Category Archives for "Allergies"

Eczema & Probiotics

The majority of this post was written by Dr. Taylor Edwards, who was a medical student that rotated with me earlier this year, now she is a Doctor of Osteopathic Medicine off to residency!  I take medical students from Ohio University and work with the pharmacists in my area to expose them to different areas of pharmacy practice. I also talk to them a lot about functional medicine and depending on the speciality they are interested in, we look at what they could study that will impact how they treat patients in the future.  Dr. Edwards. is training to be a dermatologist so of course we talked about gut health and it’s relationship to atopic conditions such as eczema. I hope you enjoy her post!

Dr. Hartzler

 

Eczema, also called atopic dermatitis, is a common, chronic and relapsing skin condition characterized by extreme itching. Currently, the incidence of eczema in industrialized nations is 20%, representing a 2-3 fold increase in recent decades.1,2 The reason for this increase remains unclear due to the complex etiology of the disease. However, it is reasonable to assume that this increase cannot be explained by genetic factors alone. Research has demonstrated that food allergy, defects in the gut mucosal barrier (ie leaky gut), and increased intestinal permeability may play a role in the development of eczema.3 Dietary manipulation remains a controversial topic in the treatment of atopic diseases, however, some studies show promise for the use of probiotics in the treatment and prevention of atopic dermatitis in young children.4

Probiotics are normal, healthy bacteria of the human gut that can be consumed in food or as dietary supplements.5 Lactobacilli and bifidobacteria are the most studied types of probiotics and are thought to assist the neonatal immune system in creating T-regulatory immune cells that are vital in preventing atopic disease.3,6-8 One large study supports the use of probiotics as preventative care due to findings that the incidence of eczema was 20% lower in infants and children that were exposed to probiotics early in life or during gestation.9

Another study demonstrated that probiotics may represent a helpful adjuvant therapy in the treatment of eczema. Forty young children between the ages of 3 months and 6 years with a diagnosis of eczema were divided equally into two groups and treated with probiotics (a mixture of 7 strains including Lactobacilli and bifidobacteria gena) or placebo. At the end of 8 weeks, the children that were treated with the probiotic mixture demonstrated a significant reduction in the severity of their eczema.10 While not all studies regarding probiotics as a modality to improve eczema have demonstrated consistent results, one large meta-analysis that evaluated data from ten studies and 678 patients found that when compared to placebo, probiotics may play a role in reducing the severity of eczema.11

Along with probiotics, cow’s milk is another area of interest for eczema researchers. Many parents believe the development of eczema in their child was temporally associated with the introduction of cow’s milk or cow’s milk based formula. Nearly 100 studies have examined the influence of hydrolyzed formulas versus cow’s milk based formulas in the development of eczema.  The most well-known study, the GINI study, found that infants given exclusively hydrolyzed formula were 50% less likely to develop eczema compared to infants who were fed cow’s milk based formula (hydrolyzed formula did not show benefit over breast milk).12-16 Soy based formula is often believed to be less allergenic than cow’s milk based formula, however, research does not support this claims.17

Exclusion diets have also been studied in individuals with eczema with less promising results. However, children with eczema and suspected egg allergy may benefit from a diet excluding eggs.18 In situations where special diets are attempted, it is recommended to adhere to the diet for a limited time of 4-8 weeks and then return to a normal diet to assess the efficacy of dietary interventions.4

So the PharmToTable Rx for eczema definitely includes quality probiotics (find them in my fullscript store!) and addressing gut health! My favorite quality probiotics include those by OrthoMolecular, Metagenics, Klaire Labs, and Young Living. For kids omega-3’s and vitamin D are certainly another good idea to reduce inflammation and support gut healing. For breastfed babies, elimination diets for mom are also important if you can figure out the trigger. For formula fed babies, a hydrolyzed formula is a good place to start, but possibly further reducing allergens by moving to a corn-free and hydrolyzed option like Alimentum Ready Feed may be necessary. You definitely have to give it at least a month if not two months to see the full effect.

Also check out this post by the National Eczema Association as well for further reading on this topic! There is also some interested new thoughts and emerging evidence about using probiotics topically to help heal the skin. This article discusses the topic.

