Allergy development and the intestinal microflora during the first year of life☆☆☆

Abstract 

Background: The intestinal microflora is a likely source for the induction of immune deviation in infancy. Objective: The purpose of this study was to prospectively relate the intestinal microflora to allergy development in 2 countries differing with respect to the prevalence of atopic diseases. Methods: Newborn infants were followed prospectively through the first 2 years of life in Estonia (n = 24) and Sweden (n = 20). By that age, 9 Estonian and 9 Swedish infants had developed atopic dermatitis and/or positive skin prick test results. Stool samples were obtained at 5 to 6 days and at 1, 3, 6, and 12 months, and 13 groups of aerobic and anaerobic microorganisms were cultivated through use of standard methods. Results: In comparison with healthy infants, babies who developed allergy were less often colonized with enterococci during the first month of life (72% vs 96%; P < .05) and with bifidobacteria during the first year of life (17% to 39% vs 42% to 69%; P < .05). Furthermore, allergic infants had higher counts of clostridia at 3 months (median value, 10.3 vs 7.2 log₁₀; P < .05). The prevalence of colonization with Staphylococcus aureus was also higher at 6 months (61% vs 23%; P < .05), whereas the counts of Bacteroides were lower at 12 months (9.9 vs 10.6 log₁₀; P < .05). Conclusion: Differences in the composition of the gut flora between infants who will and infants who will not develop allergy are demonstrable before the development of any clinical manifestations of atopy. Because the observations were made in 2 countries with different standards of living, we believe that our findings could indicate a role for the intestinal microflora in the development of and protection from allergy. (J Allergy Clin Immunol 2001;108:516-20.)

Keywords:  Allergy, atopic dermatitis, infants, microflora, bifidobacteria, enterococci, clostridia, Staphylococcus aureus, Bacteroides, prospective study

Abbreviations:  CCFA: , Cefoxitin-cycloserine-fructose agar, CNA: , Columbia agar with colistin and nalidixic acid, COA: , Columbia agar with colistin sulfate and oxolinic acid, CONS: , Coagulase-negative staphylococci, FAA: , Fastidious anaerobes agar, LAM: , Leeds acinetobacter medium