Probiotics Reduce Allergic Rhinitis in Children and Adults

Ingrid Hein

June 18, 2020

Breast-fed newborns who receive a supplemental probiotic — Lactobacillus reuteri — are less likely to develop allergic rhinitis later in life, a study of 9-year-old children suggests.

"Adding a probiotic to a child's diet changes the composition of microbiota," said Lilijana Besednjak-Kocijančič, MD, from the Primary Paediatric Health Centre in Nova Gorica, Slovenia.

"The changes are very important for the maturation of a child's immune system," she said during her presentation at the European Academy of Allergy and Clinical Immunology (EAACI) 2020 Digital Congress.

Besednjak-Kocijančič and her colleagues assessed 316 healthy-weight newborns who had parents with test-confirmed allergy.

All infants were breast-fed for 4 to 6 months. "They had the same diet, and the mothers were told to avoid probiotics," Besednjak-Kocijančič said.

The 115 infants in the probiotic group received five drops of L reuteri daily from the age of 4 weeks to 12 weeks. "The drops were put on the mother's nipple, directly to the child's mouth," she explained.

The 201 children in the control group were breast-fed without any supplements. All children were followed by the same pediatrician until they were 9 years of age.

During the follow-up period, 19.6% of the children had developed allergic rhinitis or allergic rhinoconjunctivitis — confirmed with elevated IgE and positive skin-prick tests — at some point.

Children in the probiotic group were three times less likely to develop allergic rhinitis than those in the control group (4.3% vs 13.9%; P ≤ .01).

For allergic rhinoconjunctivitis, the difference was less pronounced (8.7% vs 9.5%; P > .05). "There was a tendency toward lower allergic rhinoconjunctivitis, but not a significant difference," Besednjak-Kocijančič said.

We know that the immune response in the gut can modulate immune responses in distant organs, including the nose, she said. In fact, the frequency of allergic rhinitis and the mean duration of episodes were "significantly lower" in the probiotic group than in the control group (P < .01 for both).

Probiotics for Adults

The benefit of another probiotic, NVP-1703 — a mix of Bifidobacterium longum IM55 and Lactobacillus plantarum IM76 — in adults with allergic rhinitis was shown in separate study presented at EAACI by Min-Gyu Kang, MD, from Chungbuk National University Hospital in Cheongju, South Korea.

Kang and his colleagues assessed 84 adults who had received a diagnosis of perennial allergic rhinitis at least 2 years prior. They randomly assigned 41 adults to NVP-1703 at a dose of 1 × 1010 CFU plus maltodextrin 2 g/day. The other 43 adults, who served as the control group, were assigned to maltodextrin 2 g/day.

At weeks 1, 3, and 4, changes in IgE, interleukin (IL)-10, Rhinitis Control Assessment Test (RCAT) score, and Total Nasal Symptom Score (TNSS) were evaluated in all participants.

IgE specific to dust mites was significantly lower in the probiotic group than in the control group (P = .033).

And the reduction in IL-10 from baseline was significantly greater in the probiotic group than in the control group (p = .047).

The increase in RCAT score from baseline to week 4 was greater in the probiotic group than in the control group (3.83 vs 2.21; P = .049).

In addition, changes in TNSS from baseline were significantly greater in the probiotic group than in the control group.

Change in Total Nasal Symptom Score from Baseline
Week Probiotic Group Control Group P Value
1 –0.47 +0.10 .033
3 –1.25 –0.40 .031
4 –1.69 –0.64 .029

 

NVP-1703 could be a new treatment option for allergic rhinitis, Kang said.

"We need more studies looking at the benefits of probiotics," said Erika von Mutius, MD, from the University of Munich, who was not involved in either study.

"Probiotics are now add-ons in the food market, and therefore regulation is not as rigid as with real drugs. That's part of the problem," she told Medscape Medical News.

Because the microbiome is very complex, there are so many different angles to investigate.

It's rare that probiotics are studied in clinical trials, she added.

"Because the microbiome is very complex, there are so many different angles to investigate," von Mutius said. "Maybe in 20 years or so we will better understand" its role in disease and disease prevention and "be able to develop new medicines."

Besednjak-Kocijančič, Kang, and von Mutius have disclosed no relevant financial relationships.

European Academy of Allergy and Clinical Immunology (EAACI) 2020 Digital Congress.

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