Skip to main content

Dietary modification of atopic disease: Use of probiotics in the prevention of atopic dermatitis

Current Allergy and Asthma Reports volume 4, pages 270–275 (2004)Cite this article

Abstract

The increased prevalence of atopic diseases, atopic dermatitis, allergic rhinitis, and asthma has been described as an epidemic. New approaches in the fight against allergic diseases are called for, the target being the persistence of the atopic T helper 2-skewed immune responder pattern beyond infancy. Atopic dermatitis, the earliest of these conditions, might act as a portal for the development of IgE-mediated atopic manifestations. Abundant evidence implies that specific strains selected from the healthy gut microbiota exhibit powerful antipathogenic and antiinflammatory capabilities, and several targets for the probiotic approach have emerged in atopic dermatitis: degradation/structural modification of enteral antigens, normalization of the properties of aberrant indigenous microbiota and of gut barrier functions, regulation of the secretion of inflammatory mediators, and promotion of the development of the immune system. Better understanding of the effects of different probiotic strains and deeper insight into the mechanisms of the heterogeneous manifestations of atopic disease are needed for the validation of specific strains carrying anti-allergic potential.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee: Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998, 351:1225–1232.

    Article  Google Scholar 

  2. Sibbald B, Rink E, D’Souza M: Is the prevalence of atopy increasing? Br J Gen Pract 1990, 40:338–340.

    PubMed  CAS  Google Scholar 

  3. Nakagawa T, Nakagomi T, Hisamatsu S, et al.: Increased prevalence of elevated serum IgE and IgG4 antibodies in students over a decade. J Allergy Clin Immunol 1996, 97:1165–1166.

    Article  PubMed  CAS  Google Scholar 

  4. Isolauri E, Huurre A, Salminen S, Impivaara O: The allergy epidemic extends beyond the past few decades. Clin Exp Allergy, In press.

  5. Isolauri E, Rautava S, Kalliomäki M, et al.: Role of probiotics in food hypersensitivity. Curr Opin Immunol Clin Allergol 2002, 2:263–271.

    Article  Google Scholar 

  6. Leung DYM, Bieber T: Atopic dermatitis. Lancet 2003, 361:151–160.

    Article  PubMed  Google Scholar 

  7. Hannifin JM: Atopic dermatitis. J Allergy Clin Immunol 1984, 73:211–222.

    Google Scholar 

  8. Novak N, Bieber T, Leung DYM: Immune mechanisms leading to atopic dermatitis. J Allergy Clin Immunol 2003, 112:S128-S139. An interesting review that ties together current views on atopic dermatitis and the history behind them.

    Article  PubMed  CAS  Google Scholar 

  9. Novak N, Bieber T: Allergic and nonallergic froms of atopic diseases. J Alergy Clin Immunol 2003, 112:252–262.

    Article  Google Scholar 

  10. Pepys J: "Atopy": a study in definition. Allergy 1994, 49:397–399.

    Article  PubMed  CAS  Google Scholar 

  11. Johansson S, Hourihane J, Bousquet J, et al.: A revised nomenclature for allergy: an EAACI position statement from the EAACI nomenclature task force. Allergy 2001, 56:813–824.

    Article  PubMed  CAS  Google Scholar 

  12. Apter AJ: Early exposure to allergen: Is this the cat’s meow, or are we barking up the wrong tree? J Allergy Clin Immunol 2003, 111:938–946. This excellent review article outlines the cascade of events in the development of atopic diseases and challenges the current thinking of exposure, sensitization, and disease. Useful reading for clinicians to obtain a deeper insight into clinical trials.

    Article  PubMed  Google Scholar 

  13. Kulig M, Tacke U, Forster J, et al.: Serum IgE levels during the first 6 years of life. J Pediatr 1999, 134:453–458.

    Article  PubMed  CAS  Google Scholar 

  14. Kulig M, Bergmann R, Klettke U, et al.: Natural course of sensitization to food and inhalant allergens during the first 6 years of life. J Allergy Clin Immunol 1999, 103:1173–1179.

    Article  PubMed  CAS  Google Scholar 

  15. Lau S, Illi S, Sommerfeld C, et al.: Early exposure to housedust mite and cat allergens and development of childhood asthma: a cohort study. Lancet 2000, 356:1392–1397.

    Article  PubMed  CAS  Google Scholar 

  16. Kalliomäki M, Salminen S, Kero P, et al.: Probiotics in the primary prevention of atopic disease: a randomised, placebo-controlled trial. Lancet 2001, 357:1076–1079. This well-controlled study provides the first clinical evidence of probiotic efficacy in the prevention of atopic disease.

    Article  PubMed  Google Scholar 

  17. Riedler J, Braun-Fahrländer C, Eder W, et al.: Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey. Lancet 2001, 358:1129–1133. This study documents that human immune function might be programmed by external factors early in life, such as microbial exposure associated with food intake.

    Article  PubMed  CAS  Google Scholar 

  18. Jones CA, Holloway JA, Popplewell EJ, et al.: Reduced soluble CD14 levels in amniotic fluid and breast milk are associated with the subsequent development of atopy, eczema, or both. J Allergy Clin Immunol 2002, 109:858–866.

