Probiotics: A novel approach in the management of food allergy,☆☆,,★★

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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 × 108 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 α 1-antitrypsin, tumor necrosis factor-α, 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 α 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-α 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. (J Allergy Clin Immunol 1997;99:179-85.)

Section snippets

Patients and study design

In the first part of the study 31 infants, aged 2.5 to 15.7 months, fulfilling the Hanifin criteria18 for atopic eczema in infants, were evaluated. They had been referred to a pediatric clinic because of atopic eczema and a clinical history suggestive of cow's milk allergy. In addition to atopic eczema, gastrointestinal disturbances such as loose stools, vomiting, or diarrhea were seen in six (19%) patients. A positive family history of atopic diseases (asthma, atopic eczema, and allergic

Clinical data

The mean (95% CI) age at onset of symptoms of atopic eczema was 2.4 months (1.4 to 3.3 months) in patients in the first part of the study (n = 27). The durations of exclusive and total breast-feeding were 2.8 months (2.1 to 3.5 months) and 5.9 months (4.5 to 7.2 months), respectively. The mean (95% CI) serum total IgE was 31 kU/L (15 to 61 kU/L). RAST for cow's milk was positive (>0.4 kU/L) in 10 patients (37%). The result of skin prick test with cow's milk was positive in eight patients (30%).

Discussion

Antigen processing in the gut is associated with the generation of oral tolerance.25 There is evidence that during the process of absorption across the intestinal mucosa, antigens are subtly altered into tolerogenic form.26 Newborns lack many specific and nonspecific intestinal features that are necessary for protecting them from environmental antigens.1 In the immature gut, because of an immature mucosal barrier, antigen transfer in intact form is increased,27 an important prerequisite for the

Acknowledgements

We thank Ms. Marjo Leponiemi and Soili Mäkinen-Kiljunen, MSc, for their excellent assistance; Leena Metsäniitty, MSc, for providing extensively hydrolyzed whey formulas from Valio Ltd.; and Maija Saxelin, PhD, for the determinations of Lactobacillus GG concentrations in feces.

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    From the Medical School, University of Tampere and the Department of Pediatrics, Tampere University Hospital.

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    Supported by the Academy of Finland, the Medical Research Fund of Tampere University Hospital, and the Finnish Foundation for Pediatric Research.

    Reprint requests: Erika Isolauri, MD, Medical School, University of Tampere, P.O. Box 607, 33101 Tampere, Finland.

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