References: 

  1. Thestrup-Pedersen K. Treatment principles of atopic dermatitis. J Eur Acad Dermatol Venereol. 2002;16(1):1-9. http://www.ncbi.nlm.nih.gov/pubmed/11952283. Accessed February 11, 2018.
  2. Eichenfield LF, Hanifin JM, Beck LA, et al. Atopic Dermatitis and Asthma: Parallels in the Evolution of Treatment. Pediatrics. 2003;111(3):608-616. doi:10.1542/peds.111.3.608.
  3. Isolauri E. Intestinal involvement in atopic disease. J R Soc Med. 1997;90 Suppl 30:15-20. http://www.ncbi.nlm.nih.gov/pubmed/9176124. Accessed February 11, 2018.
  4. Finch J, Munhutu MN, Whitaker-Worth DL. Atopic dermatitis and nutrition. Clin Dermatol. 2010;28(6):605-614. doi:10.1016/j.clindermatol.2010.03.032.
  5. Salminen S, Bouley C, Boutron-Ruault MC, et al. Functional food science and gastrointestinal physiology and function. Br J Nutr. 1998;80 Suppl 1:S147-71. http://www.ncbi.nlm.nih.gov/pubmed/9849357. Accessed February 11, 2018.
  6. Smits HH, Engering A, van der Kleij D, et al. Selective probiotic bacteria induce IL-10–producing regulatory T cells in vitro by modulating dendritic cell function through dendritic cell–specific intercellular adhesion molecule 3–grabbing nonintegrin. J Allergy Clin Immunol. 2005;115(6):1260-1267. doi:10.1016/J.JACI.2005.03.036.
  7. Prescott SL, Björkstén B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol. 2007;120(2):255-262. doi:10.1016/J.JACI.2007.04.027.
  8. Pessi T, Sütas Y, Hurme M, Isolauri E. Interleukin-10 generation in atopic children following oral Lactobacillus rhamnosus GG. Clin Exp Allergy. 2000;30(12):1804-1808. http://www.ncbi.nlm.nih.gov/pubmed/11122221. Accessed February 11, 2018.
  9. Pelucchi C, Chatenoud L, Turati F, et al. Probiotics Supplementation During Pregnancy or Infancy for the Prevention of Atopic Dermatitis. Epidemiology. 2012;23(3):402-414. doi:10.1097/EDE.0b013e31824d5da2.
  10.   Farid R, Ahanchian H, Jabbari F, Moghiman T. Effect of a new synbiotic mixture on atopic dermatitis in children: a randomized-controlled trial. Iran J Pediatr. 2011;21(2):225-230. http://www.ncbi.nlm.nih.gov/pubmed/23056792. Accessed February 11, 2018.
  11.   Michail SK, Stolfi A, Johnson T, Onady GM. Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy, Asthma Immunol. 2008;101(5):508-516. doi:10.1016/S1081-1206(10)60290-6.
  12.   Laubereau B, Brockow I, Zirngibl A, et al. Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life—results from the GINI-birth cohort study. J Pediatr. 2004;144(5):602-607. doi:10.1016/J.JPEDS.2003.12.029.
  13.   Banks JR. THE EFFECT OF HYDROLYZED COW’S MILK FORMULA FOR ALLERGY PREVENTION IN THE FIRST YEAR OF LIFE: THE GERMAN INFANT NUTRITIONAL INTERVENTION STUDY, A RANDOMIZED, DOUBLE-BLIND TRIAL. Pediatrics. 2004;114(2):521-522. doi:10.1542/peds.114.2.S1.521-b.
  14.   Oldaeus G, Anjou K, Björkstén B, Moran JR, Kjellman NI. Extensively and partially hydrolysed infant formulas for allergy prophylaxis. Arch Dis Child. 1997;77(1):4-10. http://www.ncbi.nlm.nih.gov/pubmed/9279143. Accessed February 11, 2018.
  15.   Halken S, Hansen KS, Jacobsen HP, et al. Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention: a prospective, randomized study. Pediatr Allergy Immunol. 2000;11(3):149-161. http://www.ncbi.nlm.nih.gov/pubmed/10981524. Accessed February 11, 2018.
  16.   Nentwich I, Michková E, Nevoral J, Urbanek R, Szépfalusi Z. Cow’s milk-specific cellular and humoral immune responses and atopy skin symptoms in infants from atopic families fed a partially (pHF) or extensively (eHF) hydrolyzed infant formula. Allergy. 2001;56(12):1144-1156. http://www.ncbi.nlm.nih.gov/pubmed/11736743. Accessed February 11, 2018.
  17.   Osborn DA, Sinn JK. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. October 2006. doi:10.1002/14651858.CD003741.pub4.
  18.   Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. 1998;9(1):13-19. http://www.ncbi.nlm.nih.gov/pubmed/9560837. Accessed February 11, 2018.

 

Allergic Rhinitis & The Gut..Is it time for Probiotics?