    Article  PubMed  CAS  Google Scholar 

  19. Von Berg A, Koletzko S, Grübl A, et al.: The effect of hydrolyzed cow’s milk formula for allergy prevention in the first year of life: The German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol 2003, 111:533–540. An important study that sheds light on the immunomodulatory/ preventive potential of hydrolyzed formulas in allergic disease, including atopic dermatitis.

    Article  Google Scholar 

  20. Bos JD, Kapsenberg ML, Sillevis Smitt JH: Pathogenesis of atopic eczema. Lancet 1994, 343:1338–1341.

    Article  PubMed  CAS  Google Scholar 

  21. Hanifin JM: Atopiform dermatitis: Do we need another confusing name for atopic dermatitis? Br J Dermatol 2002, 147:430–432.

    Article  PubMed  CAS  Google Scholar 

  22. Strachan DP: Hay fever, hygiene, and household size. BMJ 1989, 299:1259–1260.

    Article  PubMed  CAS  Google Scholar 

  23. Yazdanbakhsh M, Kremsner PG, van Ree R: Allergy, parasites, and the hygiene hypothesis. Science 2002, 296:490–494.

    Article  PubMed  CAS  Google Scholar 

  24. Isolauri E: Probiotics in human disease. Am J Clin Nutr 2001, 73:1142S-1146S.

    PubMed  CAS  Google Scholar 

  25. Salminen S, Bouley C, Boutron-Ruault MC, et al.: Gastrointestinal physiology and function—targets for functional food development. Br J Nutr 1998, 80(Suppl):147–171.

    Article  Google Scholar 

  26. Favier C, Vaughan E, de Vos W, Akkermans A: Molecular monitoring of succession of bacterial communities in human neonates. Appl Environm Microbiol 2002, 68:219–226.

    Article  CAS  Google Scholar 

  27. Hartmann G, Weiner GJ, Krieg AM: CpG DNA: a potent signal for growth, activation, and maturation of human dendritic cells. Proc Natl Acad Sci USA 1999, 96:9305–9319.

    Article  PubMed  CAS  Google Scholar 

  28. Neish AS, Gewirtz AT, Zeng H, et al.: Prokaryotic regulation of epithelial responses by inhibition of IkappaB-alpha ubiquitination. Science 2000, 289:1560–1563.

    Article  PubMed  CAS  Google Scholar 

  29. Fukaura H, Kent SC, Pietrusewitz MJ, et al.: Induction of circulating myelin basic protein and proteolipid proteinspecific transforming growth factor-beta1-secreting Th3 T cells by oral administration of myelin in multiple sclerosis patients. J Clin Invest 1996, 98:70–77.

    Article  PubMed  CAS  Google Scholar 

  30. Kalliomäki M, Ouwehand A, Arvilommi H, et al.: Transforming growth factor-beta in breast milk: a potential regulator of atopic disease at an early age. J Allergy Clin Immunol 1999, 104:1251–1257.

    Article  PubMed  Google Scholar 

  31. Sudo N, Sawamura S, Tanaka K, et al.: The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol 1997, 159:1739–1745.

    PubMed  CAS  Google Scholar 

  32. Gr:anlund MM, Arvilommi H, Kero P, et al.: Importance of intestinal colonisation in the maturation of humoral immunity in early infancy: a prospective follow up study of healthy infants aged 0–6 months. Arch Dis Child 2000, 83:F186-F192.

    Google Scholar 

  33. Kalliomäki M, Kirjavainen P, Eerola E, et al.: Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol 2001, 107:129–134.

    Article  PubMed  Google Scholar 

  34. Björkstén B, Sepp E, Julge K, et al.: Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol 2001, 108:516–520.

    Article  PubMed  Google Scholar 

  35. Isolauri E, Salminen S, Ouwehand AC: Manipulation of the gut microbiota: probiotics. Bailliere’s Best Pract Clin Gastroenterol 2004, 18:299–313.

    Article  Google Scholar 

  36. Majamaa H, Isolauri E: Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997, 99:179–186.

    Article  PubMed  CAS  Google Scholar 

  37. Isolauri E, Arvola T, Sütas Y, et al.: Probiotics in the management of atopic eczema. Clin Exp Allergy 2000, 30:1605–1610.

    Article  Google Scholar 

  38. Rosenfeldt V, Benfeldt E, Dam Nielsen S, et al.: Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol 2003, 111:389–395.

    Article  PubMed  Google Scholar 

  39. Kalliomäki M, Salminen S, Poussa T, et al.: Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003, 361:1869–1871. This study demonstrates that the preventive potential of specific probiotics in atopic dermatitis is not transient, but might extend beyond infancy.

    Article  PubMed  Google Scholar 

  40. 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, 109:119–121.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, Turku University Central Hospital, 20520, Turku, Finland

    Erika Isolauri MD

Authors
  1. Erika Isolauri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Isolauri, E. Dietary modification of atopic disease: Use of probiotics in the prevention of atopic dermatitis. Curr Allergy Asthma Rep 4, 270–275 (2004). https://doi.org/10.1007/s11882-004-0070-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-004-0070-9

Keywords

  • Atopic Dermatitis
  • Allergy Clin Immunol
  • Intestinal Microbiota
  • Probiotic Strain
  • Atopic Disease