Probiotics and prebiotics in atopic dermatitis: Review of the theoretical background and clinical evidence: Review Article

Department of Pediatric Respiratory Medicine, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Pediatric Allergy and Immunology (Impact Factor: 3.4). 08/2009; 21(2 Pt 2):e355-67. DOI: 10.1111/j.1399-3038.2009.00915.x
Source: PubMed


van der Aa LB, Heymans HSA, van Aalderen WMC, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence. Pediatr Allergy Immunol 2010: 21: e355–e367. © 2009 John Wiley & Sons A/S
The prevalence of atopic dermatitis (AD) has risen over the past decades, especially in western societies. According to the revised hygiene hypothesis this increase is caused by a changed intestinal colonization pattern during infancy, which has an impact on the immune system. Manipulating the intestinal microflora with pro-, pre- or synbiotics is an innovative way to prevent or treat AD. This review provides an overview of the theoretical basis for using probiotics and prebiotics in AD and presents the current evidence from randomized controlled trials (RCTs) regarding prevention and treatment of AD and food allergy in children with pro-, pre- and synbiotics. Seven RCTs on prevention and 12 RCTs on treatment were found by searching the Pubmed, Embase and Cochrane databases. Results of these trials are conflicting. In conclusion, at this moment there is not enough evidence to support the use of pro-, pre- or synbiotics for prevention or treatment of AD in children in clinical practice.

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    • "For instance, the increasing prevalence of allergies in the developed world could be partially explained by the 'hygiene hypothesis' (Strachan, 1989). This hypothesis postulates that improved hygiene, healthcare and smaller families leads to a decrease in antigen exposure, including bacteria and fungi, thereby affecting immune development of infants and children (Van der Aa et al., 2010). The lack of bacterial exposure skews the immune response to a more IgE-mediated T H 2-response, which is associated with allergies and other pathologies. "
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    ABSTRACT: This study aimed to systematically evaluate safety of probiotics and synbiotics in children ageing 0-18 years. This study is the third and final part in a safety trilogy and an update is provided using the most recent available clinical data (2008-2013) by means of the Common Terminology Clinical Adverse Events (CTCAE version 4.0) classification. Safety aspects are represented and related to number of participants per probiotic strain/culture, study duration, dosage, clinical condition and selected afflictions. Analysis of 74 clinical studies indicated that probiotic and/or synbiotic administration in children is safe with regard to the specific evaluated strains, dosages and duration. The population of children include healthy, immune compromised and obese subjects, as well as subjects with intestinal disorders, infections and inflammatory disorders. This study revealed no major safety concerns, as the adverse events (AEs) were unrelated, or not suspected to be related, to the probiotic or synbiotic product. In general the study products were well tolerated. Overall, AEs occurred more frequent in the control arm compared to children receiving probiotics and/or synbiotics. Furthermore, the results indicate inadequate reporting and classification of AEs in the majority of the studies. In addition, generalizability of conclusions are greatly limited by the inconsistent, imprecise and potentially incomplete reporting as well as the variation in probiotic strains, dosages, administration regimes, study populations and reported outcomes.
    Beneficial Microbes 03/2015; 1(-1):1-16. DOI:10.3920/BM2014.0157 · 2.61 Impact Factor
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    • "Moreover, Lactobacillus was shown to inhibit S. aureus growth and to improve the epithelial barrier function9,15,16. However, a study on the ex-vivo immunomodulatory effects of probiotics in children with AD returned inconclusive results17. Most of the studies on Lactobacillus used the L. rhamnosus strain to evaluate the clinical and immunological responses. "
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    ABSTRACT: BackgroundAtopic dermatitis (AD) patients suffer from xerosis. Proper skin care, including the use of emollients, may help improve xerosis and minimize disease exacerbation. Lactobacillus sakei probio 65, isolated from the Korean vegetable-based product kimchi, can decrease interleukin 4 and immunoglobulin E levels and inhibit Staphylococcus aureus. Moreover, it has reportedly shown positive dermatological effects in both animal and clinical studies.ObjectiveTo compare the effects of an emollient that contains Lactobacillus (treated) with a normal emollient (control) on AD.MethodsThis double-blind, randomized, split-body clinical trial involved 28 patients with AD. The patients applied the Lactobacillus-containing emollient on one side of their body and the control emollient on the other side twice daily for 4 weeks. Trans-epidermal water loss (TEWL) and skin capacitance were evaluated and investigator global assessment and the visual analogue scale (VAS) were administered on weeks 0, 1, 2, and 4.ResultsThe treated sides had significantly lower TEWL and VAS values and significantly higher skin capacitance values over time than the control sides.ConclusionTopical application of Lactobacillus-containing emollients may improve the skin permeability of patients with AD.
    Annals of Dermatology 04/2014; 26(2):150-5. DOI:10.5021/ad.2014.26.2.150 · 1.39 Impact Factor
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    • "Prenatal supplementation of pregnant women did not result in reduction of AD incidence in infants: incidence of AD and IgE-associated eczema in 1-yaer old infants at high risk for atopic diseases, born to 250 mothers supplemented with LGG from the 36th week of gestation to delivery, did not show a significant reduction respect to mothers who have not been supplemented [38]. Some recently published reviews and meta-analysis, including a Cochrane Collaboration review, concluded that there is still insufficient evidence for supporting the use of probiotics in the prevention of AD [39,40,41,42], whereas some others, including the most recently published one, stated that convincing evidence exists for encouraging supplementation with probiotics for the prevention of AD in children [43,44,45,46]. "
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    ABSTRACT: There is increasing interest in the potential beneficial role of probiotic supplementation in the prevention and treatment of atopic diseases in children. Probiotics are defined as ingested live microorganisms that, when administered in an adequate amount, confer a health benefit to the host. They are mainly represented by Lactobacilli and Bifidobacteria. Several epidemiological data demonstrate that intestinal microflora of atopic children is different from the one of healthy children. Many literature data show that probiotics may modulate the intestinal microflora composition and may have immunomodulatory effect. Based on this hypothesis, probiotics are supposed to confer benefits to allergic diseases. Administration of probiotics when a natural population of indigenous intestinal bacteria is still developing could theoretically influence immune development by favoring the balance between Th1 and Th2 inflammatory responses. For this reason, some studies have evaluated the potential impact of probiotics supplementation in the prevention of atopic dermatitis, with contrasting results. Clinical improvement in immunoglobulin (Ig)E-sensitized (atopic) eczema following probiotic supplementation has been reported in some published studies and the therapeutic effects of probiotics on atopic dermatitis seemed to be encouraging. However, as far as the usefulness of probiotics as a prevention strategy is concerned, results are still inconclusive. In fact, the clinical benefits of probiotic therapy depend upon numerous factors, such as the type of bacteria, dosing regimen, delivery method and other underlying host factors, such as age and diet. More studies are still needed to definitively prove the role of probiotics in the treatment of allergic eczema.
    Pharmaceuticals 12/2012; 5(7):727-744. DOI:10.3390/ph5070727
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