From the Hospital for Children and Adolescents, Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland.
World Allergy Organ J. 2009 May;2(5):69-76. doi: 10.1097/WOX.0b013e3181a45ee5.
Several fold increase in allergic diseases in developed, high-income countries during recent decades is attributed to environmental changes such as urbanization with improved hygiene. This, together with conquering severe bacterial infections during childhood, has reduced the microbial stimulation of the developing immune system of infants. Studies on the pathogenesis of allergy both in man and experimental animal have shown the importance of commensal bacteria in the gastrointestinal tract in stimulating and directing the immune system. The interest in modulating commensal bacterial flora with probiotics to prevent and treat allergy has multiplied in recent years.In the present review we report results on randomized, controlled studies in which childhood atopic eczema was treated or which aimed to prevent development of allergy during childhood.Nine studies with 639 patients have looked at the effect of probiotics in treatment of eczema. While 3 studied showed no effect, other studies suggested a moderate benefit of the use of probiotics on the severity of eczema. Studies suggested that the effect may be seen particularly in patients with food allergy and/or sensitization.Nine studies have reported on the prevention of allergy on 6 study population with altogether 1989 high risk infants. While the early study reporting the development of allergy at ages 2, 4 and 7 years showed a marked reduction of eczema in 77 treated infants, later studies have failed to show similar success. Two studies showed no effect. In the largest study with more than 900 children at age 2 atopic eczema was reduced by 20%, but at age 5 positive effect was present in only the subgroup of children who had born by cesarean section. None of studies has reported adverse effects of probiotics in infants.Result in both treatment and prevention studies are quite variable, the major reason being the use of different strains of probiotic bacteria and varying types of intervention. Even if the results are encouraging, we need a stronger effect. This may be reached by finding new strains of probiotics affecting stronger stimulation of immune system, together with longer lasting and varying treatment schedules. However, safety issues have to be observed.
在过去几十年中，发达国家和高收入国家的过敏性疾病发病率呈数倍增长，这归因于城市化和卫生条件改善等环境变化。这种情况，再加上儿童期严重细菌感染的减少，减少了婴儿发育中免疫系统受到的微生物刺激。人类和实验动物过敏发病机制的研究表明，胃肠道内共生菌在刺激和指导免疫系统方面具有重要意义。近年来，人们对使用益生菌来调节共生菌群以预防和治疗过敏的兴趣倍增。
在本综述中，我们报告了一些随机对照研究的结果，这些研究旨在治疗儿童特应性皮炎或预防儿童时期过敏的发生。有 9 项研究涉及 639 名患者，研究了益生菌对湿疹的治疗效果。其中 3 项研究没有效果，其他研究表明益生菌的使用对湿疹严重程度有一定的益处。研究表明，这种效果可能在食物过敏和/或致敏的患者中更为明显。
有 9 项研究报告了对 6 项研究人群（共 1989 名高危婴儿）的过敏预防。尽管早期的研究报告称，在 2、4 和 7 岁时发展为过敏的儿童中，77 名接受治疗的儿童湿疹明显减少，但后来的研究未能取得类似的成功。两项研究没有效果。在最大的研究中，有 900 多名 2 岁时患有特应性皮炎的儿童中，湿疹减少了 20%，但在 5 岁时，仅在剖宫产出生的儿童亚组中存在阳性效果。没有研究报告益生菌在婴儿中的不良反应。
治疗和预防研究的结果差异很大，主要原因是使用了不同的益生菌菌株和不同类型的干预措施。尽管结果令人鼓舞，但我们需要更强的效果。这可能通过找到新的益生菌菌株来实现，这些菌株可以更强烈地刺激免疫系统，同时延长和改变治疗方案。然而，必须注意安全问题。
