allergies Archives

Healthy Benefits of Probiotics for Children

Children’s Health, Healthy Aging / By @drHoberman

As we start the New Year with resolutions for living healthy, I want to share with you an article⁽¹⁾ that assesses the healthy benefits of probiotics for children.

The December issue of Pediatrics included a report, “Clinical Report – Probiotics and Prebiotics in Pediatrics,” prepared by the Committee on Nutrition, a component of the American Academy of Pediatrics – an organization comprised of 60,000 pediatricians.

The purpose of the report was to provide guidance to pediatric health care providers on the usefulness and benefits of probiotics and prebiotics for children. In doing so, the committee:

Reviewed published clinical studies that provided children with probiotics or prebiotics to prevent or treat a variety of health issues, and
Analyzed the quality of the reports and determined whether there was enough evidence to recommend the use of probiotics for the specific disorders.

In the last five years there has been an explosion of clinical studies using probiotics. Most of the studies have proven efficacy or general positive benefits, leading to an increase in the recommendation of probiotics by mainstream medicine.

Committee on Nutrition: Probiotic Recommendations

After thoroughly reviewing and assessing previous studies, the American Academy of Pediatrics’ committee suggested probiotics and/or prebiotics may have a positive impact on the following conditions.

#1: Acute Infectious Diarrhea
The committee reviewed studies to determine if probiotics could prevent episodes of acute infectious diarrhea that occur in child care centers. Based on available studies, the committee did not recommend routine use of probiotics to prevent acute infectious diarrhea but did acknowledge there may be special circumstances that probiotics are beneficial.

#2: Viral Gastroenteritis
Trials of using probiotics to treat children with acute infectious diarrhea found that probiotics shortened the illness in children with viral gastroenteritis by one day. The conclusion stated “there is evidence to support the use of probiotics early in the course of childhood acute infectious diarrhea.”

#3: Antibiotic-Associated Diarrhea
Review of trials using probiotics to prevent antibiotic-associated diarrhea found that probiotics were beneficial. Antibiotics can decrease the healthy intestinal bacteria population and allow the unhealthy bacteria to overgrow and cause diarrhea. The conclusion was that probiotics can be used to reduce the incidence of antibiotic-associated diarrhea.

The committee reviewed numerous clinical trials that used probiotics to treat and prevent other pediatric medical disorders. While some of these studies found specific benefits, the general recommendation was that further studies were necessary to prove efficacy for the following conditions:

Irritable Bowel Syndrome
Infantile Colic
Ulcerative Colitis
Eczema

Prebiotics and Allergy Reduction

The committee also reviewed medical trials using prebiotics. Prebiotics refer to a special class of fiber in our diet that acts as “food” for the healthy bacteria, Lactobacillus and Bifidobacterium. These bacteria use the prebiotic as a source of nourishment for their growth and activity.

Studies of adding prebiotics to infant diets found reduced incidence of allergies. The conclusion of the committee was that “confirmatory studies of the benefits of prebiotics….are needed before recommendations cam be made…”

Safe and Promising Supplements

The committee also commented on the safety of both probiotic and prebiotic supplement. They stated “to date, these products seem to be safe for healthy infants and children.” Caution should be used in giving probiotics to children with compromised immune function.

The committee was generally positive about the use of probiotics in children. But, it was being very responsible in not making general recommendations. Although there are positive studies for the clinical use of probiotics, the committee wants to see more studies to confirm the benefits. Further confirmatory studies are being accomplished to prove the clinical health benefits. We await the next updated report.

In the meantime, if your child is suffering with one of the disorders mentioned above, it seems reasonable to consider a therapeutic trial with a probiotic like EndoMune – a safe supplement that contains both probiotics and a prebiotic.

Wishing you and your loved ones a very healthy 2011.

Eat healthy, exercise and stay well.
Dr. Hoberman

References:

(1) Probiotics and prebiotics in pediatrics. Thomas DW, Greer FR; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition. Pediatrics. 2010 Dec;126(6):1217-31.

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Probiotics May Decrease Allergies

Children’s Health, Healthy Aging / By @drHoberman

The increased sterilization and pasteurization of foods has led to a decrease in the amount of bacteria to which we are exposed. There is a potential this has led to the increase in allergies which today’s children are experiencing.

