Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis

  • Vibeke Rosenfeldt
    Correspondence
    Reprint requests: Vibeke Rosenfeldt, MD, University Clinic of Pediatrics, H:S Hvidovre Hospital, DK-2650 Hvidovre, Denmark
    Affiliations
    From the Department of Human Nutrition, The Royal Veterinary and Agricultural University, the University Clinic of Pediatrics, H:S Hvidovre Hospital, and the Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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  • Eva Benfeldt
    Affiliations
    From the Department of Human Nutrition, The Royal Veterinary and Agricultural University, the University Clinic of Pediatrics, H:S Hvidovre Hospital, and the Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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  • Niels Henrik Valerius
    Affiliations
    From the Department of Human Nutrition, The Royal Veterinary and Agricultural University, the University Clinic of Pediatrics, H:S Hvidovre Hospital, and the Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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  • Anders Pærregaard
    Affiliations
    From the Department of Human Nutrition, The Royal Veterinary and Agricultural University, the University Clinic of Pediatrics, H:S Hvidovre Hospital, and the Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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  • Kim Fleischer Michaelsen
    Affiliations
    From the Department of Human Nutrition, The Royal Veterinary and Agricultural University, the University Clinic of Pediatrics, H:S Hvidovre Hospital, and the Department of Dermatology, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
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      Objective

      To determine whether probiotic lactobacilli may alleviate small intestinal inflammation and strengthen the intestinal barrier function in children with atopic dermatitis.

      Study design

      In a double-blinded, placebo-controlled, cross-over study, probiotic lactobacilli ( Lactobacillus rhamnosus 19070-2 and L reuteri DSM 12246) were administered for 6 weeks to 41 children with moderate and severe atopic dermatitis. Gastrointestinal symptoms were registered before and during treatment and small intestinal permeability was measured by the lactulose-mannitol test.

      Results

      During Lactobacillus supplementation, there was a significant decrease in the frequency of gastrointestinal symptoms (39% during the placebo period versus 10% during active treatment, P = .002). There was a positive association between the lactulose to mannitol ratio and the severity of the eczema ( r = 0.61, P = .02 after placebo and r = 0.53, P = .05 after active treatment). After probiotic treatment, the lactulose to mannitol ratio was lower (0.073) than after placebo (0.110, P = .001).

      Conclusions

      Impairment of the intestinal mucosal barrier appears to be involved in the pathogenesis of atopic dermatitis. The study suggests that probiotic supplementation may stabilize the intestinal barrier function and decrease gastrointestinal symptoms in children with atopic dermatitis.
      AD ( Atopic dermatitis), GI ( Gastrointestinal), LM ratio ( Ratio of lactulose to mannitol), s-IgE ( Immunoglobulin E in serum), SCORAD ( SCORing Atopic Dermatitis)
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