Division of Allergy/Immunology, Department of Pediatrics, Private SEMA Research and Training Hospital, Istanbul, Turkey.
Allergy Asthma Proc. 2010 Mar-Apr;31(2):103-11. doi: 10.2500/aap.2010.31.3313.
Development of the child's immune system tends to be directed toward a T-helper 2 (Th2) phenotype in infants. To prevent development of childhood allergic/atopic diseases, immature Th2-dominant neonatal responses must undergo environment-driven maturation via microbial contact in the early postnatal period. Lactic acid bacteria and bifidobacteria are found more commonly in the composition of the intestinal flora of nonallergic children. Epidemiological data also showed that atopic children have a different intestinal flora from healthy children. Probiotics are ingested live health-promoting microbes that can modify intestinal microbial populations in a way that benefits the host; and enhanced presence of probiotic bacteria in the intestinal microbiota is found to correlate with protection against atopy. There is insufficient but very promising evidence to recommend the addition of probiotics to foods for prevention and treatment of allergic diseases, especially atopic dermatitis. Clinical improvement especially in allergic rhinitis and IgE-sensitized (atopic) eczema has been reported too. Literature data for food allergy/hypersensitivity and asthma are not adequate for this guaranteed conclusion; however, clinical benefit of probiotic therapy depends on numerous factors, such as type of bacterium, dosing regimen, delivery method, and other underlying host factors, e.g., the age and diet of the host. The selection of the most beneficial probiotic strain, the dose, and the timing of supplementation still need to be determined. Accordingly, probiotics can not be recommended generally for primary prevention of atopic disease; and if probiotics are used in atopic infants/children for any reason, such as therapy or prevention, cautionary approach ought to be taken.
儿童免疫系统的发育往往偏向于婴儿期的辅助性 T 细胞 2(Th2)表型。为了预防儿童期过敏/特应性疾病的发生,不成熟的 Th2 优势型新生儿反应必须通过产后早期的微生物接触进行环境驱动成熟。乳酸菌和双歧杆菌在非过敏儿童的肠道菌群组成中更为常见。流行病学数据还表明,特应性儿童的肠道菌群与健康儿童不同。益生菌是摄入的具有促进健康作用的活菌,可通过有益于宿主的方式改变肠道微生物群;并且发现肠道微生物群中益生菌的存在增强与预防特应性有关。有足够但非常有希望的证据表明,益生菌可添加到食物中,以预防和治疗过敏性疾病,特别是特应性皮炎。也有报道称,益生菌治疗在过敏性鼻炎和 IgE 敏化(特应性)湿疹方面有临床改善。食物过敏/超敏反应和哮喘的文献数据不足以得出这一结论;然而,益生菌治疗的临床获益取决于许多因素,例如细菌类型、剂量方案、给药方法和其他潜在宿主因素,例如宿主的年龄和饮食。最有益的益生菌菌株的选择、剂量和补充时间仍需确定。因此,益生菌不能普遍推荐用于特应性疾病的一级预防;如果出于治疗或预防等任何原因在特应性婴儿/儿童中使用益生菌,应采取谨慎的方法。