Microbial Host-Interaction: Tolerance versus Allergy

64th Nestlé Nutrition Institute Workshop, Pediatric Program, Sydney, November 2008

Editor(s): Brandtzaeg P. (Oslo) 
Isolauri E. (Turku) 
Prescott S.L. (Perth, W.A.) 
Table of Contents
Vol. 64, No. , 2009
Section title: Nutrition and Immunological Homeostasis
Brandtzaeg P, Isolauri E, Prescott SL (eds): Microbial–Host Interaction: Tolerance versus Allergy. Nestlé Nutr Inst Workshop Ser Pediatr Program, vol 64, pp 219–238, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2009

Probiotics and Prebiotics: Immunological and Clinical Effects in Allergic Disease

Tang M.L.K.
Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Vic., Australia

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The intestinal microbiota plays an important role in immune development and may play a role in the development of allergic disorders. Manipulation of the intestinal microbiota may therefore offer an approach to the prevention or treatment of allergic diseases. Probiotics and prebiotics, used alone or together (synbiotics), can influence the intestinal microbiota and modulate immune responses in vitro and in vivo. Clinical studies suggest a potential role for selected probiotics (alone or in combination with prebiotics) in the prevention of atopic eczema. A prenatal component of treatment appears important for beneficial effects. Effects are dependent upon the specific bacteria and characteristics of the study population. One study reported beneficial effects for prebiotics in the prevention of eczema in high-risk infants, however, further studies are required to confirm this. The use of probiotics in the treatment of allergic disease is less promising. A Cochrane meta-analysis concluded that probiotics are not effective for the treatment of atopic dermatitis. Probiotic effects in the treatment of asthma and allergic rhinitis are conflicting. Probiotics, prebiotics and synbiotics offer potential treatments for the prevention of atopic eczema; however, there is currently insufficient evidence to recommend their use in clinical practice. Studies to clarify the optimal dose, bacterial species/strains, whether there is added benefit with synbiotics, the optimal timing for intervention, and the patient populations who would benefit most from such therapies are warranted.

