It has long been known that eczema can be prevented and treated through the probiotic species Lactobacillus rhamnosus. Collaborative research, however, has not pointed to any specific strain, until six years after. Published in June 2013, a revolutionary set of clinical trials have shown Lactobacillus rhamnosus HN001 in particular to be very effective in preventing infant and childhood eczema and in lowering atopic sensitisation.
The prevention and treatment of eczema through the application of Lactobacillus rhamnosus is famous in gastrointestinal immunology. Furthermore, quite a number of previous clinical trials and extensive supporting evidence have also shown the efficacy of this species in the treatment of a wide range of gastrointestinal conditions. The relationship between probiotics and the risk of atopic development and eczema in infants particularly, are influenced by many factors, including dosage, pre- and post-natal timing, duration of treatment, and the actual probiotic strain administered.
How the Trial for the Prevention and Treatment of Childhood Eczema was Conducted
A double-blind randomised placebo controlled trial was performed on 425 high risk infants (with either parent dignosed with allergic disease). The mothers of these infants were given 6 x 109 CFU/day (6 Billion CFU) of L. rhamnosus HN001 from 35 weeks gestation until the infant turned 6 months old for nursing mothers, and directly administered to infants from birth until 2 years of age. Prevalence of eczema in infants receiving the supplementation was dramatically reduced to 50% at the age of 2. 2 years after the treatment stopped, this positive effect continued to persist in the infants at the age of 4. At this time, infant development has been found by researchers to be protected from rhinoconjunctivitis, a significant effect not found with other well-known L. rhamnosus strains.
Follow-up data from the same infants, now 6 years of age, were obtained by researchers, and the follow-up trial was supported by powerful assessment criteria which included parental questionnaires, total IgE serum specific IgE, Skin prick test sensitization, and SCORAD Eczema Severity Scale. 4 years after probiotic supplementation was stopped, a monumental 40% decline in cumulative prevalence in eczema, along with a 30% reduction of developing atopic sensitisation, was noted by the researchers.
How Lactobaccilus rhamnosus HN001 Works in the Prevention and Treatment of Eczema in Children
By providing a more balanced Th1/Th2 immune profile, probiotics are able to influence the innate immune system. Dominant Th2 responses have long been linked with allergic diseases, thus, by suppressing Th2 cytokines and stimulating Th1 cytokines, probiotics may protect against atopic conditions. An increase in natural killer cells and neutrophil activity have also been attributed to L. rhamnosus HN001.
In this trial, the elevations of interferon gamma (IFNγ) found in the cord blood, and the elevations of transforming growth factor beta (TGF-β) found in the breast milk of mothers, clearly show the immunomodulatory effects of L. rhamnosus HN001.(1,2) This has been identified as a protection against the immunological outcomes of allergy. Probiotics’ epigenetic effects on gene expression may also play a significant part on the above findings.(2)
For the evidence-based practitioner, the lasting protective effect after the 2-year initial treatment is of fundamental clinical significance. Gestational/infant supplementation of L. rhamnosus HN001 has proven to be an effective defense against eczema and atopic sensitization into the first 6 years of life. Further research regarding immunological protection in adolescence and adulthood can be done with the immunomodulatory effects discussed above.
Based on the article: Wickens K, Stanley TV, Mitchell EA, et al, Early supplementation with Lactobacillus rhamnosus HN001 reduces eczema prevalence to 6 years: Does it also reduce atopic sensitization? Epidemiology of Allergic Disease. 2013 Jun; 10.1111/cea.12154
References available on request.