Atopic Dermatitis And Eczema

Probiotics have the potential to moderate inflammatory and immune responses and strengthen the intestinal barrier function, three actions that are useful in addressing the underlying pathophysiological processes involved in atopic dermatitis (AD) and eczema (Rosenfeldt et al 2004). The use of probiotic therapy to prevent allergic disease has been demonstrated in studies using L. rhamnosus GG in neonates, whereas studies in infants and children with established AD have found that probiotics reduce the severity of the condition (Fume 2005, Weston et al 2005). Prevention of allergy A randomised, double-blind placebo-controlled study Probiotics 953

showed that perinatal administration of probiotics (L rhamnosus GG) reduced the

development of atopic eczema In children by 50% during the first 2 years of life. Some 1 59 mothers were randomly allocated to receive 2 capsules of placebo or 1010 viable L. rhamnosus GG daily for 4 weeks before expected delivery. After delivery, capsules were taken for 6 months. During lactation either the mother or the infant consumed the preparations. In a 4-year follow-up study, it was revealed that the preventive effect of the probiotic on atopic eczema extended beyond infancy (Kalliomaki et al 2003).

Treatment of established allergy A randomised, double-blind study of 56 young children (aged 6-18 months) with moderate or severe atopic AD found that treatment with L. fermentum VRI-033 PCC (1 ■ 109; Probiomics) twice daily produced a significant reduction in the Severity Scoring of Atopic Dermatitis (SCORAD) index (Weston et al 2005). At week 16, 92% of children receiving probiotics had a SCORAD index that was significantly better than baseline compared with the placebo group (n = 17, 63%) (P = 0.01). Another randomised double-blind study has found that supplementation of infant formulas with viable but not heat-inactivated L. GG may have benefits for the management of atopic eczema and cow's milk allergy (Kirjavainen et al 2003).

According to two other placebo-controlled studies, it appears that people with greater allergic responses may be better suited to treatment and experience superior effects. Rosenfeldt et al found that treatment with two Lactobacillus strains (lyophilised L rhamnosus 19070-2 and L reuteri DSM 122460) given in combination for 6 weeks to children aged 1-13 years with AD resulted in 56% experiencing improvement (Rosenfeldt et al 2003). Interestingly, the total SCORAD score did not change significantly. Allergic patients with a positive skin prick test response and increased IgE levels experienced a more pronounced response to treatment. Similarly, a study by Sistek et al (2006) found that a combination of two probiotics (Lactobacillus rhamnosus and Bifidobacteria lactis) given to children with established AD effectively reduced the SCORAD index among the food-sensitised children, but not in other children (Sistek et al 2006). Children in this study received 2 ■ 1010 colony-forming units/g of probiotic or placebo daily as a powder mixed with food or water.

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