PEDIATRICS Vol. 114 No. 2 August 2004, pp. 521
EFFECT OF PROBIOTIC LACTOBACILLUS STRAINS IN CHILDREN WITH ATOPIC DERMATITIS
Melissa A. Wood, MD and
Stacie M. Jones, MD
Little Rock, AR
Rosenfeldt V, Benfeldt E, Nielsen SD, et al. J Allergy Clin Immunol. 2003;111:389–395
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Purpose of the Study.
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To evaluate the clinical and antiinflammatory effects of probiotic
supplementation among children with atopic dermatitis (AD).
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Study Population.
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Subjects were 43 children (1–13 years of age) in Denmark
with known AD.
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Methods.
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A randomized, double-blind, crossover design placed patients
into 2 treatment groups, group A (placebo followed by probiotics)
and group B (probiotics followed by placebo). Dosing was twice
daily for 6 weeks, with a 6-week washout period between treatment
arms. The probiotics used included
Lactobacillus rhamnosus 19070-2
and
Lactobacillus reuteri DSM 12246, strains previously shown
to adhere to intestinal mucosa. The placebo was skim milk powder
and dextrose. Patients were evaluated 2 weeks before study onset,
with the scoring AD (SCORAD) system (consisting of itch score,
intensity, and extent of eczema) and measurement of serum immunoglobulin
E levels. Skin prick test results and serum immunoglobulin E
levels were used to divide patients into allergic and nonallergic
groups. At weeks 0, 6, 12, and 18, SCORAD indices, serum eosinophilic
cationic protein levels, and cytokine (interleukin-2, interleukin-4,
interleukin-10, and interferon-
) levels were measured. Subjective
evaluations of the status of AD were obtained from patients/parents
at 6, 12, and 18 weeks. Patients continued to receive topical
corticosteroids, with the quantity of medication being recorded
at each visit.
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Results.
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The SCORAD indices at study onset were 18 to 64 (scale: 0–80),
indicating moderate to severe AD in the study groups. Thirty-nine
patients completed subjective evaluations, with 22 (56%) indicating
improvement after active therapy, compared with 6 (15%) after
placebo. In the total study group (
n = 43), a 24.7% reduction
in the extent of eczema after active treatment was seen (
P =
.02), whereas itch scores and intensity only trended toward
lower values. The overall SCORAD index improved slightly during
active treatment (from a score of 35.6 to 31.6,
P = .06), but
no improvement was seen with placebo. For patients whose subjective
evaluations indicated improvement during active treatment, the
total SCORAD index was significantly improved, compared with
placebo (
P < .0001). Serum eosinophilic cationic protein
levels decreased during active treatment, compared with placebo
(
P = .03). Cytokine levels did not change during any treatment.
In the allergic group (
n = 27), the total SCORAD index and the
extent of disease score both decreased (
P = .04 and
P = .008,
respectively). Topical corticosteroid use was similar for all
patients.
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Conclusions.
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The use of probiotic
Lactobacillus strains produced improvement
in moderate to severe eczema, with respect to both subjective
evaluations and extent of eczema. Results were more pronounced
in the allergic group.
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Reviewers’ Comments.
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This study supports current evidence that intestinal inflammation
and subsequent disruption of the intestinal mucosa occur in
AD and that probiotics may work to reduce intestinal inflammation.
The results indicate another therapy for the treatment of AD.
The long-term effectiveness of probiotic use for treatment of
AD remains to be addressed.
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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Purpose of the Study.
Study Population.
