1. ABSTRACT:
CONCLUSION
REFERENCES
Eczema is a prevalent condition of red, dry and itchy skin commonly
found in western countries, especially among children. There are
many theories behind the incidence and severity of eczema, but the
exact mechanism by which it arises is unknown. Recent studies
investigating probiotic supplementation for eczema prevention have
shown a correlation between maternal intake of probiotics and the
prevalence of eczema in newborn infants.
OBJECTIVES
APPLICATIONS: DURING AND
AFTER PREGNANCY
PHYSIOLOGICAL ASPECTS
RELATED NUTRIENTS
Maternal Probiotic Supplementation to Reduce the
Incidence of Infant Eczema
Kaite Hoffman, Sarah Allison, & Megan Blackburn
Department of Food Science & Human Nutrition, Colorado State University, Fort Collins, CO
•To evaluate whether or not probiotic supplements taken during
pregnancy and breastfeeding have an effect on infant eczema rates.
•To present possible mechanisms by which probiotic supplements
have an impact on infant eczema prevalence.
•To study types and combinations of probiotics that may be
beneficial for the prevention of infant eczema.
Eczema is one of the most abundant diseases in children in the United
States1
. It is speculated that a recent increased prevalence in eczema is
attributed to the hygiene hypothesis -- decreased exposure to
pathogens in early life may lead to immunological dysfunction later,
such as eczema, asthma and other allergies2
. This association led to
recent speculation about the potential for maternal probiotic
supplementation during and after pregnancy as a function in reducing
the incidence of infant eczema3
.
BACKGROUND
The incidence of eczema can be attributed to multiple factors:
genetics and family history5
. Genetic factors may compromise an
individual's immune response as well as compromise the skin’s ability
to protect the body from microbial overgrowth6
. However, there are
other factors that can influence prevalence, such as additional
allergies, race, work or school cleanliness conditions, and age. The
cause of eczema is generally unknown, although there are theories
surrounding the issue as to what makes a person more susceptible.
These reasons include dysfunctional immune systems, sensitive skin,
certain strains of bacteria present on the skin, and the surrounding
environment1
.
Probiotic supplementation is associated with decreased prevalence of eczema in
infant populations4
. Probiotics are live microorganisms that provide health
benefits when ingested through foods such as yogurt, fermented products and
supplements7
.
• Current research supports the use of probiotic supplementation during
pregnancy and breastfeeding to minimize the incidence of eczema in
infants2,3,4,8,9,10,11,12,13
.
• Certain strains may be more effective for the decreased incidence of eczema8
.
• Eczema is caused by a Th1 immune response and cytokine mediated
inflammation. Probiotics help to modulate immunity to restore healthy
Th2/Th1 balance and reduce pro-inflammatory cytokines14
.
• There is increasing evidence that the supplementation of certain
strains of probiotics during pregnancy has the potential to reduce
the incidence of infant eczema.
• The longer duration of time the probiotics are supplemented, the
higher the success rate in reducing the incidence of infant
eczema2,4,12,13
. For example, supplementing four to six months
before birth and four to six months after birth, while continuing to
breastfeed until six months.
• The reduction of eczema is attributed to promotion of a Th2
mediated immune response to reduce pro-inflammatory immune
cells.
1. Eyerich K, Novak N. Immunology of atopic eczema: overcoming the Th1/Th2 paradigm. European Journal of Allergy and Clinical Immunology. 2013; 68: 974-982. DOI:
10.1111/all.12184
2. Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary
prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatric Allergy and Immunology Journal. 2010; 21, 386-393. DOI: 10.1111/j.1399-
3038.2009.00958
3. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breast-feeding reduces the risk of eczema in the infant. American
Academy of Allergy, Asthma, & Immunology. 2012; 130, 1355-1360. DOI: 10.1016/j.jaci.2012.09.003
4. Bertelsen R, Brantseter A, Magnus M, et. al. Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases. Journal of Allergy and Clinical
Immunology. January 2014; 133(1): 165-171. Doi: 10.1016/j.jaci.2013.07.032
5. Atopic dermatitis (eczema). - Mayo Clinic. Available at: http://www.mayoclinic.org/diseases-conditions/eczema/basics/definition/con-20032073. Accessed April 11, 2016.
6. Boguniewicz M, Leung D. Recent Insights into Atopic Dermatitis and Implications for Management of Infectious Complications. Journal of Allergy and Clinical Immunology.
2010; 125. DOI: 10.1016/j.jaci.2009.11.027.
7. NCCIH. NCCIH 2011. Available at: https://nccih.nih.gov/health/probiotics/introduction.htm. Accessed April 11, 2016.
8. Boyle RJ, Ismail IH, Kivivuori S, Licciardi PV, Robins-Browne RM, Mah LJ, et al. Lactobacillus GG treatment during pregnancy for the prevention of eczema: a randomized
controlled trial. Journal of Allerg. 2011; 66: 509–516. DOI: 10.1111/j.1398-9995.2010.02507.
9. Doege K, Grajecki D, Zyriax BC, Detinkina E, Eulenburg C, Buhling KJ. Impact of maternal supplementation with probiotics during pregnancy on atopic eczema in childhood: a
meta-analysis. British Journal of Nutrition 2012; 107: 1–6. DOI: 10.1017/S0007114511003400.
10. Dotterud C, Storrø O, Johnsen R, Øien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. British Journal of Dermatology. May 2010;
163: 616-623. doi: 10.1111/j.1365-2133.2010.09889.x
11. Kuitunen M, Kukkonen A, Savilahti E. Impact of Maternal Allergy and Use of Probiotics during Pregnancy on Breast Milk Cytokines and Food Antibodies and Development of
Allergy in Children until 5 Years. International Archives of Allergy and Immunology. May 2012; 159(2): 162-170. doi: 10.1159/000336157
12. Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. Journal of the
European Academy of Dermatology and Venerology. 2014; 29: 232–242. DOI: 10.1111/jdv.12496.
13. Ou CY, Kuo HC, Wang L, at al. Prenatal and postnatal probiotics reduces maternal but not childhood allergic diseases: a randomized, double-blind, placebo-controlled trial.
Clinical & Experimental Allergy. 2012; 42, 1386-1396.
14. Grewe M, Bruijnzeel-Koomen C, Schopf E, Thepen T, Langeveld-Wildschut A, Ruzicka T, Krutman J. A Role for Th1 and Th2 cells in the immunopathogenesis of atopic
dermatitis. Elsevier Science. 1998; 19, 359-361.
Spring 2016
Image from: Grewe M, Bruijnzeel-Koomen C. et al. 1998.
Probiotic Strain Placebo Group Probiotic Group
Bifidobacterium bifidum,
Bifidobacterium lactis,
Lactobacillus acidophilus
Cumulative incidence
after 12 months: 62.9%
Cumulative incidence
after 12 months: 36.4%2
Lactobacillus rhamnosus
GG (LGG),
Bifidobacterium animalis
subsp. lactis Bb-12 (Bb-
12) and L. acidophilus
La-5 (La-5).
Cumulative incidence
after 24 months: 40%
Cumulative incidence
after 24 months: 28%10
Lactobacillus rhamnosus
LPR and Bifidobacterium
longum BL999
(LPR+BL999)
Cumulative incidence
after 24 months: 71%
Cumulative incidence
after 24 months: 29%3
PLACEBO VS. PROBIOTIC CUMULATIVE
INCIDENCE
THE INFLAMMATORY IMMUNE RESPONSE
OF ECZEMA