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  1. Tang MLK: Immune effects of probiotic bacteria. (eds) Lee YK, Salminen S, Nomoto K: Handbook of Probiotics and Probiotics 2New York, Wiley, 2008;
  2. Bjorksten B, Naaber P, Sepp E, et al: The intestinal microflora in allergic Estonian and Swedish 2-year-old children. Clin Exp Allergy 1999;29:342-346
  3. Watanabe S, Narisawa Y, Arase S, et al: Differences in fecal microflora between patients with atopic dermatitis and healthy control subjects. J Allergy Clin Immunol 2003;111:587-591
  4. Kalliomäki M, Kirjavainen P, Eerola E, et al: Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol 2001;107:129-134
  5. Bjorksten B, Sepp E, Julge K, et al: Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol 2001;108:516-520
  6. Sepp E, Julge K, Vasar M, et al: Intestinal microflora of Estonian and Swedish infants. Acta Paediatr 1997;86:956-961
  7. Penders J, Thijs C, van den Brandt PA, et al: Gut microbiota composition and development of atopic manifestations in infancy: the KOALA Birth Cohort Study. Gut 2007;56:661-667
  8. Ouwehand AC, Isolauri E, He F, et al: Differences in Bifidobacterium flora composition in allergic and healthy infants. J Allergy Clin Immunol 2001;108:144-145
  9. Stsepetova J, Sepp E, Julge K, et al: Molecularly assessed shifts of Bifidobacterium ssp. and less diverse microbial communities are characteristic of 5-year-old allergic children. FEMS Immunol Med Microbiol 2007;51:260-269
  10. Suzuki S, Shimojo N, Tajiri Y, et al: Differences in the composition of intestinal Bifidobacterium species and the development of allergic diseases in infants in rural Japan. Clin Exp Allergy 2007;37:506-511
  11. Gore C, Munro K, Lay C, et al: Bifidobacterium pseudocatenulatum is associated with atopic eczema: a nested case-control study investigating the fecal microbiota of infants. J Allergy Clin Immunol 2008;121:135-140
  12. Wang M, Karlsson C, Olsson C, et al: Reduced diversity in the early fecal microbiota of infants with atopic eczema. J Allergy Clin Immunol 2008;121:129-134
  13. Hart AL, Lammers K, Brigidi P, et al: Modulation of human dendritic cell phenotype and function by probiotic bacteria. Gut 2004;53:1602-1609
  14. von der Weid T, Bulliard C, Schiffrin EJ: Induction by a lactic acid bacterium of a population of CD4(+) T cells with low proliferative capacity that produce transforming growth factor beta and interleukin-10. Clin Diagn Lab Immunol 2001;8:695-701
  15. Braat H, van den Brande J, van Tol E, et al: Lactobacillus rhamnosus induces peripheral hyporesponsiveness in stimulated CD4+ T cells via modulation of dendritic cell function. Am J Clin Nutr 2004;80:1618-1625
  16. Di Giacinto C, Marinaro M, Sanchez M, et al: Probiotics ameliorate recurrent Th1-mediated murine colitis by inducing IL-10 and IL-10-dependent TGF-beta-bearing regulatory cells. J Immunol 2005;174:3237-3246
  17. Pessi T, Sutas Y, Hurme M, et al: Interleukin-10 generation in atopic children following oral Lactobacillus rhamnosus. GG Clin Exp Allergy 2000;30:1804-1808
  18. Rautava S, Kalliomäki M, Isolauri E: Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol 2002;109:119-121
  19. Christensen HR, Frokiaer H, Pestka JJ: Lactobacilli differentially modulate expression of cytokines and maturation surface markers in murine dendritic cells. J Immunol 2002;168:171-178
  20. Miettinen M, Matikainen S, Vuopio-Varkila J, et al: Lactobacilli and streptococci induce inter-leukin-12 (IL-12), IL-18, and gamma interferon production in human peripheral blood mononuclear cells. Infect Immun 1998;66:6058-6062
  21. Pohjavuori E, Viljanen M, Korpela R, et al: Lactobacillus GG effect in increasing IFN-gamma production in infants with cow's milk allergy. J Allergy Clin Immunol 2004;114:131-136
  22. He F, Morita H, Hashimoto H, et al: Intestinal Bifidobacterium species induce varying cytokine production. J Allergy Clin Immunol 2002;109:1035-1036
  23. Maassen CB, van Holten JC, Balk F, et al: Orally administered Lactobacillus strains differentially affect the direction and efficacy of the immune response. Vet Q 1998;20:(suppl 3)181-S83
  24. Isolauri E, Joensuu J, Suomalainen H, et al: Improved immunogenicity of oral D x RRV reassortant rotavirus vaccine by Lactobacillus casei GG. Vaccine 1995;13:310-312
  25. Kaila M, Isolauri E, Soppi E, et al: Enhancement of the circulating antibody secreting cell response inhuman diarrhea by a human Lactobacillus strain. Pediatr Res 1992;32:141-144