A Finnish team of researchers conducted a study with pregnant women; some received a probiotic while others received a placebo. From eight months pregnancy to delivery, these women took a daily dose of probiotics or its placebo counterpart.

The children were examined by pediatricians at 3, 6 and 24 months of age. The conclusion was that:

To read the article in its entirety, visit: http://www.newscientist.com/article/dn13778

Key proteins associated with tissue inflammation were 50% higher on average in the blood of probiotic-treated infants than in the blood of placebo-treated infants. Inflammation is thought to stimulate the immune system, and so reduce allergic reaction.
Probiotic children were 30% less likely than their untreated counterparts to develop an itchy skin condition known as atopic eczema, which is often an early manifestation of allergies.

While more research is needed, it seems plausible that probiotics may be a key ingredient to decreasing the likelihood of your child developing allergies.

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Probiotics and the Prevention of Food Allergies

Children’s Health, Diet, Healthy Aging / By @drHoberman

Most of us are familiar with the term “food allergy.” Case in point, children with an allergy to peanuts can experience allergic reactions ranging from hives to coma, or even death. Sensitized children must have medication with them at all times to immediately treat reactions.

Strict avoidance of peanuts is their sole option to stay well. Schools have tried to create awareness for students and their parents to avoid bringing foods like peanut butter to school if there is a child with a peanut allergy.

In the last two weeks, there have been a number of news reports on the dramatic increase in food allergies experienced by children.

In the June issue of the medical journal Pediatrics⁽¹⁾, a study found that about eight percent of children under the age of 18 (almost 6 million) suffer from one or more food allergies. These numbers are twice as high as reported by the CDC in 2007, which reported a rate just below four percent. Additionally, the severity of the episodes has increased.

The lead author of the June study, Dr. Ruchi Gupta, reported that “based on our data, about one in 13 children has a food allergy. We are seeing a lot more cases in schools than we used to see. It does seem that food allergy is on the rise.” In addition, Dr. Gupta noted, “What’s more, nearly two out of every five affected children suffer from a severe food allergy. For these children, accidental ingestion of an allergenic food may lead to difficulty breathing, a sharp drop in blood pressure, and even death.”

With the growing severity of food allergies, how can probiotics help? There are some very interesting studies that suggest probiotics may lessen the risk of food allergies in children.

To get a better understanding of this topic, this newsletter will discuss:

What is a “food allergy”
What is the cause
How to diagnose a food allergy
How is a food allergy treated
Can probiotics help lessen the risk of developing a food allergy

What is food allergy?

Food allergy is a term used to describe an adverse immune response to a protein in some foods.

When we are born, our intestinal immune cells have to constantly survey what is being ingested. The immune cells determine if they have to mount a protective reaction to a potentially harmful virus, bacteria, parasite or toxin.

Sometimes, the immune cells react to harmless proteins in our food and produce antibodies that can result in allergic reactions like hives, eczema, asthma, rhinitis and gastrointestinal symptoms of cramps, nausea, vomiting and diarrhea.

The most serious reaction is called anaphylaxis, which causes severe breathing difficulty and a major drop in the blood pressure. Oxygen, epinephrine injections and IV fluids can be lifesaving.

Anaphylactic reactions due to food allergies account for 30,000 episodes annually and possibly 200 deaths each year.⁽²⁾

The CDC estimates that eight types of foods are responsible for 90 percent of all food allergies in children: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.

What is the cause of a food allergy?

The exact cause of food allergies is not known. However, there have been several proposed explanations why food allergies occur and have been on the increase over the last 20-30 years.

Factors thought to contribute to food allergies include genetic predisposition and the introduction of foods too early in infancy.

The other major factor is the “Hygiene Theory”.⁽³⁾ This theory is based on the idea that in the Western developed countries the exposure to harmful bacteria, parasites, viruses and other toxins has decreased due to our efforts at keeping everything sanitized. As a result, our immune system has more time to spend mounting a reaction to harmless proteins in our diet and other allergens like pollens.

Epidemiologic studies have found that the prevalence of allergies is highest in developed countries.

