Abstract

ObjectiveTo determine effects of probiotic consumption on clinical and immunological parameters of seasonal allergic rhinitis (SAR) in an out-of-season single nasal allergen challenge.MethodsIn a study registered at ClinicalTrials.Gov (NCT01123252), a 16-week dietary intervention was undertaken in 60 patients with allergic rhinitis (>16 years old). Using a double-blinded, placebo-controlled anonymised design, the patients were divided equally into two groups. One group was given a dairy drink containing Lactobacillus casei Shirota to ingest daily while the other consumed a similar drink without bacteria. Participants attended the clinic on two consecutive days before the intervention and then again at the end of the study period. On the first day of each 2-day visit, following clinical examination, assessments were made of total nasal symptoms scores and peak nasal inspiratory flow. Nasal scrapings, nasal lavage and blood were collected for laboratory analyses of cellular phenotypes, soluble mediator release and in vitro responses to pollen allergen. These procedures were repeated 24 hours following nasal allergen challenge.ResultsPrior to and following intervention there were no detectable differences between study groups in measured clinical outcome. After intervention, there were differences between groups in their percentages of CD86+ epithelial cells (p = 0.0148), CD86+CD252+ non-epithelial cells (p = 0.0347), sIL-1RII release (p = 0.0289) and IL-1β (p = 0.0224) levels at the nasal mucosa. Delivery of probiotic also suppressed production of sCD23 (p = 0.0081), TGF-β (p = 0.0283) and induced increased production of IFN-γ (p = 0.0351) in supernatants of cultured peripheral blood.Conclusions & Clinical RelevanceThis study did not show significant probiotic-associated changes with respect to the primary clinical endpoint. An absence of overt clinical benefit may be due to an inability of single nasal challenges to accurately represent natural allergen exposure. Nevertheless, oral delivery of probiotics produced changes of the immunological microenvironment at the nasal mucosa in individuals affected by SAR.Trial RegistrationClinicalTrials.Gov NCT01123252

Highlights

  • Epidemiological studies and recent experimental research support the idea that microbial stimulation of the immune system can influence development of tolerance to innocuous allergens [1]

  • One of the proposed mechanisms for this includes direct interaction of Lactobacilli with epithelial cells to modify their production of inflammatory mediators [2].In a study of patients with allergic rhinitis out of the pollen season, 4 weeks’ treatment with L. casei reduced the number of CD16/CD56 cells, L. plantarum decreased production of IL-5 and IL-13 and both probiotics reduced the amount of birch-pollen specific IgE [3]

  • In this study immune parameters were determined in serum and peripheral blood mononuclear cell cultures and the patients were not exposed to allergen, which makes it impossible to evaluate the impact of these findings on allergic disease

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Summary

Introduction

Epidemiological studies and recent experimental research support the idea that microbial stimulation of the immune system can influence development of tolerance to innocuous allergens [1]. This makes the gastrointestinal microbiota composition of particular interest, as it provides a major source of immune stimulation and that seems to be a prerequisite for the development of oral tolerance. One of the proposed mechanisms for this includes direct interaction of Lactobacilli with epithelial cells to modify their production of inflammatory mediators [2].In a study of patients with allergic rhinitis out of the pollen season, 4 weeks’ treatment with L. casei reduced the number of CD16/CD56 cells, L. plantarum decreased production of IL-5 and IL-13 and both probiotics reduced the amount of birch-pollen specific IgE [3]. Serum levels of specific IgG increased and IgE decreased in the probiotic group [4]

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