For health professionals, impartially curated by OptiBac

It is now commonly understood that the gut is the principle interface between microbes and the immune system. When the balance of ‘good’ and ‘bad’ microbes is lost in favour of increased levels of pathogenic strains then damage to the lining of the gastro-intestinal tract can occur. Not only does this allow pathogens and toxins to reach the bloodstream, but the damage to the gut mucosa also triggers an inflammatory reaction from the immune system. The continuous cycle of damage to the gut lining and the low-grade systemic inflammation that it causes, can have far-reaching consequences in the body. As healthcare professionals you may already by aware that one of the possible outcomes is eczema.


It is estimated that 1 in 5 children in the UK has eczema

The introduction of probiotics into a gut that is over-populated by pathogenic species is believed to increase the competition for space on the epithelial wall, and also the competition for available food and nutrients. In this way probiotics can effectively ‘crowd out’ less desirable strains of bacteria and help to restore the gut flora to its natural balance, giving the epithelial lining a chance to heal. If the gut lining regains its integrity and becomes less 'leaky' then a significant burden is taken off the immune system, meaning that it is less likely to 'over-react' thus reducing our susceptibility to allergies.

Clinical evidence

Preliminary research seems to suggest that skin conditions such as eczema and psoriasis can be linked back to an imbalance of good and bad bacteria in the gut. However, not all strains of friendly bacteria exert a protective effect against the development of atopic eczema, and research is still ongoing as to the best strains to use.

One large study in 2010 on a strain of Lactobacillus rhamnosus showed babies exposed to probiotics prenatally & after birth for 6 months were less likely to develop eczema than those not given probiotics. This study was followed up in 2012 by a paper published in the journal ‘Clinical and Experimental Allergy’1. The same strain of Lactobacillus was given to pregnant mothers from 35 weeks gestation to 6 months post birth (if breastfeeding), and their infants were also supplemented from birth until age 2yrs. The study results showed that of the 425 participants, the incidence of eczema at age 4 years (2 years after the cessation of probiotic supplementation) was greatly reduced in the probiotic group as compared to placebo. The researchers believed that this protective effect was gained through the modulation of the immune system and the suppression of pro-inflammatory cytokines, which are ‘messenger’ molecules within the immune system.

A smaller study2 found that infants with eczema were found to have less variation in their gut microbiota than babies without eczema. The entire study can be accessed via the following link.

Additionally, in a 2007 study3, 188 pregnant women from families with high incidence of allergic conditions were given probiotics or placebo from week 36 of gestation to birth. Their infants were then subsequently supplemented with the same probiotic from birth to age 12 months. The probiotic strain used was: Lactobacillus reuteri ATCC 55730. Clinical results showed that the probiotic group of infants had less IgE-associated eczema (IgE is a certain type of antibody).

In the same year Australian researchers analysed 12 studies covering 2000 infants to find that probiotics such as Lactobacillus rhamnosus, and prebiotics such as GOS amd FOS demonstrated benefits for various allergic and atopic diseases, and food intolerances. The majority of the studies analysed for the report administered probiotics during the mother's pregnancy or when breastfeeding, or added probiotics to infant formula for the first sixth months4.

Update March 2018

A new study, which was commissioned by the UK Food Standards Agency, found that supplementing with probiotics during late pregnancy and whilst breastfeeding might reduce the risk of children developing eczema.

This comprehensive systematic review (see Probiotics Learning Lab for definition), which utilised over 400 studies involving 1.5 million participants (mothers and toddlers), evaluated how an infant’s diet in their first year of life and diet during pregnancy and lactation, influenced their risk of developing allergic diseases.

It is not clear if the exposure to probiotics in the first few months of life was via maternal diet during pregnancy and breastfeeding, or via direct supplementation, but, based on the results from 19 studies, the review by Garcia-Larsen et al., (2018) found that taking a probiotic supplement from 36 - 68 weeks of gestation and during the first 3 to 6 months of life reduced the risk of developing eczema by 22 percent5.

No particular combination of probiotic strains were identified to be particularly responsible for this reduction, and the dose taken isn’t clear, but based on their findings, the researchers deduced that taking a probiotic like Lactobacillus rhamnosus during the last few months of pregnancy and through lactation may help reduce eczema.

Overall, more research will be needed in order to get conclusive answers about the best strains and dosage for eczema support, but the findings from this review strongly supports the benefits probiotics have on allergic diseases.

For more detailed information on this topic you may also like to read the following article by Dr Georges Mouton, health practitioner and expert in digestive health: Probiotics & Eczema

You might also find the following related blog interesting:

Probiotics for eczema? More experts back friendly bacteria over steroids

Or see this blog in the Probiotics Learning Lab: Probiotics & Skin: the next big thing in beauty?

References:
1 A protective effect of Lactobacillus rhamnosus HN001 against eczema in the first 2 years of life persists to age 4 years. Authors: K. Wickens, P. Black,T. V. Stanley, E. Mitchell, C. Barthow, P. Fitzharris, G. Purdie, J. Crane First published: 15 June 2012
2 Erick Forno et al. September 2012. Diversity of the gut microbota and eczema in early life. Clinical & Molecular Allergy 6:11
3 J Allergy Clin Immunol. 2007 May;119(5):1174-80. Epub 2007 Mar 8. Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. Abrahamsson TR1, Jakobsson T, Böttcher MF, Fredrikson M, Jenmalm MC, Björkstén B, Oldaeus G.
4 Osborn, D.A. Sinn, J.K. Prebiotics in infants for prevention of allergic disease and food hypersensitivity . Cochrane Database of Systematic Reviews 2007, Issue 4. 5 Garcia-Larsen, V. et al., 2018. Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLOS Medicine, 15(2), pp. 1-25.

This FAQ has been answered by Joanna Scott-Lutyens, BA (hons), DipION, Nutritional Therapist.