Issue 127

This week
we consider some recent papers on probiotics in respiratory and allergic disease.

Probiotics and immunity

Arbor Clinical Nutrition Updates 2002;127:1-2 ISSN 1446-5450

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NUTRITION RESEARCH REVIEW

Study one: Probiotic milk and respiratory infection Children who take probiotic containing milk may suffer less respiratory infections, according to recent Finnish research. Subjects: 571 healthy children aged 1-6 years from 18 day care centres. Method: Randomised double blind placebo controlled trial where intervention was consumption of milk with or without added lactobacillus GG. Average consumption of both groups was 260 ml/day. Results: There was a significant reduction in the number of days spent away from child care because of illness - see Table. The incidence of respiratory infections with complications or involving the lower respiratory tract was reduced by 17% (p=0.05) and of 19% in the number of respiratory infections treated by antibiotics (p=0.03). However, after adjustment for age, none of these differences remained statistically significant.
Reference: Hatakka K. et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ 2001 Jun 2;322(7298):1327

Study two : Probiotics prevent eczema Another recent trial from Finland found that probiotics given during pregnancy to the mother and then postnatally to the child substantially reduced the incidence of eczema in those children at 2 years of life. Subjects: 159 pregnant women with a first degree family history of atopy. Method: Randomised placebo-controlled trial with active treatment being daily dose of Lactobacillus GG (10x10th colony forming units) for 2-4 weeks prior to expected delivery. Thereafter the mothers had the choice of either continuing to take the probiotic themselves if breastfeeding, or giving it orally to their child. Most mothers chose to give the dose to the infant directly. Results: The frequency of atopic eczema at two years of age was reduced by a half in those children given probiotics (relative risk = 0.51, 95% CI: 0.32-0.84). There were no significant differences between groups in regard to total IgE, RAST readings or pin prick reactivity.
Reference: Kalliomaki M. et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 2001 Apr 7;357(9262):1076-9.

Table: Effect of probiotic milk Age n=

(95% CI)

Probiotic Placebo 4.6 yrs 4.4 yrs 282 289

(44 -55)

Signif.

Absence due to illness 4.9

5.8

(53 -64)

p<0.03

Study three: Probiotics treat eczema Further research from Finland demonstrated a significant improvement from giving probiotics during weaning in infants who had atopic eczema during the period of exclusive breast feeding. Subjects: 27 infants (average age 4.6 months) who had atopic eczema during the time they had been exclusively breast fed. Method: Randomised placebo-controlled trial in which the infants were weaned to extensively hydrolysed whey formulas, either with or without added Bifidobacterium lactis Bb-12 or Lactobacillus strain GG. Comments In our previous issue on probiotics we concluded that the evidence was now very strong that probiotics protect can against and treat diarrhoea of various origins. This conclusion has been reinforced by subsequent reviews and meta-analysis 1. The research summarised in our current issue highlights the potential of probiotics in respiratory and allergic disorders in children. These results are most interesting, although follow up studies are needed. In the first study the differences were no longer statistically significant after adjusting for age, whilst the second and third studies involved small sample sizes. But they are certainly encouraging. A number of possible mechanisms might be involved in such protective effects. It may be that probiotics have a direct immune stimulating effect 2. Alternatively, they may decrease leakage across the gut wall, which can be one element in atopic disease in early childhood. The potential uses that have been proposed for probiotics include: gastrointestinal health, preventing or treating allergic disorders, stimulation of immune function, managing lactose intolerance and helping to prevent cancer 3. We can only await further clinical trials with interest. One issue that such research will need to address is the specificity of particular probiotic species for each clinical indication - the various probiotic species are not all alike in their actions and indications. Safety is another issue, especially so where they are being given to children, pregnant women and patients with

Results: The SCORAD score (reflecting the extent and severity of atopic eczema) was improved in significantly more of the active than placebo treated group (chisquare = 12.27, p=0.002). This was accompanied by a reduction in the concentration of soluble CD4 in serum and eosinophilic protein X in urine.
Reference: Isolauri E. et al. Probiotics in the management of atopic eczema. Clin Exp Allergy 2000 Nov;30(11):1604-10.

compromised immunity. Although the probiotics so far used in clinical trials have generally been described as ' safe 4, there have been some concerns expressed that this needs research, example in the immuno further for compromised 5. References:

1.Szajewska H et al. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr GastroenterolNutr 2001 Oct;33 Suppl 2:S17-25 2. Cross ML et al. Can immunoregulatory lactic acid bacteria be used as dietary supplements to limit allergies? Int Arch Allergy Immunol 2001 Jun;125(2):112-9 3. Kopp-Hoolihan L.. Prophylactic and therapeutic uses of probiotics: a review. J Am Diet Assoc 2001 Feb;101(2):229-38 4. Ishibashi N et al. Probiotics and safety. Am J Clin Nutr 2001 Feb;73(2 Suppl):465S-470S 5. Murch SH.. Toll of allergy reduced by probiotics. Lancet. 2001 Apr 7;357(9262):1057-9.

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