Over the last 30 years there has been a two-to-three fold increase in childhood allergies in developed countries when compared to those less developed.⁽⁴⁾

There have been a number of reports that have found children growing up on a farm have less allergies.⁽⁴⁾ Playing with animals and in the dirt may actually be healthy.

How to diagnose food allergies?

A child might have a food allergy, if he/she has recurrent swelling of lips and face, hives, eczema, wheezing, stuffy nose, abdominal pain, diarrhea.

The best method for diagnosing food allergy is to be evaluated by an allergist. The allergist will review the patient’s history and the symptoms or reactions that have been noted after food ingestion. If the allergist feels the symptoms or reactions are consistent with food allergy, special tests can be performed.

Skin testing can aid in detecting the antibody(IgE) to the suspected food protein.

Blood tests can measure IgE antibodies

Sometimes it is necessary to perform a food challenge while being observed by the physician

How is a food allergy treated?

The only proven therapy is food elimination. All patients at risk for anaphylaxis must be trained to identify early symptoms and be prepared to use an auto-injectable epinephrine pen.

Can Probiotics lessen the risk of developing a food allergy?

To understand how probiotics may lessen the risk of food allergies requires a little primer on how the immune system in the intestines works.

Seventy percent of our immune system is in the intestines. Since the intestines serve as our window to our environment, it is important that the intestines monitor our exposure to harmful infections and toxins.

The lymphocytes (immune cells) in the intestines are of several types:

Th1 helps to fight infections due to bacteria and viruses

Th2 responds to infections caused by parasites

If an infant is not exposed to infectious bacteria and viruses, then Th1 will be less active, causing a shift in the balance of activity in favor of the Th2 lymphocytes, producing antibodies to parasites and also to harmless allergens.

Recently, another lymphocyte called a regulatory cell (Treg) has been identified(5). This lymphocyte can regulate the activity of both Th1 and Th2 lymphocytes.

Probiotics can modulate the immune response by acting on the Treg cells. Studies have shown that probiotics can decrease or down regulate the activity of the Th2 cells and lessen the immune reaction against proteins in foods. ^(6,7) The term “oral tolerance” is used to describe the process when the immune cells don’t mount a reaction.

Mice raised in a germ-free environment do not develop oral tolerance to food protein.⁽⁸⁾ But when a mixture of oral probiotics were given to the mice, the IgE antibodies were not produced.

Since 1997, probiotics have been used in the management of food allergy. Infants with eczema due to cow’s milk had improvement when given a probiotic in their formula.⁽⁸⁾

In another study, either probiotics or a placebo were given to mothers during the last 4 weeks of their pregnancy. Their newborn infants were breast fed and given a probiotic supplement or a placebo for 6 months. The children who were exposed to probiotics had a 50% reduction in allergies compared to the placebo group.⁽⁹⁾

Not all clinical studies have shown that probiotics are able to lessen allergic diseases in children.⁽¹⁰⁾ The good news is that the probiotics seem very safe. No serious adverse effects have been reported in the clinical studies.

There is no question that probiotics can influence the intestinal immune system to lessen allergic responses. Some of the future challenges include determining the most effective:

Probiotic strains
Combination of bacterial species and strains
Dose of bacteria in a serving size
Timing of introducing the probiotic to the infant/child
Duration of probiotic therapy

Take Home Message

If you don’t live on a farm or your child doesn’t include dirt in their diet, you might consider giving your child a probiotic. For women who are allergy prone, taking a probiotic like EndoMune may help prevent eczema in their offspring. In addition, giving EndoMune Junior to your child during infancy may help to lessen the risk of developing allergies. It is always recommended that you talk with your doctor before taking new medications and supplements.

Eat healthy, exercise and live well!

Dr. Hoberman

(1) The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States.Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL.Pediatrics. 2011 Jun 20

(2) Epidemiology of anaphylaxis in Olmsted County: A population-based study. Yocum MW, Butterfield JH,Klein JS, Volcheck GW, Schroeder DR, Silverstein MD.Yocum MW,Butterfield JH, Klein JS, Volcheck GW, Schroeder DR, Silverstein MD.

(3) The hygiene theory: fact or fiction? Sheikh A, Strachan DP.Curr Opin Otolaryngol Head Neck Surg. 2004Jun;12(3):232-6. Review.

