized to be due to environmental factors, because genetic factors would not be expected to change in this short of a time frame. Oral probiotic therapy is one intervention being evaluated for a role in the management of atopic dermatitis.
In this current double-blind, placebo-controlled, crossover study, Rosenfeldt and colleagues tested the impact of a probiotic preparation comprised of dried Lactobacillus rhamnosus 19070-2 and Lactobacillus reuteri DSM 122460 on clinical and anti-inflammatory indicators in children. The probiotic preparation was administered for 6 weeks to children 1 to 13 years of age diagnosed with atopic dermatitis.
During the study, several parameters were measured:
- Subjective evaluation by each patient, indicating if their condition was better, unchanged, or worse
- The clinical severity of the eczema was evaluated by a validated research tool known as the scoring atopic dermatitis (SCORAD) tool
- Inflammation was measured using biomarkers, eosinophil cationic protein in serum and cytokine production by peripheral blood mononuclear cells
After treatment with the probiotic, 56% of the patients reported improved eczema compared to 15% in the placebo group. These results were statistically valid. When data from patients with at least one positive skin prick test and elevated IgE levels were considered separately, the SCORAD rating was lower in the probiotic group. However, the SCORAD index showed no statistically valid difference between the probiotic and placebo when data from all subjects were included. Therefore, the treatment was more effective in allergic (at least one positive skin prick test response and elevated IgE levels) than non-allergic patients. During active treatment, most of the indicators of inflammation (cytokines IL-2, IL-4, IL-10, or IFN-gamma) were unchanged. The exception was a decrease in serum eosinophil cationic protein levels.
The authors concluded that a combination of L. rhamnosus 19070-2 and L. reuteri DSM 122460 was beneficial in the management of atopic dermatitis, especially in patients with a positive skin prick test response and increased IgE levels.
This same probiotic preparation was tested by this research group in two previous studies on infectious diarrhea in children (Rosenfeldt et al. 2002. Pediatr Infect Dis J. 21:411-6; Rosenfeldt, et al. 2002. Pediatr Infect Dis J. 21:417-9). The first study reported on the ability of these probiotics to promote recovery from rotavirus enteritis in hospitalized children. Interestingly, the effects were more pronounced in children treated early in the diarrheal phase. The study followed 69 hospitalized children diagnosed with acute diarrhea. Administration of 1010 cfu of each strain (L. rhamnosus 19070-2 and L. reuteri DSM 122460) twice daily for 5 days promoted resolution of acute diarrhea in hospitalized children, reduced the period of rotavirus excretion and was associated with a reduced length of hospital stay.
The other paper reported on the impact of probiotics on non-hospitalized children with mild gastroenteritis. This same probiotic preparation (also used twice daily for 5 days) was given to 43 children (9-44 months) recruited from local day care centers. Subjective assessments were conducted by the parents. The results showed a reduction of duration of diarrhea (76 h in patients treated with probiotics vs. 116 h in the placebo group). Similarly to the study with hospitalized children, the probiotic effect was more pronounced in patients treated early (diarrhea <60 hours prior to start of treatment).
The authors concluded that children from day-care centers with mild gastroenteritis benefited from the tested probiotic preparation in reducing the duration of diarrhea early in the diarrheal phase.