Probiotics for Allergies and Food Intolerances



Probiotics for Allergies and Food Intolerances

Introduction

Adverse reactions to food resulting in gastrointestinal symptoms are very common but only a minority of people have an immune mediated reaction to food, known as an allergy.(1) Therefore, although allergies can be due to an adverse reaction to food, they are different from a food intolerance. A food allergy occurs when the body’s immune system reacts to a food protein and this food triggers an allergic reaction. Food intolerance is an adverse reaction to food that does not involve the immune system and is triggered by a physical reaction to a food.

The cause of an allergy is the inappropriate or exaggerated reaction of the immune system to a protein. The immune system forms antibodies against harmless substances, which are misidentified as potential harmful proteins. These allergy causing substances are referred to as allergens and the adverse reaction to them, hypersensitivity. In infants reactions to food normally cause gastro-intestinal symptoms but as children get older allergic reactions causing skin, systemic and respiratory symptoms are more common.(9) This review also noted that there was significant improvement in the allergic symptoms of infants receiving milk formula containing Lactobacillus rhamnosus. Probiotics seem capable of enhancing the acquisition of tolerance to food protein antigens, an important step in the prevention of food allergy.

Role of the Microflora

The intestinal immune system of infants develops as it comes into contact with antigens from their diet and from bacteria. The gut microflora also have a significant impact on the development of the immune system and there is evidence that it maintains a balance between tolerating harmless proteins and mounting an inflammatory response towards potential pathogens.(12)

The intestinal microflora maintain a microbial barrier against the development of pathogenic bacteria in the digestive tract and are vital to the establishment of oral tolerance to food antigens.(3) Probiotic supplements help to restore normal intestinal microflora and intestinal permeability, which in turn will strengthen the immune system.(7) This can be observed by a reduction in the generation of pro-inflammatory cytokines, characteristic of allergic inflammation.

Further evidence of the role of the microflora in allergic disease was collated in a literature review, which found that children with allergies and those who develop them later in life, have abnormal gut microflora.(10) Allergic infants have more Clostridia spp. and less Bifidobacteria spp. in their gut microflora than those who do not have any signs of allergy.(11) This observation may be linked to feeding method, as babies fed on milk formula have less Bifidobacteria spp. in their gut than those who receive their mothers milk.

Role of the Immune System

A review of the literature concluded that probiotic bacteria have effects in the intestinal lumen and on epithelial cells and immune cells, which have the potential to be anti-allergic.(6) These effects include enhancing the degradation of antigens, the gut barrier function and the regulation of immune responses. A study gave patients with a range of allergic symptoms a probiotic containing Lactobacillus acidophilus, Lactobacillus delbrueckii and Streptococcus thermophilus and measured their levels of CD34+ hemopoietic precursor cell.(8) Those patients taking the multistrain probiotic had significantly lower circulating CD34+ cell values after treatment, indicating that systemic allergic inflammation had been reduced.

Lactose Intolerance

Some people have an inability to digest the sugar found in milk, lactose. This is due to a lack or depletion of the enzyme lactase, which is responsible for digesting lactose. Lactase breaks down lactose into the simpler sugar units, glucose and galactose that can be absorbed into the bloodstream. If there is none or not enough lactase produced, then lactose will remain undigested in the gut. It is this undigested lactose which causes intestinal problems including; diarrhoea, vomiting, bloating and abdominal cramps. Excess gas is produced when lactose is fermented by the gut microflora and diarrhoea is thought to be caused by an osmotic response leading to excess water in the faeces.

Different people may produce different amounts of lactase and will therefore be able to tolerate different amounts of lactose in their diet. The production of the enzyme lactase can be effected by digestive diseases or injuries to the small intestine. Children can also be born without the ability to produce lactase but in many cases a deficiency develops over time and people may not experience symptoms until they are older. It is a natural occurrence that a person produces less lactase as they grow older but not all will develop lactose intolerance or experience associated symptoms. People from particular countries or of a specific race my also be more likely to have a certain degree of lactose maldigestion. For example only 5-15% of people living in Great Britain have lactose maldigestion compared to 80% of black people in North America.(2)

One solution for lactose intolerance would be to avoid all dairy products but this can be difficult as many processed foods contain hidden milk ingredients. Alternatively you could increase the amount of lactase produced by the body, either in the form of an enzymatic supplement or a probiotic, whose bacterial components have a natural lactase activity. Probiotic bacteria are known to improve lactose digestion and the symptoms of lactose intolerance. Many probiotic bacteria including Lactobacillus bulgaricus and Streptococcus thermophilus actually produce lactase themselves. These lactic acid bacteria produce β-galactosidase (lactase), which can survive passage through the stomach and is released by bile salts into the small intestine, where lactose digestion occurs.(2)

Various studies have shown that supplementing with probiotic bacteria improves the ability of patients to tolerate lactose. Non-fermented milk containing either Lactobacillus acidophilus or Lactobacillus bulgaricus were given to patients who were lactose maldigesters and their degree of maldigestion monitored using a breath hydrogen test.(5) Both treatments significantly improved the symptoms of lactose intolerance and those given Lactobacillus bulgaricus also had significantly less hydrogen in their breath. Temporary lactose intolerance can occur in children and adults after a period of diarrhoea, which damages the gut villi and reduces the ability to produce lactase. This kind of lactose intolerance often occurs after a course of antibiotic therapy, probiotics would therefore be a useful to help to prevent diarrhoea and the associated lactose intolerance.

