Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis. Epidemiology of Allergic Rhinitis Caused by Grass Pollen or House-dust Mites in Spain Poster 1014: Omalizumab efficiency in patients with allergic rhinitis and chronic sinusitis World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomized, placebo-controlled trial (GA2LEN Study) SQ house dust mite sublingually administered immunotherapy tablet (ALK) improves allergic rhinitis in patients with house dust mite allergic asthma and rhinitis symptoms. Probiotics in Treatment of Allergic Rhinitis Prediction of the incidence and persistence of allergic rhinitis in adolescence: a prospective cohort study. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. Effect of probiotics on allergic rhinitis in Df, Dp or dust-sensitive children: A randomized double blind controlled trial Immune-modulatory effect of probiotic Bifidobacterium lactis NCC2818 in individuals suffering from seasonal allergic rhinitis to grass pollen: an exploratory, randomized, placebo-controlled clinical trial Allergy immunotherapy for allergic rhinitis effectively prevents asthma: Results from a large retrospective cohort study. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. Bacillus clausii effects in children with allergic rhinitis Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial Preventing progression of allergic rhinitis: the role of specific immunotherapy Efficacy and safety of the SQ house dust mite sublingual immunotherapy tablet in Japanese adults and adolescents with house dust mite–induced allergic rhinitis An open-label, multicentre study of levocetirizine for the treatment of allergic rhinitis and urticaria in Taiwanese patients. Effect of tetanus immunization on t-helper cytokine production in adults with and without allergic rhinitis.
Previous studies have suggested that probiotic administration may have therapeutic and /or preventive effects on atopic dermatitis in infants ; however , its role in allergic airway diseases remains controversial . To determine whether daily supplementation with specific Lactobacillus gasseri A5 for 8 weeks can improve the clinical symptoms and immunoregulatory changes in school children suffering from asthma and allergic rhinitis ( AR ) . We conducted a r and omized , double-blind , placebo-controlled study on school children ( age , 6 - 12 years ) with asthma and AR . The eligible study subjects received either L. gasseri A5 ( n = 49 ) or a placebo ( n = 56 ) daily for 2 months . Pulmonary function tests were performed , and the clinical severity of asthma and AR was evaluated by the attending physicians in the study period . Diary cards with records of the day- and nighttime peak expiratory flow rates ( PEFR ) , symptoms of asthma , and AR scores of the patients were used for measuring the outcome of the treatment . Immunological parameters such as the total IgE and cytokine production by the peripheral blood mononuclear cells ( P BMC s ) were determined before and after the probiotic treatments . Our results showed the pulmonary function and PEFR increased significantly , and the clinical symptom scores for asthma and AR decreased in the probiotic-treated patients as compared to the controls . Further , there was a significant reduction in the TNF-α , IFN-γ , IL-12 , and IL-13 production by the P BMC s following the probiotic treatment . In conclusion , probiotic supplementation may have clinical benefits for school children suffering from allergic airway diseases such as asthma and AR Background Although the prevalence of allergic rhinitis ( AR ) is increasing , relatively little is known about patient characteristics in Spain . The aim of this study was to investigate the clinical profile and therapeutic strategies in patients attending Spanish specialists for AR caused by grass pollen or house-dust mites ( HDMs . Methods This was a multicenter cross-sectional epidemiological study of consecutive patients aged ≥5 years with confirmed diagnosis of AR caused by grass pollen or HDMs attending allergy specialists throughout Spain . Demographic and clinical data and information on treatment were collected . Results Data from 1043 patients