Disclosures: Ciprandi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

May 11, 2022
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Probiotics may prevent asthma exacerbations among children with allergy

Disclosures: Ciprandi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Supplementation with a mixture of two probiotics may prevent asthma exacerbations among children with allergy, particularly those with house dust mite allergies, according to a study published in Annals of Allergy, Asthma & Immunology.

“Asthma is usually recognized as a type 2 inflammation associated with impaired type 1 immune response, which is responsible for fighting infections,” Giorgio Ciprandi, MD, an allergist with the Allergy Clinic in Casa di Cura Villa Serena in Genoa, Italy, told Healio.

Children with allergies had a 0.18 odds ratio for seeing reductions in asthma exacerbations with probiotics, while children specifically with house dust mite allergies had a 0.25 odds ratio.
Data were derived from Ciprandi, et al. Ann Allergy Asthma Immunol. 2022;doi:10.1016/j.anai.2022.04.026.

Children with asthma have dysbiosis in the gut and airways, Ciprandi said, adding that they are prone to respiratory infections as well.

Giorgio Ciprandi

“Asthma exacerbations are usually preceded by acute respiratory infections,” Ciprandi said. “Probiotics may restore immune response switching from type 2 to type 1, exert anti-inflammatory activity and rebalance microbiota to eubiosis.”

According to the previous PRObiotics in Pediatric Asthma Management (PROPAM) study, a probiotic mixture including Bifidobacterium breve B632 and Ligilactobacillus salivarius LS01 significantly reduced the number of asthma exacerbations experienced by children with asthma.

Since allergy is a main pathogenic factor in asthma, the researchers hypothesized, children with allergy would also respond to probiotic supplementation.

The 422 children in the PROPAM study included 164 with allergy (38.8%), with a mean age of 8.8 years (SD ± 3.31) and a split of 60 (36.6%) girls and 104 (63.4%) boys.

However, 16 did not meet inclusion criteria and were not randomized for the double-blind allergy study, and three were lost to follow-up, leaving 84 (51%) for the placebo group and 80 (49%) for the probiotic group.

The supplementation lasted 4 months. Participants received the probiotic mixture or placebo twice each day, once in the morning and once in the evening, for 8 weeks, and then once a day for 8 additional weeks.

After a post hoc analysis, the researchers found that children with allergies who received the probiotic mixture saw reductions in asthma exacerbations (OR = 0.18), with better outcomes for those with house dust mite allergies (OR = 0.25).

“The probiotic mixture significantly prevented asthma exacerbations,” Ciprandi said.

Noting that the leading cause of asthma exacerbations is acute viral respiratory infection, the researchers called restoring the physiological immune response essential to asthma management.

Additionally, the researchers said, using these strains in probiotic supplementation could prevent asthma exacerbations and therefore reduce health care costs and medication side effects while improving quality of life.

“Probiotics should be considered as add-on treatment,” Ciprandi said.

“As many children with asthma have uncontrolled or partially controlled asthma and previous exacerbations are the main risk factor for further asthma exacerbations, probiotics could be beneficial in preventing them,” he added.

However, Ciprandi cautioned that pharmacological treatment should always be used on a guidelines-oriented basis. He also said that research in these areas should continue.

“Post hoc analyses were performed in preschoolers, schoolchildren and allergic subjects,” he said. “All these analyses confirmed the positive effects. Further studies could explore the effect on asthma control and biomarkers.”

For more information:

Giorgio Ciprandi, MD, can be reached at gio.cip.libero.it.