Evidence of preventive effect of probiotics and prebiotics for infantile eczema
ABSTRACT Infantile eczema, and in particular atopic dermatitis are, in many children, the first manifestation of their predisposition to an atopic disease. Among existing prevention strategies, supplementation with probiotics and prebiotics belong to the most promising beneficial interventions. Highlighting the most recent literature, we review here the most recent studies on probiotics and prebiotics and hypothesize on the most efficient intervention strategies.
Various probiotics and prebiotics, either alone or in combinations, have been administered, in general, during the late phase of pregnancy and up to 6 months of age. In general, a combination of probiotics and prebiotics given from pregnancy until early infancy has a higher potential for protecting the infant from developing early manifestations of eczema than short administration of one specific microorganism.
The effect of probiotics and prebiotic supplementations on early manifestations of atopy such as infantile eczema are conflicting. Nevertheless, prevention strategies should aim for an enhanced efficacy by addressing not only interventions on the microbiota, but by combining them to other interventions, for example, to those aiming at actively inducing antigen-specific tolerance.
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ABSTRACT: Eosinophilic esophagitis (EoE) was historically distinguished from gastroesophageal reflux disease on the basis of histology and lack of responsiveness to acid suppressive therapy, but it is now appreciated that esophageal eosinophilia can respond to proton pump inhibitors. Genetic and environmental factors contribute to risk for EoE-particularly early-life events. Disease pathogenesis involves activation of epithelial inflammatory pathways (production of eotaxin-3 [encoded by CCL26]), impaired barrier function (mediated by loss of desmoglein-1), increased production and/or activity of transforming growth factor-β, and induction of allergic inflammation by eosinophils and mast cells. Susceptibility has been associated with variants at 5q22 (TSLP) and 2p23 (CAPN14), indicating roles for allergic sensitization and esophageal specific protease pathways. We propose that EoE is a unique disease characterized by food hypersensitivity, strong hereditability influenced by early-life exposures and esophageal specific genetic risk variants, and allergic inflammation and that the disease is remitted by disrupting inflammatory and T-helper type 2 cytokine-mediated responses and through dietary elimination therapy. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.Gastroenterology 02/2015; 148(6). DOI:10.1053/j.gastro.2015.02.002 · 13.93 Impact Factor
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ABSTRACT: Eosinophilic esophagitis (EoE) is an allergic disorder characterized by eosinophil-predominant esophageal inflammation, which can be ameliorated by food antigen restriction. Though recent studies suggest that changes in dietary composition may alter the distal gut microbiome, little is currently known about the impact of a restricted diet upon microbial communities of the oral and esophageal microenvironments in the context of EoE. We hypothesize that the oral and esophageal microbiomes of EoE patients are distinct from non-EoE controls, that these differences correspond to changes in esophageal inflammation, and that targeted therapeutic dietary intervention may influence community structure. Using 16S rRNA gene sequencing, we characterized the bacterial composition of the oral and esophageal microenvironments using oral swabs and esophageal biopsies from 35 non-EoE pediatric controls and compared this cohort to samples from 33 pediatric EoE subjects studied in a longitudinal fashion before and after defined dietary changes. Firmicutes were more abundant in esophageal samples compared to oral. Proportions of bacterial communities were significantly different comparing all EoE esophageal microbiota to non-EoE controls, with enrichment of Proteobacteria, including Neisseria and Corynebacterium in the EoE cohort, and predominance of the Firmicutes in non-EoE control subjects. We detected a statistically significant difference between actively inflamed EoE biopsies and non-EoE controls. Overall, though targeted dietary intervention did not lead to significant differences in either oral or esophageal microbiota, reintroduction of highly allergenic foods led to enrichment in Ganulicatella and Campylobacter genera in the esophagus. In conclusion, the esophageal microbiome in EoE is distinct from that of non-EoE controls, with maximal differences observed during active allergic inflammation.06/2015; 3(1):23. DOI:10.1186/s40168-015-0085-6