were analyzed ( 524 with grass pollen allergy and 519 with HDM allergy ; mean age , 27.1 years ) . Three-quarters had persistent AR as per the Allergic Rhinitis and Its Impact on Asthma ( ARIA ) definition , with disease duration of > 2 years in 94.3 % of those with pollen allergy and 85.5 % of those with HDM allergy . Approximately 38 % had concurrent asthma . Over one-half of the patients were considered to have gotten worse since the first onset of symptoms . In total , 51.5 % did not achieve good disease control with pharmacotherapy and 47.7 % were treated with immunotherapy ( 52.2 % of HDM allergic patients and 43.2 % of grass pollen-allergic patients . Conclusion The duration of AR in patients attended for the first time by specialists is long and , in general , the disease does not improve over time and is often not well controlled with pharmacologic interventions . Less than one-half of patients receive allergen-specific immunotherapy that is more often prescribed in HDM allergy Background Allergic rhinitis ( AR ) is a very common chronic respiratory disorder and has also been shown to negatively impact quality of life with many comorbiliditys like Chronic rhinosinusitis ; There is evidence that IgE antibodies play a role in chronic sinusitis . Investigations have shown that total IgE levels correlate with the severity of sinusitis , as assessed by CT scan . Allergies occur more frequently in patients with chronic sinusitis than in the general population . Omalizumab has shown to be effective for AR in allergen challenge studies and clinical trials . Multiple r and omized , double-blind , placebo-controlled studies have shown efficacy of omalizumab in seasonal and perennial AR Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants Background / objectives : An imbalance between Th1 and Th2 cells is involved in allergic rhinitis ( AR ) that may be improved by probiotics . To test the efficacy of the probiotic Lactobacillus paracasei subsp . paracasei LP-33 , a double-blind , placebo-controlled , r and omized trial was carried out in patients with AR to grass pollen treated with loratadine and presenting altered quality of life . Subjects/ methods : Subjects with persistent AR , symptomatic during the grass pollen season , and a positive skin test or specific immunoglobulin E to grass pollens were included by general practitioners ( GPs ) . All received loratadine for 5 weeks . The primary end point was the improvement in Rhinitis Quality of Life ( RQLQ ) global score at the fifth week of LP-33 consumption compared with placebo ( in addition to loratadine ) . Secondary end points included nasal and ocular symptoms ( individual and total symptom scores ) , visual analogue scale and time of first exacerbation of the symptoms when loratadine was stopped . Results : A total of 425 subjects were included . Using intent-to-treat analysis , the RQLQ global score decreased significantly more in the LP-33 group than in the placebo group ( P=0.0255 , difference=−0.286 ( 95 % confidence interval ( CI ) : −0.536 ; −0.035 ) ) . No significant differences were noted for the change of the rhinitis total symptom score 5 global score between groups ( P=0.1288 , difference=−0.452 ( 95 % CI : −1.036 ; 0.132 ) ) . Significant differences in ocular symptoms ( RQLQ ) were observed between groups ( P=0.0029 , difference=−0.4087 ( 95 % CI : −0.6768 ; −0.1407 ) ) . Conclusions : This study performed by GPs shows that LP-33 improves the quality of life of subjects with persistent AR who are currently being treated with an oral H1-antihistamine . Whereas nasal symptoms had not changed , ocular symptoms had consistently improved BACKGROUND House dust mite ( HDM ) allergy is associated with persistent allergic rhinitis ( AR ) and allergic asthma . OBJECTIVE To investigate the efficacy and safety of a SQ HDM sublingually administered immunotherapy tablet ( ALK , Hørsholm , Denmark ) in adults and adolescents with HDM respiratory allergic disease and report the AR results . METHODS Six hundred four subjects at least 14 years old with HDM AR and mild to moderate HDM allergic asthma were r and omized 1:1:1:1 to double-blinded daily treatment