An open, non-randomized pilot study to evaluate adjuvant effects of drops with L. reuteri DSM 17938 + vitamin D3, ingested concomitantly with sublingual immunotherapy (SLIT), in adults with seasonal rhinitis due to Parietaria pollen.
The product with L. reuteri + vit D3 was ingested during the first month of SLIT (of three in total). Patients’ perceptions of symptom severity and medication use were assessed and compared in retrospect to the previous pollen season. 15 patients ingested the L. reuteri + vit. D product and 15 were control subjects who received SLIT only. There were significant reductions in symptom severity and use of medications, both within and between groups.
This pilot study suggests that vitamin D3 plus Lactobacillus reuteri DSM 17938 supplementation might improve the effectiveness of a single pre-co-seasonal SLIT course in reducing symptom severity and medication use in patients with seasonal allergic rhinitis.
In a study on prevention of allergy in newborns, L. reuteri ATCC 55730 reduced the incidence of IgE-associated allergic disease in infancy. This treatment might therefore also reduce the risk of asthma and allergic rhino‑conjunctivitis in school age, which this follow-up study set out to investigate. It also evaluated whether this supplementation was associated with any long-term side effects. The age at follow-up was 7y.
In the 2007 double-blind, and placebo controlled trial, 232 infants were randomised and 188 completed. 184 children took part in the follow-up, whereof 94 in the L. reuteri group and 90 in placebo group.
For the allergic disease outcomes there were no differences between groups: The prevalence of asthma was 15% in the L. reuteri vs. 16% in placebo group; allergic rhino conjunctivitis: 27% vs. 20%; eczema: 21% vs. 19%; skin prick test reactivity: 29% vs. 26%. Growth indices and gastrointestinal symptoms were similar in the two groups. No severe adverse events were reported.
Conclusion: The effect of L. reuteri on sensitization and IgE-associated eczema in infancy did not lead to a lower prevalence of respiratory allergic disease in school age. Thus, the effect of L. reuteri on the immune system seems to be transient. Administration of L. reuteri during the last weeks of gestation and in infancy was not associated with any long-term side effects.
Randomized, double-blind and placebo controlled trial of the effect of L. reuteri in children 6-14y with well-controlled asthma, on airway inflammation measured by certain inflammatory parameters, and clinically. L. reuteri or placebo was ingested during 60 days, with 22 in the active group and21 in the placebo group.
Compared to placebo L. reuteri significantly reduced airway inflammation, shown as changed levels in exhaled breath condensate:
• reduction of exhaled nitric oxide (FeNO)
• reduction of the cytokine IL-2
• increase of the cytokine IL-10
Bronchial airway inflammation was significantly reduced, without change in clinical parameters.
Randomized, double-blind and placebo controlled trial of the effect of L. reuteri in children on the cytokine production in the lung in 4-10 year old children with atopic (AD) and non-allergic dermatitis. Study products were ingested for 8 weeks, with 26 in the L. reuteri group and 25 in the placebo group.
In AD patients only L. reuteri significantly increased the IFN-gamma production and decreased IL-4 levels in exhaled breath condensate. The quotient of the Th2/Th1 cytokines was thereby modified in a positive way. There were no changes in clinical scores of eczema.
Oral administration of a specific probiotic strain in patients with atopic dermatitis can modulate the cytokine pattern at a body site distant from the intestines.
This prospective, randomised, double blind, placebo-controlled study identified factors affecting the prevalence of Lactobacillus reuteri in the faeces and breast milk of 232 mothers with a history of atopic disease, and in the faeces of their babies after oral supplementation with Lactobacillus reuteri ATCC 55730.
Women were randomly assigned to take either Lactobacillus reuteri or placebo for the last 4 weeks of their pregnancy. Their babies continued with the same study product from birth until 12 months of age. The prevalence of Lactobacillus reuteri was higher in the faeces of infants whose mothers had taken the active supplement compared with those whose mothers had taken placebo.
The highest prevalence was recorded at 5–6 days of age (82% in treated vs. 20% in placebo; p<0.001). The first expressed breast milk (colostrum) was positive for Lactobacillus reuteri in 12% of the mothers given Lactobacillus reuteri and in 2% of mothers in the placebo group. Breast-feeding seemed to reduce faecal Lactobacillus reuteri counts while antibiotics did not appear to have any effect. Lactobacillus reuteri supplementation did not appear to affect bifidobacteria or C. difficile colonisation.
Lactobacillus reuteri can be detected in breast milk after oral supplementation to the mother and in almost all infants after oral supplementation during the first year of life. Lactobacillus reuteri can also occasionally be detected in the faeces of untreated infants.
A double blind, placebo-controlled trial on the effects of Lactobacillus reuteri ATCC 55730 on the extent and severity of atopic dermatitis in children given standard treatment.
Fifty children, 3 months – 4 years old, were randomized into two groups, each with 25 children. Group A was given 1×10^8 of Lactobacillus reuteri in an oil suspension daily and group B an identical placebo, for 12 months. Responses of skin prick tests to several food allergens and total blood IgE were assessed at baseline and at 12 months. Eczema was evaluated according to a validated scoring system (SCORAD).
The extension of the eczema was significantly reduced over time in the Lactobacillus reuteri group compared to the placebo group (p=0.024). Itching and loss of sleep was also significantly reduced in group A compared to group B (p=0.024). Skin prick test for peanut was reduced in the Lactobacillus reuteri group (p=0.023). During the 12-month study period the total IgE levels significantly increased in the placebo group (p=0.022) but not in the Lactobacillus reuteri group (p=0.133).