(4) Exposure to environmental microorganisms and childhood asthma. Ege MJ, Mayer M, Normand AC, Genuneit J, Cookson WO, Braun-Fahrländer C, Heederik D, Piarroux R, von Mutius E; GABRIELA Transregio 22 Study Group. N Engl J Med. 2011 Feb 24;364(8):701-9.

(5) Hygiene theory and allergy and asthma prevention. Liu AH.Paediatr Perinat Epidemiol. 2007 Nov;21 Suppl 3

(6) Probiotics, prebiotics, and synbiotics: impact on the gut immune system and allergic reactions.Gourbeyre P, Denery S, Bodinier M. J Leukoc Biol. 2011 May;89(5):685-95.

(7) Food allergy and probiotics in childhood. del Giudice MM, Leonardi S, Maiello N, Brunese FP. J Clin Gastroenterol. 2010 Sep;44 Suppl 1:S22-5.

(8) Probiotics: a novel approach in the management of food allergy.Majamaa H, Isolauri E.J Allergy Clin Immunol. 1997 Feb;99(2):179-85

(9) Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial.Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Lancet. 2003 May 31;361

(10) Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial.Abrahamsson TR, Jakobsson T, Böttcher MF, Fredrikson M, Jenmalm MC, Björkstén B, Oldaeus G.J Allergy Clin Immunol. 2007 May;119(5)

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Yale Workshop on Probiotics Presents New Research

Drug interactions, Probiotics / By @drHoberman

I just returned from the 3rd Yale Workshop on “Advances in Probiotic Use” and am pleased to report there is a large amount of active research in the area of the intestinal bacteria. Namely, research is examining how bacteria impact human health and disease.

Among various findings, researchers presented new information about how probiotic bacteria can modulate the intestinal immune system. They have discovered how probiotic bacteria interact with the intestinal lining cells to improve the inflammatory conditions that occur due to infection colitis and ulcerative colitis.

In addition, there were a number of discussions about how the healthy intestinal bacteria can break down or ferment indigestible dietary starches. The breakdown products (short chain fatty acids) enhance the intestinal function, improve intestinal motility and lessen the risk of colon cancer. This is called a symbiotic relationship – mutually beneficial for the human host and the bacteria.

The conclusions from the various presentations are that probiotics can:

Lessen irritable bowel syndrome symptoms
Shorten the duration of infectious diarrhea in children
Aid in the prevention of antibiotic-associated diarrhea
Aid in the management of ulcerative colitis
Aid in the prevention of childhood allergies like eczema

Transplantation Therapy to Improve Bacteria Balance

An infection with a bacterium called Clostridia difficile can cause life-threatening colitis. The infection occurs when the healthy intestinal bacteria are reduced as a result of taking an antibiotic for something like a sinus infection.

There are special antibiotics that can destroy the Clostridia difficile infection. Unfortunately, there is a tendency for the infection to recur multiple times in the same person despite taking appropriate antibiotics to kill the Clostridia difficile organisms.

In an attempt to treat Clostridia difficile, a new innovative form of therapy was also discussed. The therapy involves the transplantation of stool from healthy individuals into patients as a means to re-establish a healthy intestinal bacterial balance.

There have been a few published case reports dating back to 1958 of transplanting healthy stool into patients who had recurrent Clostridia infections, and the results were very promising. Larger trials of infusing suspensions of healthy stool into ill patients have been recently done. The results have shown a cure rate of more than 90% within two days!!

This presentation was very thought provoking. To have this type of cure rate certainly indicates the importance of the healthy intestinal bacteria. The procedure is aesthetically unpleasing, but the alternative is to give the healthy bacteria in capsule form – accomplished when probiotics are prescribed.

Take Home Message

All of the presentations at the Yale Workshop provide further evidence of the importance of a healthy balance of intestinal bacteria. In addition, the studies confirm that probiotic bacteria have many beneficial benefits in helping to improve and maintain normal intestinal immune and digestive functions.

Please consider taking a high quality probiotic like EndoMune if you are going to take antibiotics or if you are struggling with ongoing GI symptoms despite medical evaluation.

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Can Probiotics Lessen Infantile Allergies?

