Do probiotics really help with eczema?

Eczema in Infants – A product of our lifestyle?

The prevalence of infantile eczema, characterised by rash, redness, papules, and severe itchiness, has risen steeply in developed countries. (1) Although the exact causes for the development of eczema are not entirely understood, one potential explanation stems from the increasingly sterile lifestyles we are leading, and the effect this has on our gut microbiome. (1) Although our increased awareness of cleanliness has drastically reduced rates of infection and disease, it does come with a downside: conditions that don’t support the gastrointestinal microbe colonisation or their ability to fight against potential pathogens. (1) This may explain the rise in allergic disease, including eczema, in infants and young children. (1) Eczema can severely hamper quality of life, and effective treatments are scarce. For this reason, prevention is the best option, and luckily there are an increasing numbers of scientific studies researching exactly how this might be possible with the help of specific probiotic strains.




What are probiotics?

Probiotics are cultures of living microorganisms that can be taken as a supplement, or by consuming foods and drinks such as kimchi, sauerkraut, kombucha and kefir. (1, 2) They essentially add more good bacteria to your gut, and have been shown in multiple studies to have beneficial health effects, including improved symptoms in gastrointestinal diseases such as IBS, IBD and diarrhea, as well as decreasing the incidence of allergic diseases such as eczema. (2)

One of the most widely used probiotic strains is Lactobacillus Rhamnosus GG, otherwise known as LGG. It has many well-documented health benefits including treatment of gastrointestinal infections and diarrhea, plus stimulation of certain immune responses that can prevent allergic symptoms, including eczema. (3)

Can probiotics help with eczema?

Numerous scientific studies have shown that probiotics can help to decrease the incidence of eczema in infants. In 2015, the World Allergy Organisation guideline panel suggested that women at high risk of having an allergic baby, women who breastfed babies at high risk of developing allergy, and infants themselves at high risk of developing an allergy, should consider using a probiotic. (4) These studies administered the probiotics in various ways; to the pregnant woman, to the breastfeeding mother, and/or directly to the infant.

Many of the studies reviewed used a combination of these methods and found a significant reduction in the infants’ risk of developing eczema. (5) One meta analysis (the highest level of evidence available) observed, in multiple randomised, double-blind, placebo-controlled trials, that the consumption of probiotics by pregnant and/or breastfeeding mothers, and/or their babies reduced the incidence of eczema by approximately 31%. (1) Another review of seven trials, which only administered the probiotic to the mother and not the baby, found that probiotic intervention was most effective in reducing eczema in the baby if it was started by the mother during her pregnancy, and then continued postnatally. (6) For this positive effect to be observed for high risk infants, the mother only had to take a probiotic supplement for two months before the birth, and two months after the birth. (6) In these particular cases, a combination of LGG (Lactobacillus rhamnosus) and BB536 (Bifidobacterium longum) was used to promote this clinically and statistically significant result in infants that were at high risk of developing eczema. (6)

Although some of these meta analyses and trials included a broad range of probiotic strains to achieve these results, there are many that singled out particular strains that seem to be most beneficial for reducing the incidence of eczema. One systematic review and meta analysis concluded that both Bifidobacterium and Lactobacillus strains seemed to have a particularly positive effect on reducing the risk of children developing eczema. (7) It points out that the use of a probiotic supplement beginning during pregnancy through to the first six months of life decreased the incidence of eczema in infants by 26%, but that this further decreased to 52% when the probiotic supplement included Lactobacillus paracasei. (7)

LGG features highly in many of the successful trials. One study showed that a combination of LGG given to the mother 2 - 4 weeks before birth, plus for six months after birth to the baby, showed a lowered risk of eczema at the ages of two, four, and seven. (8) LGG supplements alone, or in combination with BB-12 probiotics, administered to children under the age of two for six months have also been proven to significantly reduce the incidence of eczema diagnoses in these children. (4, 9)

Why do probiotics help eczema?

Although there are still several unknowns in the emerging arena of gut health, it appears that our gut microbes play a significant role in the development of eczema. We do know that individuals with eczema have an imbalance with their T cell-mediated immune response, preventing the Th2-dominated immune response from quickly switching back towards a Th1 immune response. (1) Healthy gut microbial establishment starting from birth can enhance Th1 immunity and help to reduce the Th2-mediated allergic inflammation (i.e. eczema). (1) Our gut microbes are also capable of stimulating the expression of IgA, which enhances the musosal defence system, reducing the inflammatory responses such as eczema. (1)

Interestingly, we also know that children with eczema have different microbial compositions to their peers without eczema, exhibiting a higher ratio of Clostridium strain and lower levels of Bifidobacterium. (9) In contrast, non-allergic children have higher levels of Lactobacilli and Bifidobacteria, supporting the theory that these particular strains seem to be protective against allergic disease such as eczema and offering an explanation as to why a probiotic is capable of proving such positive reductions in eczema prevalence. (9)

References

1. Dang D, Wenli Z, Zhi Jun L, Xin M, Dong Xuan W, Hui W. Meta-analysis of probiotics and/or prebiotics for the prevention of eczema. Journal of International Medical Research. 2013;41(5):1426-36.

2. Markowiak P, Sli’zewska K. Effects of Probiotics, Prebiotics, and Synbiotics on Human Health. Nutrients [Internet]. 2017 Sept [cited 2020 May 27]; 9(9):[30 pp.]. Available from: https://pubmed.ncbi.nlm.nih.gov/28914794/

3. Segers ME, Lebeer S. Towards a better understanding of Lactobacillus rhamnosus GG--host interactions. Microb Cell Fact. 2014;13 Suppl 1(Suppl 1):S7-S.

4. Schmidt RM, Pilmann Laursen R, Bruun S, Larnkjaer A, Mølgaard C, Michaelsen KF, et al. Probiotics in late infancy reduce the incidence of eczema: A randomized controlled trial. Pediatric allergy and immunology: official publication of the European Society of Pediatric Allergy and Immunology. 2019;30(3):335-40.

5. Cuello-Garcia CA, Brożek JL, Fiocchi A, et al. Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2015;136(4):952-961. doi:10.1016/j.jaci.2015.04.031

6. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. The Journal of Allergy and Clinical Immunology. 2012;130(6):1355-60.

7. Mansfield JA, Bergin SW, Cooper JR, Olsen CH. Comparative probiotic strain efficacy in the prevention of eczema in infants and children: a systematic review and meta-analysis. Military medicine. 2014;179(6):580-92.

8. Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: A cumulative risk reduction of eczema in a randomized, placebo-controlled trial. 2007. p. 1019-21.

9. Berni Canani R, Di Costanzo M, Pezzella V, Cosenza L, Granata V, Terrin G, et al. The Potential Therapeutic Efficacy of Lactobacillus GG in Children with Food Allergies. Pharmaceuticals. 2012;5(6):655-64.

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