Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E
Department of Paediatrics, University of Turku and Turku University Hospital, Finland.
Lancet. 2001 Apr 7;357(9262):1076-9. doi: 10.1016/S0140-6736(00)04259-8.
Reversal of the progressive increase in frequency of atopic disease would be an important breakthrough for health care and wellbeing in western societies. In the hygiene hypothesis this increase is attributed to reduced microbial exposure in early life. Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora. We assessed the effect on atopic disease of Lactobacillus GG (which is safe at an early age and effective in treatment of allergic inflammation and food allergy).
In a double-blind, randomised placebo-controlled trial we gave Lactobacillus GG prenatally to mothers who had at least one first-degree relative (or partner) with atopic eczema, allergic rhinitis, or asthma, and postnatally for 6 months to their infants. Chronic recurring atopic eczema, which is the main sign of atopic disease in the first years of life, was the primary endpoint.
Atopic eczema was diagnosed in 46 of 132 (35%) children aged 2 years. Asthma was diagnosed in six of these children and allergic rhinitis in one. The frequency of atopic eczema in the probiotic group was half that of the placebo group (15/64 [23%] vs 31/68 [46%]; relative risk 0.51 [95% CI 0.32-0.84]). The number needed to treat was 4.5 (95% CI 2.6-15.6).
Lactobacillus GG was effective in prevention of early atopic disease in children at high risk. Thus, gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics, for prevention of atopic disease.
逆转特应性疾病发病率的逐步上升，对西方社会的医疗保健和福祉而言将是一项重大突破。在卫生假说中，这种发病率上升归因于生命早期微生物接触减少。益生菌是健康肠道微生物群中潜在有益细菌的培养物。我们评估了鼠李糖乳杆菌GG（在幼年时安全且对治疗过敏性炎症和食物过敏有效）对特应性疾病的影响。
在一项双盲、随机、安慰剂对照试验中，我们对至少有一位患有特应性湿疹、过敏性鼻炎或哮喘的一级亲属（或伴侣）的母亲在孕期给予鼠李糖乳杆菌GG，并在产后对其婴儿给予6个月。慢性复发性特应性湿疹是生命最初几年特应性疾病的主要体征，为主要终点。
132名2岁儿童中有46名（35%）被诊断为特应性湿疹。其中6名儿童被诊断为哮喘，1名被诊断为过敏性鼻炎。益生菌组特应性湿疹的发病率是安慰剂组的一半（15/64 [23%] 对31/68 [46%]；相对风险0.51 [95%可信区间0.32 - 0.84]）。需治疗人数为4.5（95%可信区间2.6 - 15.6）。
鼠李糖乳杆菌GG对预防高危儿童早期特应性疾病有效。因此，肠道微生物群可能是迄今未被探索的天然免疫调节剂和益生菌来源，可用于预防特应性疾病。
