Advertisement

Early probiotic supplementation for allergy prevention: Long-term outcomes

Published:September 10, 2012DOI:https://doi.org/10.1016/j.jaci.2012.07.018
      Progressive change in the patterns and diversity of microbial exposure in early life remains a leading candidate in the rise in many inflammatory diseases. Initial attempts to redress this consequence of modern lifestyle change by using probiotic strains have met with some degree of success in preventing common inflammatory conditions such as allergic diseases. However, much research is still needed to more clearly define optimal early colonization profiles and the best strategies to achieve these. A critical part of this process is understanding long-term and strain-dependent effects, and it is therefore essential that long-term outcomes of early interventions are reported. So far, only 2 randomized placebo-controlled studies have examined long-term (ie, ≥5 years) outcomes.
      • Kalliomaki M.
      • Salminen S.
      • Arvilommi H.
      • Kero P.
      • Koskinen P.
      • Isolauri E.
      Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.
      • Kalliomaki M.
      • Salminen S.
      • Poussa T.
      • Arvilommi H.
      • Isolauri E.
      Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial.
      • Kalliomaki M.
      • Salminen S.
      • Poussa T.
      • Isolauri E.
      Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial.
      • Kuitunen M.
      • Kukkonen K.
      • Juntunen-Backman K.
      • Korpela R.
      • Poussa T.
      • Tuure T.
      • et al.
      Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.
      Both studies used a high-risk cohort and supplemented the children with probiotics pre- (4 weeks) and postnatally (6 months); the study by Kalliomaki et al
      • Kalliomaki M.
      • Salminen S.
      • Arvilommi H.
      • Kero P.
      • Koskinen P.
      • Isolauri E.
      Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.
      • Kalliomaki M.
      • Salminen S.
      • Poussa T.
      • Arvilommi H.
      • Isolauri E.
      Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial.
      • Kalliomaki M.
      • Salminen S.
      • Poussa T.
      • Isolauri E.
      Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial.
      used Lactobacillus rhamnosus GG, which significantly reduced the risk of developing eczema during the first 7 years of life; the study by Kuitunen et al
      • Kuitunen M.
      • Kukkonen K.
      • Juntunen-Backman K.
      • Korpela R.
      • Poussa T.
      • Tuure T.
      • et al.
      Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.
      used a probiotic mixture (2 lactobacilli, 1 Bifidobacterium, and 1 Propionibacterium), which significantly reduced the risk of developing IgE-associated allergic diseases, namely, sensitization and eczema, but only for cesarean-delivered children. Here, we report the long-term effects of postnatal supplementation with Lactobacillus acidophilus (LAFTI L10/LAVRI-A1), which was paradoxically associated with an increased risk of sensitization in the first year of life.
      • Taylor A.L.
      • Dunstan J.A.
      • Prescott S.L.
      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.
      • Prescott S.L.
      • Wiltschut J.
      • Taylor A.
      • Westcott L.
      • Jung W.
      • Currie H.
      • et al.
      Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase.
      As noted in the original study, the high-risk children in this cohort were randomized to receive L acidophilus or maltodextrin placebo from birth for the first 6 months of life.
      • Taylor A.L.
      • Dunstan J.A.
      • Prescott S.L.
      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.
      At 5 years of age, all initial participants were invited to a follow-up visit to assess doctor-diagnosed eczema, IgE-mediated food allergy, allergic rhinitis, asthma, and sensitization to common food and aeroallergens, as described more fully in this article’s Online Repository at www.jacionline.org.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Allergy and Clinical Immunology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kalliomaki M.
        • Salminen S.
        • Arvilommi H.
        • Kero P.
        • Koskinen P.
        • Isolauri E.
        Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial.
        Lancet. 2001; 357: 1076-1079
        • Kalliomaki M.
        • Salminen S.
        • Poussa T.
        • Arvilommi H.
        • Isolauri E.
        Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial.
        Lancet. 2003; 361: 1869-1871
        • Kalliomaki M.
        • Salminen S.
        • Poussa T.
        • Isolauri E.
        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
        • Kuitunen M.
        • Kukkonen K.
        • Juntunen-Backman K.
        • Korpela R.
        • Poussa T.
        • Tuure T.
        • et al.
        Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.
        J Allergy Clin Immunol. 2009; 123: 335-341
        • Taylor A.L.
        • Dunstan J.A.
        • Prescott S.L.
        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
        • Prescott S.L.
        • Wiltschut J.
        • Taylor A.
        • Westcott L.
        • Jung W.
        • Currie H.
        • et al.
        Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase.
        Allergy. 2008; 63: 1481-1490
        • West C.E.
        • Hammarström M.L.
        • Hernell O.
        Probiotics during weaning reduce the incidence of eczema.
        Pediatr Allergy Immunol. 2009; 20: 430-437
        • Boyle R.J.
        • Ismail I.H.
        • Kivivuori S.
        • Licciardi P.V.
        • Robins-Browne R.M.
        • Mah L.J.
        • et al.
        Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized controlled trial.
        Allergy. 2011; 66: 509-516
        • Wickens K.
        • Black P.N.
        • Stanley T.V.
        • Mitchell E.
        • Fitzharris P.
        • Tannock G.W.
        • 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

      References

        • Taylor A.L.
        • Dunstan J.A.
        • Prescott S.L.
        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
        • Prescott S.L.
        • Wiltschut J.
        • Taylor A.
        • Westcott L.
        • Jung W.
        • Currie H.
        • et al.
        Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase.
        Allergy. 2008; 63: 1481-1490
        • Hanifen J.
        • Rajka G.
        Diagnostic features of atopic dermatitis.
        Acta Derm Venereol. 1980; 92: 44-47
        • Anonymous
        Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis.
        Dermatology. 1993; 186: 23-31
        • Fewtrell M.S.
        • Kennedy K.
        • Singhal A.
        • Martin R.M.
        • Ness A.
        • Hadders-Algra M.
        • et al.
        How much loss to follow-up is acceptable in long-term randomised trials and prospective studies?.
        Arch Dis Child. 2008; 93: 458-461
        • Pistiner M.
        • Gold D.R.
        • Abdulkerim H.
        • Hoffman E.
        • Celedon J.C.
        Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy.
        J Allergy Clin Immunol. 2008; 122: 274-279