The Use of Lactobacillus reuteri as an Adjunct in the Treatment of Children with Newly Diagnosed Asthma in a Tertiary Hospital in the Philippines

Jose Carlo Miguel M. Villanueva, Agnes M. Gonzalez-Andaya

Apr 2023 DOI 10.35460/2546-1621.2019-0079     Access   

Abstract

Rationale:

Probiotics are live microorganisms that exert beneficial effects on the host, including a reduction of allergic disease symptoms. Lactobacillus reuteri in particular was shown to attenuate the allergic airway, and when used as an adjunct in the treatment of asthma in children, resulted in decreased fractional exhaled nitric oxide and interleukin levels when compared to placebo. However, insufficient information is available regarding the significance of L. reuteri as an adjunct in the treatment of allergic disorders, particularly in allergic airway disease.

Objectives:

The objective of the study was to determine the efficacy of L. reuteri as an adjunct for the control of newly diagnosed asthma in children.

Methodology and Population:

In this analytical, experimental, prospective, randomized controlled trial, 44 asthmatic patients aged 6–18 years were recruited from the University of Santo Tomas Hospital outpatient department, for a study period of three months. Baseline clinical assessment included skin prick test to aeroallergens, spirometry, and Childhood Asthma Control Test. Asthma severity and level of control was based on the National Asthma Education and Prevention Program’s Expert Panel 3 (EPR-3) and the Global Initiative for Asthma Guidelines 2018, respectively. Patients were randomized and half of them received L. reuteri 26.5 mg/chewable tab (at least 100 million colony forming units) once daily for 30 days, while the other half did not. Spirometry and C-ACT test were conducted at the start of intervention as baseline, after one month, two months, and three months post intervention. The results of patients from the experimental group were compared to results of patients in the control group.

Results:

The FEV1 of patients in the L. reuteri group was significantly higher than those in the control group (p = 0.045). The median FVC of the two groups significantly differed from each other through time (p = 0.007), with the L. reuteri group having significantly higher FVC than the control group. There were statistically significant improvements in ACT scores between patients in the L. reuteri and control groups, particularly at two months and three months of treatment. Among polysensitized patients, there were significant improvements in the FEV1, FEF25–75, and FVC between the L. reuteri and control group.

Conclusion:

The use of L. reuteri as an adjunct was associated with significant lung function improvement and asthma symptom control amongst newly diagnosed asthmatic children.

