Rosenfeldt V, Benfeldt E, Nielsen SD, et al. J Allergy Clin Immunol. 2003;111:389–395
Purpose of the Study.
To evaluate the clinical and antiinflammatory effects of probiotic supplementation among children with atopic dermatitis (AD).
Subjects were 43 children (1–13 years of age) in Denmark with known AD.
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-γ) 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.
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.
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.
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.