  26. Mullie C, Yazourh A, Thibault H, et al: Increased poliovirus-specific intestinal antibody response coincides with promotion of Bifidobacterium longum-infantis and Bifidobacterium breve in infants: a randomized, double-blind, placebo-controlled trial. Pediatr Res 2004;56:791-795
  27. Majamaa H, Isolauri E, Saxelin M, et al: Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr 1995;20:333-338
  28. Macfarlane GT, Steed H, Macfarlane S: Bacterial metabolism and health-related effects of galacto-oligosaccharides and other prebiotics. J Appl Microbiol 2008;104:305-344
  29. Schley PD, Field CJ: The immune-enhancing effects of dietary fibres and prebiotics. Br J Nutr 2002;87:(suppl 2)S221-S230
  30. Nakamura Y, Nosaka S, Suzuki M, et al: Dietary fructooligosaccharides up-regulate immunoglobulin A response and polymeric immunoglobulin receptor expression in intestines of infant mice. Clin Exp Immunol 2004;137:52-58
  31. Hosono A, Ozawa A, Kato R, et al: Dietary fructooligosaccharides induce immunoregulation of intestinal IgA secretion by murine Peyer's patch cells. Biosci Biotechnol Biochem 2003;67:758-764
  32. Nagura T, Hachimura S, Hashiguchi M, et al: Suppressive effect of dietary raffinose on T-helper 2 cell-mediated immunity. Br J Nutr 2002;88:421-426
  33. Yoshida T, Hirano A, Wada H, et al: Alginic acid oligosaccharide suppresses Th2 development and IgE production by inducing IL-12 production. Int Arch Allergy Immunol 2004;133:239-247
  34. Sonoyama K, Watanabe H, Watanabe J, et al: Allergic airway eosinophilia is suppressed in ovalbumin-sensitized Brown Norway rats fed raffinose and alpha-linked galactooligosaccharide. J Nutr 2005;135:538-543
  35. Vos AP, van Esch BC, Stahl B, et al: Dietary supplementation with specific oligosaccharide mixtures decreases parameters of allergic asthma in mice. Int Immunopharmacol 2007;7:1582-1587
  36. Vos AP, Haarman M, Buco A, et al: A specific prebiotic oligosaccharide mixture stimulates delayed-type hypersensitivity in a murine influenza vaccination model. Int Immunopharmacol 2006;6:1277-1286
  37. Roller M, Rechkemmer G, Watzl B: Prebiotic inulin enriched with oligofructose in combination with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis modulates intestinal immune functions in rats. J Nutr 2004;134:153-156
  38. Sepp E, Mikelsaar M, Salminen S: Effect of Lactobacillus casei strain GG administration on the gastrointestinal microbiota of newborns. Microbial Ecol Health Dis 1993;6:309-314
  39. Weston S, Halbert AR, Richmond P, et al: Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005;90:892-897
  40. Bieli C, Eder W, Frei R, et al: A polymorphism in CD14 modifies the effect of farm milk consumption on allergic diseases and CD14 gene expression. J Allergy Clin Immunol 2007;120:1308-1315
  41. Pelto L, Isolauri E, Lilius EM, et al: Probiotic bacteria down-regulate the milk-induced inflammatory response in milk-hypersensitive subjects but have an immunostimulatory effect in healthy subjects. Clin Exp Allergy 1998;28:1474-1479
  42. Rosenfeldt V, Benfeldt E, Nielsen SD, et al: Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol 2003;111:389-395
  43. Sistek D, Kelly R, Wickens K, et al: Is the effect of probiotics on atopic dermatitis confined to food sensitized children?. Clin Exp Allergy 2006;36:629-633
  44. Viljanen M, Savilahti E, Haahtela T, et al: Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy 2005;60:494-500
  45. Kalliomäki M, Salminen S, Arvilommi H, et al: Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 2001;357:1076-1079
  46. Abrahamsson TR, Jakobsson T, Bottcher MF, et al: Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 2007;119:1174-1180
  47. Kopp MV, Hennemuth I, Heinzmann A, et al: Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention: no clinical effects of Lactobacillus GG supplementation. Pediatrics 2008;121:e850-e856
  48. Kukkonen K, Savilahti E, Haahtela T, et al: Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol 2007;119:192-198
  49. Rautava S, Arvilommi H, Isolauri E: Specific probiotics in enhancing maturation of IgA responses in formula-fed infants. Pediatr Res 2006;60:221-224
  50. Soh SE, Aw M, Gerez I, et al: Probiotic supplementation in the first 6 months of life in at risk Asian infants - effects on eczema and atopic sensitization at age of 1 year. Clin Exp Allergy 2009;39:571-578
  51. Taylor AL, Dunstan JA, Prescott SL: Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol 2007;119:184-191
  52. Wickens K, Black PN, Stanley TV, et al: A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 2008;122:788-794
  53. Kalliomäki M, Salminen S, Poussa T, et al: Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003;361:1869-1871