The results indicate that Lactobacillus reuteri may have an effect on the immune system and reduce allergic symptoms in children.
This study presents results of the prevention of allergy study in high-risk infants for a new type of immunology markers for development of allergy, so called chemokines. (See other results of this study in summaries of papers by Abrahamsson 2007, 2009, 2011 and 2013, and by Böttcher 2008.)
Chemokines are a type of proteins produced by different immune cells, and their receptors are expressed on the surface of several cell types involved in allergic inflammation. Analyses of circulating chemokines in the blood offer new tools to investigate the Th1/Th2 imbalance in allergic disease in vivo.
In this study different pre- and postnatal environmental factors, including the supplementation of Lactobacillus reuteri ATCC 55730, and their association to the expression of different chemokines were analysed in infants at birth (cord blood), and at 6, 12 and 24 months. The presence of Lactobacillus reuteri in infant stool in the first week of life was associated with low levels of the Th2-type chemokines CCL17 and CCL22 and high levels of the Th1-type chemokine CXCL11, at six months of age.
This result suggests a more rapid maturation of the immune system after birth, counteracting the Th2-deviation at birth. Of several chemokines analysed, only CCL22 (elevated levels) and CXCL11 (decreased levels) were associated with sensitisation to allergens.
Conclusion: The results imply that the previously shown effect of Lactobacillus reuteri on decreasing the risk of sensitisation in these infants may act through a mechanism involving the chemokines CCL22 and CXCL11.
A prospective, double blind, placebo-controlled study with the aim to evaluate the effect of Lactobacillus reuteri supplementation on the immunological composition of breast milk in relation to sensitization and eczema in the babies.
The study included pregnant women supplemented with Lactobacillus reuteri ATTC 55730, 1 × 10^8 colony forming units daily (n=54) or placebo (n=55) from gestational week 36 until delivery, and their infants. Colostrum (first expressed milk) and mature milk were analysed for antibodies (total IgA, secretory IgA), pro- and anti-inflammatory cytokines (TNF, TGF-ß1, TGF-ß2, IL-10) and factors that may modify immune responses to bacteria (soluble CD14). Faecal samples from the mothers were analysed for the presence of live Lactobacillus reuteri cells.
The infants were supplemented with Lactobacillus reuteri (same dose as the mothers) from birth and until 12 months old. They were followed regarding development of eczema and sensitization (defined by a positive skin prick test and/or circulating food allergen-specific IgE antibodies) at 6, 12, and 24 months of age. Supplementation with Lactobacillus reuteri during pregnancy was associated with low levels of TGF-ß2 and slightly increased levels of IL-10 in colostrum. Infants that had received colostrum with low levels of TGF-ß2, were less likely to become sensitized during their first 2 years of life (p=0.01). A similar trend was observed for development of IgE-associated eczema.
Supplementation with Lactobacillus reuteri during late pregnancy reduced breast milk levels of TGF-ß2, and low levels of this immune factor were associated with less sensitization to allergens and possibly less IgE-associated eczema (eczema with hyperreactivity to allergy-causing substances such as egg and milk) in breast-fed infants.
A prospective, double blind, randomised, placebo-controlled trial with the objective to prevent eczema and sensitization in infants born in families with allergic disease by oral supplementation with the probiotic Lactobacillus reuteri.
The study included 232 families, of whom 188 completed the study. The mothers received Lactobacillus reuteri ATCC 55730 (1 × 10^8 colony forming units) daily from gestational week 36 until delivery. Their babies then continued with the same product and dose from birth until 12 months of age and were followed up for another year.
Primary outcome was allergic disease, with or without positive skin prick test or circulating IgE to food allergens (tests indicating that sensitization has taken place). At two years of age the incidence of eczema was eczema during the second year, 8% versus 20% (P=0.02). Skin prick test reactivity was also less common in the Lactobacillus reuteri group compared to the placebo group, significantly so for infants with mothers with allergies, 14% versus 31% (P =0.02). Wheeze and other potentially allergic diseases were not affected.
Conclusion: Lactobacillus reuteri had no preventive effect on total incidence of infant eczema. At 2 years of age, however, the Lactobacillus reuteri supplemented infants had less IgE-associated eczema (i.e. eczema with hyperreactivity to allergy-causing substances such as egg and milk) and therefore possibly run a reduced risk to develop later respiratory allergic disease.
A prospective, open study in children with mild atopic dermatitis aggravated by the intake of cow’s milk.
Fifteen children, 3-5 years old, were enrolled. They all had a clinical history of improvement of atopic dermatitis after removal of cow’s milk from the diet. Allergy to cow’s milk proteins was excluded by analyses of specific IgE against milk proteins and skin prick test. The children were re-challenged with cow’s milk whilst also receiving Lactobacillus reuteri ATCC 55730 (2 tablets daily = 2 x 10^8 CFU, n=8), or no probiotic (n = 7) for a period of three months. During the first ten days of introduction of cow’s milk, antihistamine was prescribed daily for both groups and topical steroids and moisturisers were used when needed.
In the first two weeks all patients showed improvement of eczema and itching. However, during the rest of the study period none of the children in the Lactobacillus reuteri group showed aggravation of eczema or itching despite continued intake of milk. In the control group, all children showed worsening of the eczema and had to continue the use of antihistamines and topical steroids.
Conclusion: The daily intake of Lactobacillus reuteri during concomitant intake of cow’s milk for three months could prevent the aggravation of atopic dermatitis and itching in children where cow’s milk previously had been shown to worsen the eczema.