with 1 , 3 , 6 SQ-HDM or placebo . End-of-treatment rhinoconjunctivitis symptoms and medication score were predefined extrapulmonary end points . A subgroup analysis was conducted post hoc in subjects with a total combined rhinitis score ( TCRS ) > 0 ( ie , with AR symptoms and /or AR medication use during the 4-week baseline period ) . The subgroup was comprised of 498 subjects ( 82 % ) . RESULTS In the subgroup , the absolute difference in end-of-treatment TCRS between 6 SQ-HDM and placebo was -0.78 ( 95 % confidence interval -1.47 to -0.07 , relative difference 28.8 % , P = .0357 ) . Furthermore , a significant difference was found for the total score of the Rhinitis Quality of Life Question naire with St and ardized Activities RQLQ(S ) and for the individual domains : activities , sleep , non-nose and non-eye symptoms , and nasal symptoms . For the TCRS and Rhinitis Quality of Life Question naire score , a dose response was seen , with numerically lower , nonsignificant differences for 1 and 3 SQ-HDM . The predefined analysis for the entire trial population showed no statistically significant difference between the placebo and actively treated groups . No safety concerns were observed . CONCLUSION Efficacy in mild to severe AR of 6 SQ-HDM compared with placebo was demonstrated by statistically significant improvements in TCRS and Rhinitis Quality of Life Question naire score in subjects with AR present at baseline . The treatment was well tolerated . TRIAL REGISTRATION EudraCT , no 2006 - 001795 - 20 ; Clinical Trials.gov , identifier NCT00389363 Many r and omized controlled trials ( RCTs ) have been done on role of probiotics as a treatment modality in allergic rhinitis . We conducted a review on the same . A systematic search of published literature was done . RCTs comparing effect of probiotics with placebo were included . A predefined set of outcome measures were assessed . Continuous data were expressed as pooled st and ardized mean difference ( SMD ) with 95 % confidence interval ( CI ) . Dichotomous data were expressed as odds ratio with 95 % CI . P value < 0.05 was considered significant . RevMan version 5 was used for all the analyses . Seven RCTs were eligible for inclusion .  Probiotic intake  improved quality of life score in patients with allergic rhinitis [ SMD -1.17 ( 95 % CI -1.47 , -0.86 ; P < 0.00001 ) ] . Other parameter that improved with probiotic intake was decrease in the number of episodes of rhinitis per year . There was no significant change in blood or immunologic parameters in the probiotic group , SMD -0.10 ( 95 % CI -0.26 , 0.06 ; P = 0.22 ) . Adverse events were not significant . Probiotic therapy might be useful in rhinitis , but the present data do not allow any treatment recommendations BACKGROUND Predictive models have rarely been used in allergy research and practice . However , they might support physicians in advising patients . OBJECTIVE The aim of this study was to create predictive models for the incidence and persistence of  allergic rhinitis ( AR ) during adolescence . METHODS A prospect i ve population -based cohort study was conducted starting at age 9 to 11 years . Potential risk factors for atopic diseases obtained at baseline in 2810 subjects were used to create predictive logistic regression models for the incidence and persistence of physician-diagnosed AR with current symptoms at age 15 to 18 years . RESULTS Positive skin prick test responses to outdoor allergens at baseline were the most important determinant for both the incidence and persistence of AR until follow-up . For the incidence of AR , positive skin prick test responses to indoor allergens , parental history of asthma , female sex , and not having been breast-fed exclusively for 2 or more months were additional statistically significant independent risk factors . Depending on the number of risk factors present , the probability of the incidence of AR increased from 2 % ( no risk factors present ) to 72 % ( full model ; 95 % CI , 58 % to 85 % ) . The probability of persistence of AR ranged from 33 % ( no risk factors present ) to 83 % ( full model ; 95 % CI , 70 % to 97 % ) . CONCLUSION The course of AR