A Differential Effect of 2 Probiotics in the Prevention of Eczema and Atopy

Clinical Study Highlight

A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial.

J Allergy Clin Immunol. 2008 Oct;122(4):788-94.

Wickens K, Black PN, Stanley TV, Mitchell E, Fitzharris P, Tannock GW, Purdie G, Crane J.

In August 2008 we posted a clinical highlight discussing conflicting reports on the impact of L. rhamnosus GG on prevention of atopic dermatitis in infants. Using very similar, although not identical, protocols administering the same dose and strain of probiotic (1010 cfu/d L. rhamnosus GG), Kopp et al. (2008) reported no improvement, whereas Kalliomaki et al (2001) reported a 50% decrease in atopic dermatitis when subjects reached 2 years of age. One significant protocol variation was that the Kopp study did not administer probiotic directly to the infant until 3 months of age whereas the Kalliomaki study did so from birth. Both studies gave probiotic to breastfeeding mothers.

Providing additional insight into the role of probiotics in reducing the risk of skin allergy, Wickens et al (2008) reported results from a double-blind, randomized, placebo-controlled trial of eczema and point prevalence of atopy in infants at risk of allergic disease. This was a 3-arm study testing 2 freeze-dried probiotic preparations and a placebo. The probiotics tested were Lactobacillus rhamnosus HN001 (6×109 cfu/d),Bifidobacterium animalis subsp lactis strain HN019 (9×109 cfu/d) or placebo, which were administered daily to breastfeeding mothers from 35 weeks gestation until 6 months and their infants from birth to 2 years. Four hundred seventy-four subjects were randomized into one of the 3 groups. In addition to incidence and severity of eczema, skin prick tests were conducted and fecal samples were collected (birth, 3, 12 and 24 months of age).

Infants receiving L. rhamnosus HN001 had a significantly reduced risk of developing eczema by 2 years (14.8%) compared with infants in the placebo group (26.8%). Furthermore, severity of eczema, as indicated by the SCORAD scoring was also significantly improved by HN001. Even though the B. lactis HN019 strain was delivered at a slightly higher dose than the HN001 strain, it did not reduce the risk of eczema. These results show the strain-specificity of this benefit. Interestingly, the 3 groups did not differ with regard to skin prick test results. Respective percentages of infants carrying L. rhamnosus and B. animalis subsp. lactis, as determined by DNA-based, species-specific methods, were higher in the group consuming each strain. However, this method does not distinguish between live and dead cells, so no conclusion can be made regarding survival of the probiotic through intestinal transit.

These results provide evidence for a strain-specific role for probiotics in reducing the risk of skin allergies when administered to newborn infants from birth.

Kopp MV, Hennemuth I, Heinzmann A, Urbanek R. Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention: no clinical effects of Lactobacillus GG supplementation. Pediatrics. 2008. 121(4):e850-6.

Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001 Apr 7;357(9262):1076-9.