Despite summer being in full swing here in Ohio, there are a lot of people here and across the country are who are still suffering from seasonal allergies and what the medical community refers to as allergic rhinitis (AR). AR is one of the most common diseases that effects nearly 1 in every 6 Americans. AR is an inflammatory condition often leading to symptoms such as congestion, runny nose, sneezing, nasal itching, and watery/itching eyes.1 

Some experience seasonal allergies that are temporary due to triggers being pollens that come and go depending on the season. Others experience year-round or perennial allergies due to dust mites and continued triggers. Some patients could experience what is referred to as episodic allergies from triggers they encounter outside of their typical environment such as family members’ pets.1

Guidelines recommend avoiding allergic triggers as a first step in treatment such as removal of pets, using air filtration systems, and bed covers (to avoid dust mites). 1 Nasal saline rinses can be very helpful to clear out the pollens from the nasal passage before sleeping, this is my favorite one that is easy to use! Washing your hair before sleeping can also help reduce the pollens that attach to our hair follicles. From a western medicine standpoint, during serious allergy flare ups, I need to use a topical nasal steroid such as fluticasone. 1 The great part is they are now available over the counter. This can help calm down the inflammation short term as you consider other ways to address allergies more naturally. Budesonide  is the nasal steroid of choice for pregnant women, using the lowest effective dose and duration is recommended.2,3

An interesting discussion recently has been the connection between the gut and the lack of diverse healthy microbes to the development of allergies. Multiple studies indicate that the increased incidence of autoimmune and allergic diseases in developed countries may be associated with reduced diversity in bacteria exposure and changes of bacteria in various body tissue. AR and atopic eczema have been shown to be related to changes in gut microbial composition.4

“Leaky gut” is a term for an impaired intestinal barrier or an increase in gut permeability, which may also play a role in the development of asthma and allergies. The intestine should play a role as the gatekeeper of immunity and when this is broken the body can start to have a reaction to typical proteins called antigens it would not normally react to. This can include food reactions, or reactions in the nasal passageways or lungs. AR is considered by some to be an early form of an autoimmune disease.4

Thus an important part of treating seasonal allergies is making sure the gut is healthy, this is a whole post in itself that will be coming soon, but for now starting with a high quality probiotic and avoiding allergic triggers including foods that further trigger allergy symptoms is a start. For me I have a reaction to ragweed in the fall and I have found that sunflower seeds trigger my allergic rhinitis because they are similar plants. Paying attention to food triggers can be very helpful! In regards to probiotics, Vliagoftis et al performed a meta-analysis of 16 clinical trials on the treatment of AR and Asthma and found that 9 of 12 studies that elevated clinical outcomes of AR showed improvement due to the use of probiotics. They determined that probiotics may have a beneficial effect by reducing symptom severity and medication use. Most of these studies reported used some form of Lactobacillus species such as Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus rhamnosus, some included a combination with Bifidobacterium strains.5

My favorite probiotic for adults right now is OrthoBiotic from OrthoMolecular. This is a high quality mix of the strains discussed above.  It also includes Saccharomyces boulardii which is a beneficial non-pathogenic yeast that works to balance intestinal flora.  The only patients who should not take Saccharomyces would be those with compromised immune systems. Each OrthoBiotic capsule provides seven proven probiotic strains chosen for their ability to withstand the harsh gastrointestinal (GI) environment and adhere to the intestinal tract. The specific strains found in this product have be shown to increase Secretory IgA which provides enhanced gut Immunity.

Bifidobacterium lactis (B. lactis), one of the probiotics in the above formula, is predominantly found in the colon. A double-blind, randomized placebo-controlled trial on subjects receiving B. lactis or placebo for eight weeks found that B. lactis supported a balanced immune response in individuals hypersensitive to environmental allergens.6 Flora Boost can be a great option for toddlers and kiddos that don’t swallow pills yet.

Ther-Biotic Complete is another great probiotic I recommend by Klaire Labs. They also have a Women’s Formula as well that supports healthy colonization in the vaginal tract as well as provides the probiotic strains above shown to be beneficial in allergic conditions. Klaire Labs formulas do need to be refrigerated upon arrival.

You can find all of these high quality probiotics in my Supplement Store on FullScript. If you have questions, feel free to reach out! Don’t forget to contact me & sign up for blog updates if you want 15% off your first order.

Stayed tuned for my next post which will discuss my favorite supplements (Quercetin, Stinging Nettles) and nutrients (Vitamin C, Bromelain, N-Acetyl-L-Cysteine) and their useful role in supporting allergic conditions. And if you need recommendations for probiotics for babies, head over to this post.

 

References:

  1. Seidman et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery 2015, Vol. 152(1S) S1–S43.
  2. Wallace DV, Dykewicz MS, Bernstein DI, et al, “The Diagnosis and Management of Rhinitis: An Updated Practice Parameter,”J Allergy Clin Immunol, 2008, 122(2 Suppl):1-84.[PubMed 18662584]
  3. NAEPP Working Group Report on “Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment,” National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 05-5236, March 2005. Available athttp://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf
  4. Hormannsperger G, et al. Gut matters: Microbe-host interactions in allergic diseases. J Allergy Clin Immunol 2012;129:1452-9.
  5. Vliagoftis et al. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol. 2008;101:570–579
  6. Singh A, Hacini-Rachinel F, Gosoniu ML, Bourdeau T, Holvoet S, Doucet-Ladeveze R, Beaumont M, Mercenier A, Nutten S. Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial. Eur J Clin Nut. 2013 Feb;67(2):161-7.