Children’s Health, Mental Health, Women’s Health / By @drHoberman

In last month’s newsletter, I mentioned some of the benefits of probiotics for children. This month I would like to discuss how probiotics may lessen childhood allergies like asthma, eczema and hay fever.

Emergence of the Hygiene Theory

Over the last 30 years, there has been a two-to-three fold increase in childhood allergies in developed countries. This is significant as compared to the 19th century when hay fever (allergic rhinitis) and asthma were rare.

The rise in allergies like asthma, rhinitis, and eczema has not been seen in underdeveloped countries. This observation has resulted in the “Hygiene Theory”⁽¹⁾.

The theory attributes the rise of allergies to our sanitized lifestyle. In our super-clean world –
vaccinations, anti-bacterial soaps, antibiotics, and airtight doors and windows – we are keeping dirt and disease-causing germs at bay.

The Hygiene Theory explains the rise of allergies to a change in the immune activity of the gut ⁽²⁾. Our bodies no longer need to fight germs as much as they did in the past. As a result, the immune system has shifted away from fighting infection to developing more allergic tendencies.

The lymphocytes (immune cells) in the intestines are of several types:

Th1 helps to fight infections due to bacteria and viruses
Th2 responds to infections caused by parasites.

If an infant is not exposed to infectious bacteria and viruses, then Th1 will be less active, causing a shift the balance of activity in favor of the Th2 lymphocytes, producing antibodies to parasites and also to harmless allergens.

The initial theory has been modified some ⁽³⁾. There is another lymphocyte called a regulatory cell (Treg). This lymphocyte can regulate the activity of both Th1 and Th2 lymphocytes. By adding probiotic bacteria, the (Treg) cells can downregulate the Th2 allergy-mediated immune response.

Probiotics to Regulate Incidence of Eczema

In 2001, a study was done to determine if giving probiotics to mothers prenatally and to infants for the first six months could lessen the frequency of eczema ⁽⁴⁾. During the first two years of life, eczema occurred 50% less in the group given probiotics compared to the group given placebo.

Subsequent similar studies have had mixed results ⁽⁵⁾. However, a recent study found that giving a probiotic blend to pregnant women with a family history of allergies was beneficial. The women were given either a placebo or the probiotic starting 4-8 weeks before delivery and then for an additional three months. The infants receiving probiotics had a 55% less involvement with eczema at one year compared to the placebo group ⁽⁶⁾.

Based on the available studies, probiotics can modify the immune system in infants and lessen the risk of developing eczema and possibly childhood asthma.

There are very few studies that have shown that probiotics can treat existing allergies in children or adults ⁽⁵⁾. In this regard, it is of interest that a recent study reported probiotics lessened symptoms of nasal allergy in children during the birch pollen season ⁽⁷⁾.

Much more research is needed to understand how probiotics interact with the intestinal immune cells, but it is really fascinating how our intestinal bacteria play such a major role in our general health.

Take Home Message

For women who are allergy prone, taking a probiotic like EndoMune may help prevent eczema in their offspring. In addition, giving EndoMune Junior to your child during infancy may help to lessen the risk of developing allergies. It is always recommended that you talk to your doctor before taking new medications and supplements.

(1) Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989 Nov 18; 299(6710):1259–1260.

(2)Probiotics in children.Kliger B, Hanaway P, Cohrssen A. Pediatr Clin North Am.2007 Dec;54(6): 949 Kligler B, Hanaway P, Cohrssen A.

(3)Hygiene theory and allergy and asthma prevention. Liu AH.Paediatr Perinat Epidemiol. 2007 Nov;21 Suppl 3:2-7.

(4)Probiotics in primary prevention of atopic disease: a randomized placebo-controlled trial.Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E.Lancet. 2001 Apr 7;357(9262):1076-9.

(5)Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial.Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, Lee SY, Ahn KM, Ji GE.Pediatr Allergy Immunol. 2009 Oct 14.

(6)Probiotics and prebiotics in atopic dermatitis: a review of the theoretical background and clinical evidence.van der Aa LB, Heymans HS, van Aalderen WM, Sprikkelman ABPediatr Allergy Immunol. 2009 Jul 2.

(7)Specific probiotics alleviate allergic rhinitis during the birch pollen season. Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. World J Gastroenterol. 2009 Jul 14;15(26):3261-8.

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