Abstract
Probiotics are increasingly recognized as capable of modulating immune responses. Some probiotic strains show the potential of inducing a different lymphocyte polarization, promoting the Th1 phenotype and inhibiting, at the same time, the allergy-prone Th2 phenotype. On this basis, we could expect that probiotics may act synergistically to improve the clinical efficacy of sublingual allergen immunotherapy (SLIT).
In this study, 30 patients affected by allergic rhinitis undergoing SLIT, were concomitantly administered a probiotic supplement (n = 14) or not (n = 16), according to their preference.
Nasal symptom score, rescue medication score and ‘well-days’ were evaluated after 2 and 4 months of treatment.
Patients who were administered SLIT plus probiotics showed a trend toward reduction of the nasal symptoms
(-7.1%, p = ns) with a significant reduction of medication score (-32.6, p = 0.02) and an increase of ‘well-days’ (35.1, p = 0.02).
These preliminary data, from a small study population, suggest that this combined approach with SLIT and probiotics could result in an increased efficacy of the SLIT treatment.
References
Martinez FD, Holt PG. Role of microbial burden in aetiology of allergy and asthma. Lancet 1999; 354(Suppl 2): 12-15. http://dx.doi.org/10.1016/S0140-6736(99)90437-3
Sanfilippo L, Li CK, Seth R, Balwin TJ, Menozzi MG, Mahida YR. Bacteroides fragilis enterotoxin induces the expression of IL-8 and transforming growth factor-beta (TGF-beta) by human colonic epithelial cells. Clin Exp Immunol 2000; 119: 456-63. http://dx.doi.org/10.1046/j.1365-2249.2000.01155.x
Isolauri E, Arvola T, Sütas Y, Salminen S. Probiotics in the management of atopic eczema. Clin Exp Allergy 2000; 30: 1605-10. http://dx.doi.org/10.1046/j.1365-2222.2000.00943.x
Hansen G, McIntire JJ, Yeung VP, et al. CD4(+) T helper cells engineered to produce latent TGF-beta1 reverse allergen-induced airway hyperreactivity and inflammation. J Clin Invest 2000; 105: 61-70. http://dx.doi.org/10.1172/JCI7589
Sudo N, Sawamura S, Tanaka K, Aiba Y, Kubo C, Koga Y. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol 1997; 159: 1739-45.
Gaskins HR. Immunological aspects of host/microbiota interactions at the intestinal epithelium. In: Mackie RI, White BA, Isaacson RE, eds. Gastrointestinal microbiology. New York: International Thomson Publishing 1997; 537-87. http://dx.doi.org/10.1007/978-1-4757-0322-1_14
Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol 2002; 109: 119-21. http://dx.doi.org/10.1067/mai.2002.120273
Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997; 99: 179-85. http://dx.doi.org/10.1016/S0091-6749(97)70093-9
Kalliomaki M, Salminen SJ, 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: 1019-21. http://dx.doi.org/10.1016/j.jaci.2006.12.608
Manzotti G, Heffler E, Fassio F. Probiotics as a novel adjuvant approach to atopic dermatitis J Contemporary Immunol 2014; 1: 57-66.
Abrahamsson TR, Jakbsson T, Biörksten B, Oldaeus G, Jenmalm MC. No effect of probiotics on respiratory allergies: a seven-year follow-up of a randomized controlled trial in infancy. Pediatric Allergy Immunol 2013; 24: 556-61. http://dx.doi.org/10.1111/pai.12104
Harsono A, Angraini SubratLa, Endaryanto A. Immuno-Modulatory Effect of Probiotic and Sublingual Immunotherapy in Asthmatic Children. Folia Medica Indonesiana 2009; 45: 14- 21.
Moussu H, Van Overtvelt L, Horiot S, Tourdot S, Airouche S, Zuercher A, Holvoet S, Prioult G, Nutten S, Mercenier A, Mascarell L, Moingeon P. Bifidobacterium bifidum NCC 453 promotes tolerance induction in murine models of sublingual immunotherapy. Int Arch Allergy Immunol 2012; 158: 35-42. http://dx.doi.org/10.1159/000330101
Jan RL, Yeh KC, Hsieh MH, Lin YL, Kao HF, Li PH, Chang YS, Wang JY. Lactobacillus gasseri suppresses Th17 pro-inflammatory response and attenuates allergen-induced airway inflammation in a mouse model of allergic asthma. Br J Nutr 2012; 108: 130-139. http://dx.doi.org/10.1017/S0007114511005265
Annesi-Maesano I, Didier A, Klossek M, Moreau D, Bousquet J, Community E, Health R. The score for allergic rhinitis (SFAR): a simple and valid assessment method in population studies. Allergy 2002; 57: 107-114. http://dx.doi.org/10.1034/j.1398-9995.2002.1o3170.x
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, van Wijk RG, Ohta K, Zuberbier T, Schünemann HJ. Global Allergy and Asthma European Network; Grading of Recommendations Assessment, Development and Evaluation Working Group. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126: 466-76. http://dx.doi.org/10.1016/j.jaci.2010.06.047
Forno E, Onderdonk AB, McCracken J, Litonjua, AA, Laskey, D, Delaney, ML, Dubois, AM, Gold DR, et al. Diversity of the gut microbiota and eczema in early life. Clin Mol Allergy 2008; 22: 6-11. http://dx.doi.org/10.1186/1476-7961-6-11
Ozdemir O. Various effects of different probiotic strains in allergic disorders: an update from laboratory and clinical data. Clin Exp Immunol 2010; 160: 295-304. http://dx.doi.org/10.1111/j.1365-2249.2010.04109.x
Ghadimi D, Fölster-Holst R, de Vrese M, Winkler P, Heller KJ and Schrezenmeir J. Effects of probiotic bacteria and their genomic DNA on TH1/TH2- cytokine production by peripheral blood mononuclear cells (PBMCs) of healthy and allergic subjects. Immunobiology 2008; 213: 677-692. http://dx.doi.org/10.1016/j.imbio.2008.02.001
Charng YC, Lin CC, Hsu CH. Inhibition of allergen-induced airway inflammation and hyperreactivity by recombinant lactic-acid bacteria. Vaccine 2006; 24: 5931-5936. http://dx.doi.org/10.1016/j.vaccine.2005.07.107
Allergy Therapeutics Italia: Syn Gut Product Monograph. Milano 2015.
Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. Specific probiotics alleviate allergic rhinitis during the birch pollen season. World J Gastroenterol 2009; 15: 3261-8. http://dx.doi.org/10.3748/wjg.15.3261
Manzotti G, Heffler E, Fassio F. Multi-strain symbiotic preparations as a novel adjuvant approach to allergic rhinitis. J Contemporary Immunol 2014; 1: 67-80. http://dx.doi.org/10.7726/jci.2014.1008
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2016 Renato Rossi, Lucilla Rossi , Giorgio Monasterolo