over puberty can be predicted using risk factors that are easy to determine in childhood . Sensitization to outdoor allergens seems to play a much greater role for disease development than sensitization to indoor allergens . This might help pediatricians in advising patients BACKGROUND Less microbial exposure in early childhood is associated with more allergic disease later . Allergic children have a different fecal microflora , with less lactobacilli and bifidobacteria . Beneficial effects regarding the development of allergy have been suggested to come through probiotic supplementation . OBJECTIVE We sought to study the effect of probiotic and prebiotic supplementation in preventing allergies . METHODS In a double-blinded , placebo-controlled study we r and omized 1223 mothers with infants at high risk for allergy to receive a probiotic mixture ( 2 lactobacilli , bifidobacteria , and propionibacteria ) or placebo during the last month of pregnancy and their infants to receive it from birth until age 6 months . Infants also received a prebiotic galacto-oligosaccharide or placebo . At 5 years , we evaluated the cumulative incidence of allergic diseases ( eczema , food allergy , allergic rhinitis , and asthma ) and IgE sensitization . RESULTS Of the 1018 intent-to-treat infants , 891 ( 88 % ) attended the 5-year visit .  Frequencies of allergic and IgE-associated allergic disease and sensitization in the probiotic and placebo groups were similar : 52.6 % versus 54.9 % and 29.5 % versus 26.6 % , respectively , and 41.3 % in both . No significant difference appeared in frequencies of eczema ( 39.3 % vs 43.3 % ) , atopic eczema ( 24.0 % vs 25.1 % ) , allergic rhinitis ( 20.7 % vs 19.1 % ) , or asthma ( 13.0 % vs 14.1 % ) between groups . However , less IgE-associated allergic disease occurred in cesarean-delivered children receiving probiotics ( 24.3 % vs 40.5 % ; odds ratio , 0.47 ; 95 % CI , 0.23 % to 0.96 % ; P = .035 ) . CONCLUSIONS No allergy-preventive effect that extended to age 5 years was achieved with perinatal supplementation of probiotic bacteria to high-risk mothers and children . It conferred protection only to cesarean-delivered children Objective To study , we examined the effect of Lactobacillus salivarius on the clinical symptoms and medication use among children with established allergic rhinitis ( AR ) . Design Double blind , r and omized , controlled trial . Setting Hualien Tzu-Chi General Hospital . Methods Atopic children with current allergic rhinitis received 4 × 109 colony forming units/g of Lactobacillus salivarius ( n=99 ) or placebo ( n=100 ) daily as a powder mixed with food or water for 12 weeks . The SCORing Allergic rhinitis index ( specific symptoms scores [ SSS ] and symptom medication scores [ SMS ] ) , which measures the extent and severity of AR , was assessed in each subject at each of the visits — 2 weeks prior to treatment initiation ( visit 0 ) , at the beginning of the treatment ( visit 1 ) , then at 4 ( visit 2 ) , 8 ( visit 3 ) and 12 weeks ( visit 4 ) after starting treatment . The WBC , RBC , platelet and , eosinophil counts as well as the IgE antibody levels of the individuals were evaluated before and after 3 months of treatment . Results The major outcome , indicating the efficacy of Lactobacillus salivarius treatment , was the reduction in rhinitis symptoms and drug scores . No significant statistical differences were found between baseline or 12 weeks in the probiotic and placebo groups for any immunological or blood cell variables . Conclusions Our study demonstrates that Lactobacillus salivarius treatment reduces rhinitis symptoms and drug usage in children with allergic rhinitis Background / Objectives : Probiotics are defined as ‘ living micro-organisms that when administered in adequate amounts confer a health benefit to the host ’ . Different probiotic strains have been investigated for beneficial effects on allergic disorders . The purpose of the current study was to evaluate the effect of orally administering the probiotic Nestlé culture collection (NCC)2818 Bifidobacterium lactis strain on immune parameters and nasal symptom scores in subjects suffering from seasonal