Key Words: Lactobacillus reuteri, Probiotics, Asthma, Children

  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018. Available from: www.ginasthma.org
  2. Kliegman R, Stanton B, Geme JW, Schor NF, Behrman RE. Nelson textbook of pediatrics. 20th Ed. Philadelphia, PA: Elsevier; 2016.
  3. Chen Y-S, Jan R-L, Lin Y-L, Chen H-H, Wang J-Y. Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis: Effects of lactobacillus on childhood asthma and allergic rhinitis. Pediatr Pulmonol [Internet]. 2010;45(11):1111–20. Available from: http://dx.doi.org/10.1002/ppul.21296
  4. Kim S-O, Ah Y-M, Yu YM, Choi KH, Shin W-G, Lee J-Y. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol [Internet]. 2014;113(2):217–26. Available from: http://dx.doi.org/10.1016/j.anai.2014.05.021
  5. Fiocchi A, Fierro V, La Marra F, Dahdah LA. The custom clearance of pro- and prebiotics in allergy prevention. Ann Allergy Asthma Immunol [Internet]. 2016;117(5):465–7. Available from: http://dx.doi.org/10.1016/j.anai.2016.05.008
  6. Prescott SL, Björkstén B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol [Internet]. 2007;120(2):255–62. Available from: http://dx.doi.org/10.1016/j.jaci.2007.04.027
  7. Mu Q, Tavella VJ, Luo XM. Role of Lactobacillus reuteri in human health and diseases. Front Microbiol [Internet]. 2018;9:757. Available from: http://dx.doi.org/10.3389/fmicb.2018.00757
  8. Vliagoftis H, Kouranos VD, Betsi GI, Falagas ME. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Ann Allergy Asthma Immunol [Internet]. 2008;101(6):570–9. Available from: http://dx.doi.org/10.1016/S1081-1206(10)60219-0
  9. Dongarra ML, Rizzello V, Muccio L, Fries W, Cascio A, Bonaccorsi I, et al. Mucosal immunity and probiotics. Curr Allergy Asthma Rep. 2013;13:19–26.
  10. Cross ML, Stevenson LM, Gill HS. Anti-allergy properties of fermented foods: an important immunoregulatory mechanism of lactic acid bacteria? Int Immunopharmacol [Internet]. 2001;1(5):891–901. Available from: http://dx.doi.org/10.1016/s1567-5769(01)00025-x
  11. Kirjavainen PV, Arvola T, Salminen SJ, Isolauri E. Aberrant composition of gut microbiota of allergic infants: a target of bifidobacterial therapy at weaning? Gut [Internet]. 2002;51(1):51–5. Available from: http://dx.doi.org/10.1136/gut.51.1.51
  12. Valeur N, Engel P, Carbajal N, Connolly E, Ladefoged K. Colonization and immunomodulation by Lactobacillus reuteri ATCC 55730 in the human gastrointestinal tract. Appl Environ Microbiol [Internet]. 2004;70(2):1176–81. Available from: http://dx.doi.org/10.1128/AEM.70.2.1176-1181.2004
  13. Forsythe P, Inman MD, Bienenstock J. Oral treatment with live Lactobacillus reuteri inhibits the allergic airway response in mice. Am J Respir Crit Care Med [Internet]. 2007;175(6):561–9. Available from: http://dx.doi.org/10.1164/rccm.200606-821OC
  14. Del Giudice M, Maiello M, Decimo N, Fusco F, Agostino D, Sullo B, et al. Airways allergic inflammation and L. reuterii treatment in asthmatic children. Journal of Biological Regulators & Homeostatic Agents. 2012;26(1):35–40.
  15. Del Giudice M, Maiello M, Allegorico N, Iavarazzo A, Capasso L, Capristo M. Lactobacillus reuterii DSM 17938 plus Vitamin D3 as an ancillary treatment in allergic children with asthma. Ann Allergy Asthma Immunol. 2016;117:703–7.
  16. Abrahamsson TR, Jakobsson T, Björkstén B, Oldaeus G, Jenmalm MC. No effect of probiotics on respiratory allergies: a seven-year follow-up of a randomized controlled trial in infancy. Pediatr Allergy Immunol [Internet]. 2013;24(6):556–61. Available from: http://dx.doi.org/10.1111/pai.12104
  17. Kang C, Kang Sim DE. Lactobacillus for prevention of pediatric atopic disorders: A meta-analysis of randomized controlled trials. J Allergy Clin Immunol [Internet]. 2019;143(2):AB280. Available from: http://dx.doi.org/10.1016/j.jaci.2018.12.857
  18. Bora M, Alpaydin AO, Yorgancioglu A, Akkas G, Isisag A, Coskun AS, et al. Does asthma control as assessed by the asthma control test reflect airway inflammation? Multidiscip Respir Med [Internet]. 2011;6(5):291–8. Available from: http://dx.doi.org/10.1186/2049-6958-6-5-291
  19. Ciprandi G, Cirillo I. Monosensitization and polysensitization in allergic rhinitis. Eur J Intern Med [Internet]. 2011;22(6):e75-9. Available from: http://dx.doi.org/10.1016/j.ejim.2011.05.009
  20. Ha EK, Baek JH, Lee S-Y, Park YM, Kim WK, Sheen YH, et al. Association of polysensitization, allergic multimorbidity, and allergy severity: A cross-sectional study of school children. Int Arch Allergy Immunol [Internet]. 2016;171(3–4):251–60. Available from: http://dx.doi.org/10.1159/000453034

Articles related to the one you are viewing

There are currently no results to show, please try again later

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.