Supporting a Healthy Microbiome for the Primary Prevention of Eczema

Szari, Sofia; Quinn, James A.

doi:10.1007/s12016-019-08758-5

Cited by 13 publications

(8 citation statements)

References 67 publications

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“… 35 , 36 , 37 , 38 Current evidence supports breastfeeding, and when not possible formula supplemented with prebiotics and/or probiotics as a nutritional solution may prevent the primary development of eczema by supporting a healthy gut microbiome. 39 , 40 , 41 Studies on the use of prebiotics to specifically support the colonization and enrichment of beneficial B. fragilis are needed to demonstrate its potential therapeutic application for eczema prevention. Here, we postulate that the acquisition of B. fragilis during birth allows the modulation of a gut environment that would promote the establishment of butyrate and propionate producers.…”

Section: Discussionmentioning

confidence: 99%

A compromised developmental trajectory of the infant gut microbiome and metabolome in atopic eczema

Chan

Yap

et al. 2020

Gut Microbes

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Evidence is accumulating that the establishment of the gut microbiome in early life influences the development of atopic eczema. In this longitudinal study, we used integrated multi-omics analyses to infer functional mechanisms by which the microbiome modulates atopic eczema risk. We measured the functionality of the gut microbiome and metabolome of 63 infants between ages 3 weeks and 12 months with well-defined eczema cases and controls in a sub-cohort from the Growing Up in Singapore Toward healthy Outcomes (GUSTO) mother-offspring cohort. At 3 weeks, the microbiome and metabolome of allergen-sensitized atopic eczema infants were characterized by an enrichment of Escherichia coli and Klebsiella pneumoniae , associated with increased stool D-glucose concentration and increased gene expression of associated virulence factors. A delayed colonization by beneficial Bacteroides fragilis and subsequent delayed accumulation of butyrate and propionate producers after 3 months was also observed. Here, we describe an aberrant developmental trajectory of the gut microbiome and stool metabolome in allergen sensitized atopic eczema infants. The infographic describes an impaired developmental trajectory of the gut microbiome and metabolome in allergen-sensitized atopic eczema (AE) infants and infer its contribution in modulating allergy risk in the Singaporean mother-offspring GUSTO cohort. The key microbial signature of AE is characterized by (1) an enrichment of Escherichia coli and Klebsiella pneumoniae which are associated with accumulation of pre-glycolysis intermediates (D-glucose) via the trehalose metabolic pathway, increased gene expression of associated virulence factors (invasin, adhesin, flagellin and lipopolysaccharides) by utilizing ATP from oxidative phosphorylation and delayed production of butyrate and propionate, (2) depletion of Bacteroides fragilis which resulted in lower expression of immunostimulatory bacterial cell envelope structure and folate (vitamin B9) biosynthesis pathway, and (3) accompanied depletion of bacterial groups with the ability to derive butyrate and propionate through direct or indirect pathways which collectively resulted in reduced glycolysis, butyrate and propionate biosynthesis.

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Section: Discussionmentioning

confidence: 99%

A compromised developmental trajectory of the infant gut microbiome and metabolome in atopic eczema

Chan

Yap

et al. 2020

Gut Microbes

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“…Prebiotics are defined as a nondigestible food ingredient such as galacto‐oligosaccharide (GOS) or fructo‐oligosaccharide (FOS), that beneficially and selectively colonize and stimulate the activity of one or more of a limited number of beneficial, health‐promoting, gut microbiota species 11 . Evidence from multiple randomized controlled trials (RCTs) with up to 5‐year follow‐up suggests prebiotics reduce the incidence and promote the resolution of atopic symptoms, 2,12–16 reduce the incidence of atopic dermatitis (AD) in infants at risk of allergy, 14–16 improve allergic disease and lessen the progression toward other atopic conditions, a phenomenon known as the “allergic march.” 15–18 Probiotics are health‐promoting, non‐pathogenic microorganisms that inhabit the gut such as Bifidobacterium (one of the first colonizers of the breast‐fed infant gut and prominent in breastmilk), which beneficially exert immune maturation and stimulatory actions, 19–24 stimulation of gut integrity and modulation of gut microbiota 19,25–27 . Evidence from RCTs has demonstrated improvement of allergic symptoms of infants with atopic dermatitis (AD) supplemented with probiotics 3,19,25,28–31 and the use of Bifidobacterium and Lactobacillus probiotic strains has specifically been shown to significantly improve allergic symptoms 19,29–33 and intestinal inflammatory markers in those with allergy 28,34 .…”

