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| arznei-telegramm 2004; 35: 50 |
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LACTOBACILLUS GG FOR ATOPIC DERMATITIS?
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What do you think of preventing and treating atopic dermatitis with Lactobacillus? There is supposed to be a very promising "Finnish study"... Dr. A. RHEIN (KV Pfalz) The publication of a Finnish study (1) on the prevention of atopic diseases with Lactobacillus GG (LGG) in the renowned journal The Lancet has apparantly enhanced the status of the probiotic. For its dietary supplement of the same name Infectopharm asserts, "LGG ... - validly documented in neurodermitis" (2). In the two-year study, 159 pregnant women whose unborn children presented a high risk of atopic disease owing to a positive family history took two capsules daily of LGG or placebo in the period from four weeks before birth to six months afterwards. Alternatively the infants received the dissolved contents of the capsule. After two years, 23% of the children in the probiotic group were suffering from atopic dermatitis compared with 46% who had taken placebo (1). On account however, of methodological shortcomings we assessed the use as not proven (a-t 2002; 33: 21). In the meantime the follow-up has become available after another two years, which is based however only on the data from 107 (67%) children and in which blinding was not ensured. The decreased risk of atopic dermatitis persists (26% v. 46%), yet in the group that received the probiotic, numerically more children are suffering from allergic rhinitis (19% v. 9%) and asthma (5.7% v. 1.9%) (3). The use predominantly of Lactobacillus GG has been investigated in the treatment of atopic dermatitis in four studies. Three of the studies were carried out also by the Finnish working group and included infants with slight to moderately severe symptoms (4-6). The children (8 to 16 infants per treatment group) received hydrolysed whey formula with or without the addition of LGG for periods of two (4,5) or six months (6). In another Danish study (7) a total of 58 one to thirteen-year-olds with moderate to severe disease were given for six weeks alternately two new Lactobacillus strains or placebo (crossover design study). The results are contradictory. On account of the small numbers, the short period and serious methodological shortcomings (e.g. the comparability of the treatment groups is unreproducible because of inadequate details, no intention-to-treat analysis but drop-out rates up to 20%, no details of additional topical [corticosteroid] medication) the studies lack significance. Adverse effects are not mentioned in any of the studies. In isolated cases, in those with weakened immunity, Lactobacillus can however be associated with septicaemia or endocarditis. In a 74-year-old woman with high blood pressure and type 2 diabetes who had been drinking a product containing LGG for four months, bacteria were isolated from a liver abscess which were identical to the probiotic (8). In animal experiments there is clearly higher mortality among newborn mice with immunodeficiency, whose mothers are colonised by LGG compared with offsprings of non-colonised females (9). The use of the probiotic Lactobacillus GG (LGG) is not proven for either the prevention or treatment of atopic dermatitis. We advise against the use of the dietary supplement. |
(R = randomised study | ||
| R | 1 | |
2 | Infectopharm: Rundschreiben an Apotheker of 24. Jan. 2003 | |
| R | 3 | |
| R | 4 | KIRJAVAINEN, P.V. et al.: J. Pediatr. Gastroenterol. Nutr. 2003; 36: 223-7 |
| R | 5 | MAJAMAA, H., ISOLAURI, E.: J. Allergy Clin. Immunol. 1997; 99: 179-85 |
| R | 6 | |
| R | 7 | ROSENFELDT, V. et al.: J. Allergy Clin. Immunol. 2003; 111: 389-95 |
8 | RAUTIO, M. et al.: Clin. Infect. Dis. 1999; 28: 1159-60 | |
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