  54. Kalliomäki M, Salminen S, Poussa T, et al: Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol 2007;119:1019-1021
  55. Huurre A, Laitinen K, Rautava S, et al: Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double-blind placebo-controlled study. Clin Exp Allergy 2008;38:1342-1348
  56. Osborn DA, Sinn J: Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev 2007;4:CD006475
  57. Arslanoglu S, Moro GE, Schmitt J, et al: Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutr 2008;138:1091-1095
  58. Moro G, Arslanoglu S, Stahl B, et al: A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age. Arch Dis Child 2006;91:814-819
  59. Ziegler E, Vanderhoof J, Petschow B, et al: Term infants fed formula supplemented with selected blends of prebiotics grow normally and have soft stools similar to those reported for breast fed infants. J Pediatr Gastroenterol Nutr 2007;44:359-364
  60. Osborn DA, Sinn J: Prebiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev 2007;4:CD006474
  61. Hattori K, Yamamoto A, Sasai M, et al: Effects of administration of bifidobacteria on fecal microflora and clinical symptoms in infants with atopic dermatitis (in Japanese). Arerugi 2003;52:20-30
  62. Isolauri E, Arvola T, Sutas Y, et al: Probiotics in the management of atopic eczema. Clin Exp Allergy 2000;30:1604-1610
  63. Majamaa H, Isolauri E: Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179-185
  64. Brouwer ML, Wolt-Plompen SA, Dubois AE, et al: No effects of probiotics on atopic dermatitis in infancy: a randomized placebo-controlled trial. Clin Exp Allergy 2006;36:899-906
  65. Fölster-Holst R, Muller F, Schnopp N, et al: Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol 2006;155:1256-1261
  66. Gruber C, Wendt M, Sulser C, et al: Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy 2007;62:1270-1276
  67. Viljanen M, Pohjavuori E, Haahtela T, et al: Induction of inflammation as a possible mechanism of probiotic effect in atopic eczema-dermatitis syndrome. J Allergy Clin Immunol 2005;115:1254-1259
  68. Passeron T, Lacour JP, Fontas E, et al: Prebiotics and synbiotics: two promising approaches for the treatment of atopic dermatitis in children above 2 years. Allergy 2006;61:431-437
  69. Lee J, Seto D, Bielory L: Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol 2008;121:116-121
  70. Boyle RJ, Bath-Hextall F, Murrell D, et al: Probiotics for treating eczema Cochrane Database. Syst Rev 2008;4:CD006135
  71. Kirjavainen PV, Salminen SJ, Isolauri E: Probiotic bacteria in the management of atopic disease: underscoring the importance of viability. J Pediatr Gastroenterol Nutr 2003;36:223-227
  72. Hol J, van Leer EH, Elink Schuurman BE, et al: The acquisition of tolerance toward cow's milk through probiotic supplementation: a randomized, controlled trial. J Allergy Clin Immunol 2008;121:1448-1454
  73. Flinterman AE, Knol EF, van Ieperen-van Dijk AG, et al: Probiotics have a different immunomodulatory potential in vitro versus ex vivo upon oral administration in children with food allergy. Int Arch Allergy Immunol 2007;143:237-244
  74. Peng GC, Hsu CH: The efficacy and safety of heat-killed Lactobacillus paracasei for treatment of perennial allergic rhinitis induced by house-dust mite. Pediatr Allergy Immunol 2005;16:433-438
  75. Wang MF, Lin HC, Wang YY, et al: Treatment of perennial allergic rhinitis with lactic acid bacteria. Pediatr Allergy Immunol 2004;15:152-158
  76. Ciprandi G, Vizzaccaro A, Cirillo I, et al: Bacillus clausii effects in children with allergic rhinitis. Allergy 2005;60:702-703
  77. Xiao JZ, Kondo S, Yanagisawa N, et al: Effect of probiotic Bifidobacterium longum BBS36 in relieving clinical symptoms and modulating plasma cytokine levels of Japanese cedar pollinosis during the pollen season. A randomized double-blind, placebo-controlled trial. J Investig Allergol Clin Immunol 2006;16:86-93
  78. Tamura M, Shikina T, Morihana T, et al: Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized double-blind, placebo-controlled clinical trial. Int Arch Allergy Immunol 2007;143:75-82
  79. Giovannini M, Agostoni C, Riva E, et al: A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res 2007;62:215-220
  80. Helin T, Haahtela S, Haahtela T: No effect of oral treatment with an intestinal bacterial strain, Lactobacillus rhamnosus (ATCC 53103), on birch-pollen allergy: a placebo-controlled double-blind study. Allergy 2002;57:243-246
  81. Wheeler JG, Shema SJ, Bogle ML, et al: Immune and clinical impact of Lactobacillus acidophilus on asthma. Ann Allergy Asthma Immunol 1997;79:229-233

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