Section: Introductionmentioning

confidence: 99%

Synbiotic containing extensively hydrolyzed formula improves gastrointestinal and atopic symptom severity, growth, caregiver quality of life, and hospital‐related healthcare use in infants with cow's milk allergy

Hubbard

Atwal

Graham

et al. 2022

Immunity Inflam & Disease

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BackgroundHealthy gut microbiota is important for prognosis in cow's milk allergy (CMA). The application of synbiotics (specific pre‐ and probiotics) in extensively hydrolyzed formulae (eHFs) is a relatively new concept.AimsTo evaluate a synbiotic‐containing, whey‐based eHF (SeHF) with galacto‐oligosaccharides, fructo‐oligosaccharides, and bifidobacterium breve M‐16V in infants with CMA.Materials and MethodsA 31‐day one‐arm pilot study in 29 infants with CMA (mean age 30.8 weeks [SD 11]) was undertaken, with outcomes including gastrointestinal tolerance, atopic dermatitis symptoms, dietary intake, growth, SeHF acceptability, caregiver quality of life, and hospital‐related healthcare use.ResultsSignificant improvements (p < .05) in the severity of abdominal pain (in 57%), burping (in 46%), flatulence (in 79%), constipation (in 14%), rhinitis (41%), and itchy eyes (73%), as well as atopic dermatitis in those with severe baseline symptoms (PO‐SCORAD© reduction: 34.7–18.2 (p = .003), n = 6) were observed over time. Growth and caregiver quality of life scores significantly increased (+26.7%, p < .05) over time. Hospital visits and medications significantly reduced (−1.61 and −2.23, respectively, p < .005) in the 6 months after SeHF initiation.DiscussionIn this small, single‐arm, pilot study, the use of SeHF enhanced the management of infants with non‐IgE mediated CMA who were already established on eHF. Conclusion: Whilst this study adds to the evidence base for the use of SeHF in CMA, further robust research to explore the longer‐term benefits of synbiotics, specifically the blend used in this study, for the clinical management of infants with CMA is warranted.

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“…The evidence that ingested probiotics (non-pathogenic live bacteria or yeasts that can restore a dysfunctional pro-inflammatory gut microbiome) or prebiotics (nondigestible food ingredients that encourage beneficial bacteria to thrive) or both (synbiotics) can prevent AD is gathering momentum ( 32 ). The field is complicated as probiotics and prebiotics refer to a very wide range of ingredients, and they can be given to the mother during pregnancy, during lactation, to the infant after birth and various combinations of these and for different periods, leading to considerable heterogeneity which impacts on the ability to combine studies.…”

Section: The Evidencementioning

confidence: 99%

Prevention of Atopic Dermatitis

Williams¹,

Chalmers²

2020

Acta Derm Venereol

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Despite advances in atopic dermatitis (AD) treatments, research into AD prevention has been slow. Systematic reviews of prevention strategies promoting exclusive and prolonged breastfeeding, or interventions that reduce ingested or airborne allergens during pregnancy and after birth have generally not shown convincing benefit. Maternal/infant supplements such as Vitamin D have also not shown any benefit with the possible exception of omega-3 fatty acids. Systematic reviews suggest that probiotics could reduce AD incidence by around 20%, although the studies are quite variable and might benefit from individual patient data meta-analysis. Skin barrier enhancement from birth to prevent AD and food allergy has received recent interest, and results from national trials are awaited. It is possible that trying to influence major immunological changes that characterise AD at birth through infant-directed interventions may be too late, and more attention might be directed at fetal programming in utero .

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Supporting a Healthy Microbiome for the Primary Prevention of Eczema

Cited by 13 publications

References 67 publications

A compromised developmental trajectory of the infant gut microbiome and metabolome in atopic eczema

A compromised developmental trajectory of the infant gut microbiome and metabolome in atopic eczema

Synbiotic containing extensively hydrolyzed formula improves gastrointestinal and atopic symptom severity, growth, caregiver quality of life, and hospital‐related healthcare use in infants with cow's milk allergy

Prevention of Atopic Dermatitis

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