Probiotics in the management of atopic eczema

Background Over the last two decades the incidence of allergic diseases has increased in industrialized countries, and consequently new approaches have to be explored. Objective The potential of probiotics to control allergic inflammation at an early age was assessed in a randomized double‐blind placebo‐controlled study. Methods A total of 27 infants, mean age 4.6 months, who manifested atopic eczema during exclusive breast‐feeding and who have had no exposure to any infant or substitute formula were weaned to probiotic‐supplemented, Bifidobacterium lactis Bb‐12 or Lactobacillus strain GG (ATCC 53103), extensively hydrolysed whey formulas or to the same formula without probiotics. The extent and severity of atopic eczema, the growth and nutrition of infants, and concentrations of circulating cytokines/chemokines and soluble cell surface adhesion molecules in serum and methyl‐histamine and eosinophilic protein X in urine were determined. Results The SCORAD score reflecting the extent and severity of atopic eczema was 16 (7–25) during breast‐feeding, median (interquartile range). After 2 months, a significant improvement in skin condition occurred in patients given probiotic‐supplemented formulas, as compared to the unsupplemented group; χ 2 = 12.27, P = 0.002. SCORAD decreased in the Bifidobacterium lactis Bb‐12 group to 0 (0–3.8), and in the Lactobacillus GG group to 1 (0.1–8.7), vs unsupplemented 13.4 (4.5–18.2), median (interquartile range), in parallel with a reduction in the concentration of soluble CD4 in serum and eosinophilic protein X in urine. Conclusion The results provide the first clinical demonstration of specific probiotic strains modifying the changes related to allergic inflammation. The data further indicate that probiotics may counteract inflammatory responses beyond the intestinal milieu. The combined effects of these probiotic strains will guide infants through the weaning period, when sensitization to newly encountered antigens is initiated. The probiotic approach may thus offer a new direction in the search for future foods for allergy treatment and prevention strategies.