allergic rhinitis (SAR).Subjects/ Methods : The study was a double-blinded , parallel , r and omized placebo-controlled trial conducted during the peak of the pollen season . Adult subjects with clinical history of SAR and positive skin prick test to grass pollen were recruited . The subjects received B. lactis NCC2818 or placebo for 8 weeks and completed symptom question naires every week . Whole blood was collected at baseline ( V1 ) , 4 weeks ( V2 ) and 8 weeks ( V3 ) to measure immune parameters . Results : Concentrations of Th-2 cytokines , secreted by stimulated blood lymphocytes , were significantly lower in the probiotic group compared with the placebo group at V3 ( interleukin (IL)-5 , P=0.016 ; IL-13 , P=0.005 ) . Total nasal symptom scores were significantly lower in the second month of the study ( weeks 5–8 ) in the probiotic group compared with the placebo group ( P=0.03 ) . Also , percentages of activated CD63 expressing basophils were significantly lower in the probiotic group at V2 ( P=0.02 ) . Conclusions : Oral administration of the probiotic NCC2818 mitigates immune parameters and allergic symptoms during seasonal exposure . These promising results warrant that B. lactis NCC2818 be investigated further in large-scale trials for management of respiratory allergy BACKGROUND Allergic rhinitis ( AR ) is a main risk factor for the development of asthma . Two r and omized open-label trials indicated that allergy immunotherapy ( AIT ) prevents the onset of asthma in patients with AR . However , these trials have method ological limitations , and it is unclear to what extent this experimental efficacy translates into clinical effectiveness . OBJECTIVES We sought to investigate the effectiveness of AIT to prevent asthma in patients with AR . METHODS Using routine health care data from German National Health Insurance beneficiaries , we identified a consecutive cohort of 118,754 patients with AR but without asthma who had not received AIT in 2005 . These patients were stratified into one group starting AIT in 2006 and one group receiving no AIT in 2006 . Both groups were observed regarding the risk of incident asthma in 2007 to 2012 . Risk ratios ( RRs ) were calculated with generalized linear models by using a Poisson link function with robust error variance and adjustment for age , sex , health care use because of AR , and use of antihistamines . RESULTS In a total of 2431 ( 2.0 % ) patients , AIT was started in 2006 . Asthma was newly diagnosed from 2007 - 2012 in 1646 ( 1.4 % ) patients . The risk of incident asthma was significantly lower in patients exposed to AIT ( RR , 0.60 ; 95 % CI , 0.42 - 0.84 ) compared with patients receiving no AIT in 2006 . Sensitivity analyses suggested significant preventive effects of subcutaneous immunotherapy ( RR , 0.54 ; 95 % CI , 0.38 - 0.84 ) and AIT including native ( nonallergoid ) allergens ( RR , 0.22 ; 95 % CI , 0.02 - 0.68 ) . AIT for 3 or more years tended to have stronger preventive effects than AIT for less than 3 years . CONCLUSION AIT effectively prevents  asthma in patients with AR in a real-world setting . Confounding by indication can not be excluded but would lead to an underestimation of the true preventive effects of AIT BACKGROUND The increase in allergic diseases is attributed to a relative lack of microbial stimulation of the infantile gut immune system . Probiotics , live health-promoting microbes , might offer such stimulation . OBJECTIVE We studied the effect of a mixture of 4 probiotic bacterial strains along with prebiotic galacto-oligosaccharides in preventing allergic diseases . METHODS We r and omized 1223 pregnant women carrying high-risk children to use a probiotic preparation or a placebo for 2 to 4 weeks before delivery . Their infants received the same probiotics plus galacto-oligosaccharides ( n = 461 ) or a placebo ( n = 464 ) for 6 months . At 2 years , we evaluated the cumulative incidence of allergic diseases ( food allergy , eczema , asthma , and allergic rhinitis ) and IgE sensitization ( positive skin prick test response or serum antigen-specific IgE level > 0.7 kU/L ) . Fecal bacteria were analyzed during treatment and at age 