Hol Jeroen, van Leer Eduard H G, Elink Schuurman Beatrix E E, de Ruiter Lilian F, Samsom Janneke N, Hop Wim, Neijens Herman J, de Jongste Johan C, Nieuwenhuis Edward E S
Department of Pediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
J Allergy Clin Immunol. 2008 Jun;121(6):1448-54. doi: 10.1016/j.jaci.2008.03.018. Epub 2008 Apr 24.
Cow's milk allergy (CMA) is the most frequently diagnosed food allergy in infancy. In general, patients have a good prognosis because the majority acquire tolerance within the first years. Interventions have been proposed to accelerate tolerance and reduce morbidity. Probiotic supplementation could be effective through modulation of the immune system.
We sought to determine whether supplementation with a combination of probiotics (Lactobacillus casei CRL431 and Bifidobacterium lactis Bb-12) accelerates tolerance to cow's milk (CM) in infants with CMA.
We performed a double-blind, randomized, placebo-controlled trial in 119 infants with CMA. Infants received CRL431 and Bb-12 supplemented to their standard treatment of extensively hydrolyzed formula for 12 months. Primary outcome was clinical tolerance to CM at 6 and 12 months of treatment. Furthermore, we analyzed T- and B-lymphocyte subsets (CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), and CD20(+)) in peripheral blood at randomization and at 12 months with flow cytometry and examined the presence of viable probiotic strains in fecal samples.
The cumulative percentage of tolerance to CM at 6 and 12 months was similar in both groups: 56 (77%) in the probiotics group versus 54 (81%) in the placebo group. Infants in the placebo group had higher percentages of CD3(+) and CD3(+)CD4(+) lymphocytes compared with those seen in probiotic-treated infants. Probiotic intake was confirmed because probiotics were isolated from feces more often in treated infants than in the placebo group.
Supplementation of CRL431 and Bb-12 to extensively hydrolyzed formula does not accelerate CM tolerance in infants with CMA.
牛奶过敏（CMA）是婴儿期最常被诊断出的食物过敏。一般来说，患者预后良好，因为大多数人在最初几年内会获得耐受性。已提出干预措施以加速耐受性并降低发病率。补充益生菌可能通过调节免疫系统而有效。
我们试图确定补充益生菌组合（干酪乳杆菌CRL431和双歧杆菌Bb - 12）是否能加速患有CMA的婴儿对牛奶（CM）的耐受性。
我们对119名患有CMA的婴儿进行了一项双盲、随机、安慰剂对照试验。婴儿在其标准的深度水解配方奶治疗中补充CRL431和Bb - 12，为期12个月。主要结局是治疗6个月和12个月时对CM的临床耐受性。此外，我们在随机分组时和12个月时用流式细胞术分析外周血中的T淋巴细胞和B淋巴细胞亚群（CD3(+)、CD3(+)CD4(+)、CD3(+)CD8(+)和CD20(+)），并检查粪便样本中活益生菌菌株的存在情况。
两组在6个月和12个月时对CM的耐受性累积百分比相似：益生菌组为56例（77%），安慰剂组为54例（81%）。与接受益生菌治疗的婴儿相比，安慰剂组婴儿的CD3(+)和CD3(+)CD4(+)淋巴细胞百分比更高。由于在接受治疗的婴儿中比安慰剂组更频繁地从粪便中分离出益生菌，因此证实了益生菌的摄入。
在深度水解配方奶中补充CRL431和Bb - 12并不能加速患有CMA的婴儿对CM的耐受性。
