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Got Probiotics?
The acquisition of tolerance toward cow's milk through probiotic supplementation: A randomized controlled trial
Jeroen Hol, MD, Eduard H. G. van Leer, MD, PhD, Beatrix E. E. Elink Schuurman, MScN, Lilian F. de Ruiter, Janneke N. Samsom, PhD, Wim Hop, MD, PhD, Herman J. Neijens, MD, PhD, Johan C. de Jongste, MD, PhD, and Edward E. S. Nieuwenhuis, MD, PhD, on behalf of the Cow's Milk Allergy Modified by Elimination and Lactobacilli study group
It seemed like a good idea; to speed up the allergic child's tolerance to cow's milk by supplementing with probiotics. It makes sense logically, in light of the hygiene hypothesis. Many believe that an apparent decline in microbial exposure during early childhood is one of the most likely causes of the rising rates of allergic disease and it's been suggested that allergic disease results from a basic failure of underlying immune regulation. Microbial exposure early in life possibly provides the strongest environmental signal for normal maturation of the immune system. On the other hand, in a changing world where the food and water supplies have been cleaned up and we no longer live in great numbers in a rural farming community with exposure to barnyard flora, our immune systems are without the microbial training partners that for eons have been our guides toward a healthy balanced immune system. When change occurs faster than the wheels of evolution can turn, disease often occurs. In fact, in the last 25 years, the prevalence of allergic diseases has doubled in industrialized parts of the world.
It has been proposed that specific bacteria, referred to as probiotics, could potentially restore intestinal homeostasis and prevent allergy through interaction with the intestinal immune cells. This study, published in the June edition of the Journal of Allergy and Clinical Immunology, sought to determine whether supplementation with a combination of probiotics (Lactobacillus casei CRL431 and Bifidobacterium lactis Bb-12) could accelerate tolerance to cow's milk (CM) in infants with CM allergy. Although there is convincing data that specific probiotic strains can influence immune function through different pathways, including effects on local immune cells such as T and B cells, this study failed to prove it. Whether other probiotics might be more successful is unclear. No other studies have been performed to assess whether probiotics can induce cow's milk tolerance in established CM allergy. Although the authors of this study are the first to address this issue, it is likely that they have opened the door to others to ask similar questions and build upon this research to further our interest in understanding the role of probiotics in managing food allergy.
As the hygiene hypothesis suggests, we have irrevocably altered our body's immunologic connection to our surroundings and can only try to re-establish some measure of that relationship through our manipulations. As F. Scott Fitzgerald would have it, we will be borne back ceaselessly into the past.
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