Perinatal Probiotic Protects Against Eczema up to Four Years

Laurie Barclay, MD

May 30, 2003

May 30, 2003 — Perinatal administration of the probiotic Lactobacillus GG reduced the risk of children developing eczema up to age four, according to the results of a randomized, placebo-controlled trial published in the May 31 issue of The Lancet. Protection in this trial extended two years longer than reported previously.

"Our findings show that the preventive effect of Lactobacillus GG on atopic eczema in at-risk children extends to the age of four years," lead author Marko Kalliomäki, from Turku University Central Hospital in Finland, says in a news release. "This age, however, does not yet allow final assessment of any effect on respiratory allergic diseases, since these typically manifest themselves at an older age."

One theory for the increasing incidence of atopic disease in well-developed countries is the hygiene hypothesis, which suggests that reduced bacterial exposure in early life impedes full development of the immune system. Lactobacillus GG is a probiotic that is safe to ingest in infancy and effective in the treatment of allergic inflammation and food allergy. An earlier study by the Finnish group, reported two years ago in The Lancet, showed that infants given Lactobacillus GG had half the incidence of atopic eczema at two years of age compared with infants given placebo.

In this four-year follow-up study, atopic eczema developed in 14 of 53 children receiving lactobacillus perinatally compared with 25 of 54 receiving placebo (relative risk, 0.57; 95% confidence interval, 0.33 - 0.97). Skin prick test reactivity was the same in both groups.

In both studies, exposure to probiotics did not protect against development of asthma or rhinitis. However, the concentration of exhaled nitric oxide was significantly greater in children receiving placebo than in those receiving Lactobacillus GG, suggesting that the placebo group may have had more underdiagnosed or subclinical cases of respiratory disease.

"Distinct causes and pathogenic mechanisms underlie the heterogeneous manifestations of allergy. The immunological effects of probiotic strains also vary, even within the same species," the authors write. "Since the probiotic approach was promising and safe, future studies should focus on detection of new potential successful probiotic strains to be applied in combinations when combating allergic diseases."

The authors declared no financial conflicts of interest.

Lancet. 2003;361:1869-1871

Reviewed by Gary D. Vogin, MD

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