A review of the literature suggested that prebiotics, which encourage the growth of beneficial bacteria, such as Lactobacilli spp. and Bifidobacteria spp. could be used to help manage allergic conditions.(13) Recent studies have also demonstrated a reduced incidence of milk allergy in toddlers given Lactobacillus rhamnosus during early infancy.(17)

Milk Allergy

Milk allergy is caused when the immune system reacts against the proteins found in milk, believing them to be a threat. Milk allergies cause the body to react quickly, symptoms, including diarrhoea; often occur within a few minutes of consuming milk or milk products. In children allergy to milk proteins can also lead to atopic eczema, the symptoms of which can be alleviated by probiotics.

Probiotics can enhance the IgA response against food allergens, mice fed Bifidobacterium longum had higher levels of total IgA and anti-β-lactoglobulin IgA levels than controls.(3) The ability of probiotics to influence immune response was demonstrated in a study which gave milk containing Lactobacillus rhamonus to adults with or without an allergy to milk.(14) Probiotic bacteria appear to modulate the non-specific immune response differently in healthy and allergic people. They have the effect of stimulating the immune system in healthy subjects and reducing the inflammatory immune response in those with an allergy to milk.

Summary

The involvement of the gut microflora is evident in both allergies and food intolerances. Therefore, probiotic bacteria can improve these conditions and or the symptoms of by;

• Improving the balance of gut microflora

• Modulating unwanted immune responses

• Supporting the gut mucosal barrier

References

1. Bischoff S, Crowe SE (2004). Food allergy and the gastrointestinal tract. Curr Opin Gastroenterol. 20(2):156-61.

2. Michael de Vreses, Anna Stegelmann, Bernd Richter, Susanne Fenselau, Christiane Laue, and Jϋgen Schrezenmeir (2001). Probiotics – compensation for lactase insufficiency. Am J Clin Nutr. 73(suppl):421S-9S.

3. Martine Heyman (2000). Effect of Lactic Acid Bacteria on Diarrheal Disseases. Journal of the American College of Nutrition. 19(2):137S-146S.

4. Isolauri E, Majamaa H, Arvola T, Rantala I, Virtanen E, Arvilommi H (1993). Lactobacillus casei strain GG reverses increased intestinal permeability induced by cow milk in suckling rats. Gastroenterology. 105(6):1643-50.

5. Lin MY, Yen CL, Chen SH (1998). Management of lactose maldigestion by consuming milk containing lactobacilli. Dig Dis Sci. Jan;43(1):133-7.

6. Kalliomaki MA, Isolauri E (2004). Probiotics and down-regulation of the allergic response. Immunol Allergy Clin North Am. 24(4):739-52, viii.

7. Miraglia del Giudice M, De Luca MG (2004). The role of probiotics in the clinical management of food allergy and atopic dermatitis. J Clin Gastroenterol. 38(6 Suppl):S84-5.

8. Mastrandrea F, Coradduzza G, Serio G, Minardi A, Manelli M, Ardito S, Muratore L (2004). Probiotics reduce the CD34+ hemopoietic precursor cell increased traffic in allergic subjects. Allerg Immunol (Paris). 36(4):118-22.

9. Vanderhoof JA, Young RJ (2003). Role of probiotics in the management of patients with food allergy. Ann Allergy Asthma Immunol. 90(6 Suppl 3):99-103.

10. Kalliomaki M, Isolauri E (2003). Role of intestinal flora in the development of allergy. Curr Opin Allergy Clin Immunol. 3(1):15-20.

11. von der Weid T, Ibnou-Zekri N, Pfeifer A (2002). Novel probiotics for the management of allergic inflammation. Dig Liver Dis. 34 Suppl 2:S25-8.

12. Rautava S, Isolauri E (2002). The development of gut immune responses and gut microbiota: effects of probiotics in prevention and treatment of allergic disease. Curr Issues Intest Microbiol. 3(1):15-22.

13. Kirjavainen PV, Gibson GR (1999). Healthy gut microflora and allergy: factors influencing development of the microbiota. Ann Med. 31(4):288-92.

14. Pelto L, Isolauri E, Lilius EM, Nuutila J, Salminen S (1998). Probiotic bacteria down-regulate the milk-induced inflammatory response in milk-hypersensitive subjects but have an immunostimulatory effect in healthy subjects. Clin Exp Allergy. 28(12):1474-9. 

15. Di Cagno R, De Angelis M, Auricchio S, Greco L, Clarke C, De Vincenzi M, Giovannini C, D'Archivio M, Landolfo F, Parrilli G, Minervini F, Arendt E, Gobbetti M (2004). Sourdough bread made from wheat and nontoxic flours and started with selected lactobacilli is tolerated in celiac sprue patients. Appl Environ Microbiol. 70(2):1088-96.

16. Kamilova AT, Akhmedov NN, Pulatova DB, Nurmatov BA (2001). Intestinal microbiocenosis in children with intestinal enzymopathy. Zh Mikrobiol Epidemiol Immunobiol. 3:97-9.

17. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E (2001). Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 357:1076-1079.

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