Probiotics and prebiotics (Lactobacillus, Bifidobacterium, Oligofructose) for patients with Atopic allergy, Atopic dermatitis (eczema),Allergic rhinitis, Asthma

BENEFITS OF TAKING MEGAEL-DENA FOR PATIENTS WITH ATOPIC ALLERGY

Many of the microorganisms that inhabit the gastrointestinal tract (commensal microbiota, or commensal microflora) can be considered as our symbionts; their important function is to protect our bodies from invasion by pathogenic microorganisms, either by direct competition or via immunomodulation [1, 2]. The latter mechanism may be particularly important because approximately 70% of immune system cells are located in the gastrointestinal tract [3].

 

Soon after birth, the sterile gastrointestinal tract of a newborn baby is colonized by various microorganisms; colonization is complete after approximately one week, but the numbers and species of intestinal bacteria change considerably in the first several months [4]. Antimicrobial medication, sterile food, and exposure of newborns to “incorrect” sets of microorganisms in hospitals lead to an imbalance between beneficial and harmful bacteria (dysbiosis, or dysbacteriosis) [2, 5, 6]. Dysbiosis is associated with several immunological disorders, including atopic allergy, which is manifested as allergic rhinitis (or rhinoconjunctivitis), atopic dermatitis (atopic eczema), and asthma; the gut microbiota differs in healthy and allergic babies [6].

 

There are multiple regulatory mechanisms that mediate the communication between the commensal microbiota and host. The ability of the microbiota to regulate human immunity is illustrated by a study that involved healthy volunteers, which found that supplementation with L. acidophilus, L. casei, and L. rhamnosus for 7 weeks resulted in changes in the expression of genes involved in regulatory networks that control immunity and mucosal homeostasis [7]. Bacteria may directly interact with intestinal epithelial or immune cells through specific receptors and can also produce bioactive compounds that act as immune modulators [1, 2, 8]. In particular, the microbiota composition may affect the balance between Th1 and Th2 T helper cells; Th2 cells play a central role in the development of atopic allergy [9]. In 80% of atopic allergy patients, the IgE antibodies are also involved [9].

 

One way to help correct disturbances in the intestinal microbiota and their consequences is to use supplements containing probiotics, defined as “microorganisms that have a favorable influence on the host by improving the indigenous microflora” [10]. MegaEl-Dena contains 8 species of viable beneficial bacteria: 4 species of Bifidobacterium (B. bifidum, B. breve, B. lactis, and B. longum), 3 species of Lactobacillus (L. acidophilus, L. casei, and L. rhamnosus), and Streptococcus thermophilus.

There have been multiple clinical studies of the efficiency of probiotics in prevention and management of atopic allergies (reviewed by Kalliomäki and colleagues [6] and Cabana [11]). Some examples of such studies are discussed below.

 

Atopic dermatitis (eczema)

Most available data on the benefits of probiotics in patients with atopic allergy concern atopic dermatitis. Among probiotics, L. rhamnosus (one of the species included in MegaEl-Dena) has been most extensively used.

 

A study conducted in Finland found that pre- (one month) and postnatal (six months of age) administration of L. rhamnosus was associated with a significant reduction in the incidence of atopic dermatitis during the first seven years of life [12, 13]. Likewise, a more recent study conducted in New Zealand compared supplementation with another strain of L. rhamnosus and supplementation with B. lactis. Supplementation was performed either in mothers (from 35 weeks of gestation until six months after birth) or in infants (from birth until two years of age) [14]. The authors reported that both types of supplementation with L. rhamnosus were associated with a reduced prevalence of eczema (by ~50%) at the age of two and four years; significant reduction (by 31–44% depending on the parameter used) persisted at least until the age of six years [14]. In contrast, supplementation with B. lactis had no effect [14].

 

A specific difference between the effects of different bacterial species has also been reported by another Finnish study [15]. This study enrolled infants with atopic dermatitis associated with suspected cow's milk allergy; the patients received either L. rhamnosus, a mixture of four probiotic bacteria, three of which are components of MegaEl-Dena (B. breve and two strains of L. rhamnosus), or placebo for four weeks. In both groups that received probiotics, the severity of dermatitis was reduced similarly by 65%, four weeks after supplementation. However, when IgE-sensitized infants were analyzed separately, the authors found that beneficial effects of L. rhamnosus were more pronounced than those of the probiotic mixture [15].

 

The source of sensitization may also affect the beneficial effects of probiotics in patients with atopic dermatitis, as suggested by a study by Sistek and colleagues [16] which found that supplementation with a combination of L. rhamnosus and B. lactis was associated with reduced severity of dermatitis only in food-sensitized children.

 

Allergic rhinitis

Most studies on the effects of probiotics in patients with allergic rhinitis have been conducted in adults. In contrast to its beneficial effects in patients with atopic dermatitis, L. rhamnosus has been reported to have no effect in patients with allergic rhinitis [17]. However, several other probiotic species have been reported to reduce nasal symptoms and/or to improve the overall quality of life. These include two species that are components of MegaEl-Dena, L. acidophilus [18] and B. longum [19]. Another MegaEl-Dena constituent, L. casei, has been reported to have beneficial effects in pre-school children [20] but not in adults [21] (however, different L. casei strains were used in the two studies).

 

A notable case is the successful use of heat-killed Lactobacillus paracasei in adults with allergic rhinitis induced by house dust mites [22] (L. paracasei is closely related the MegaEl-Dena component L. casei and is considered by some authors as a subspecies of L. casei [23]). The authors reported that the beneficial effects of heat-killed bacteria were indistinguishable from those of live bacteria of the same species. These data imply that at least in this case the underlying mechanism did not rely on correction of dysbiosis but on direct regulation of the immune response by a bacterial antigen.

 

Asthma

The data on the effects of probiotics in patients with asthma are scarce and most studies have not found any significant effects [6, 24]. However, a recent study found positive effects of probiotics in children suffering from concomitant asthma and allergic rhinitis [25], indicating that the field needs further exploration.

 

Thus, the available data suggest that several components of MegaEl-Dena have beneficial effects for patients with atopic dermatitis (L. rhamnosus and possibly B. lactis) and allergic rhinitis (L. acidophilus and B. longum, and possibly L. casei), but probably not for patients with asthma. In most cases of the use of probiotics in patients with atopic allergy, no notable adverse effects have been reported, however on rare occasions probiotics have been reported to increase the risk of wheezing bronchitis or atopic sensitization in high-risk children [6].

References

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  7. van Baarlen, P. et al. Human mucosal in vivo transcriptome responses to three lactobacilli indicate how probiotics may modulate human cellular pathways. Proc Natl Acad Sci U S A 108 Suppl 1, 4562-4569 (2011).
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