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

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 × 10 8 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.)