2 years . RESULTS Probiotic treatment compared with placebo showed no effect on the cumulative incidence of allergic diseases but tended to reduce IgE-associated ( atopic ) diseases ( odds ratio [ OR ] , 0.71 ; 95 % CI , 0.50 - 1.00 ; P = .052 ) . Probiotic treatment reduced eczema ( OR , 0.74 ; 95 % CI , 0.55 - 0.98 ; P = .035 ) and atopic eczema ( OR , 0.66 ; 95 % CI , 0.46 - 0.95 ; P = .025 ) . Lactobacilli and bifidobacteria more frequently ( P < .001 ) colonized the guts of supplemented infants . CONCLUSION Probiotic treatment showed no effect on the incidence of all allergic diseases by age 2 years but significantly prevented eczema and especially atopic eczema . The results suggest an inverse association between atopic diseases and colonization of the gut by probiotics . CLINICAL IMPLICATION S The prevention of atopic eczema in high-risk infants is possible by modulating the infant 's gut microbiota with probiotics and prebiotics Allergic rhinitis is characterized by T-helper (Th)2 polarization as elevated levels of Th2-derived cytokines , including interleukin (IL)-4 , IL-5 and IL-13 , have been evidence d at nasal level in allergic rhinitics ( 1 ) . Th2 cytokines play a pathogenic role as they induce IgE synthesis and eosinophil infiltration . Th2 polarization in allergic subjects may occur as consequence of reduced pressure of microbial agents in the gut : the so-called Hygiene Hypothesis ( 2 ) . Probiotics may stimulate immune system at all mucosal surfaces and exert a primary prevention of atopic diseases and reduce allergic symptoms and inflammatory parameters ( 3 ) . We previously found out that Bacillus clausii was capable of modulating cytokine pattern at nasal level in allergic children with recurrent respiratory infections ( 4 ) . Particularly , B. clausii restored physiological Th1 polarization and induced T-regulatory cell response , as documented by increased levels of IL-10 and tumor growth factor (TGF)b after treatment ( 4 ) . Therefore , we conducted a pilot study to investigate the potential effects exerted by B. clausii on nasal symptoms , eosinophils , and symptomatic use of antihistamines in children with allergic rhinitis . Twenty allergic children , 13 males and seven females , with an average age of 13.4 years ( range 12–15 ) were consecutively evaluated . A detailed clinical history and a complete physical examination , including allergy evaluation , were carried out for each patient . The diagnosis of allergic rhinitis due to pollen sensitization was made according to vali date d criteria ( 5 ) . The study was blinded both to the investigator who performed the nasal eosinophil assessment and the investigator who carried out statistical analysis . Symptomatic use of levocetirizine ( 5 mg tablets ) was prescribed for all children . Ten of them were r and omly treated with oral B. clausii ( EnterogerAL LERGY 2 0 0 5 : 6 0 : 7 0 2 – 7 1 0 • COPYRIGHT a 2005 BLACKWELL MUNKSGAARD • ALL R IGHTS RESERVED • CONTRIBUT IONS TO THIS SECT ION WILL NOT UNDERGO PEER REV IEW , BUT WILL BE REV IEWED BY THE ASSOCIATE ED ITORS BACKGROUND Reversal of the progressive increase in frequency of atopic disease would be an important breakthrough for health care and wellbeing in western societies . In the hygiene hypothesis this increase is attributed to reduced microbial exposure in early life . Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora . We assessed the effect on atopic disease of Lactobacillus GG ( which is safe at an early age and effective in treatment of allergic inflammation and food allergy ) . METHODS In a double-blind , r and omised placebo-controlled trial we gave Lactobacillus GG prenatally to mothers who had at least one first-degree relative ( or partner ) with atopic eczema , allergic rhinitis , or asthma , and postnatally for 6 months to their infants .  Chronic recurring atopic eczema , which is the main sign of atopic disease in the first years of life , was the primary endpoint . FINDINGS  Atopic eczema was diagnosed in 46 of 132 ( 35 % ) children aged 2 years . Asthma  was diagnosed in six of these children and allergic rhinitis in one . The frequency of atopic eczema in the probiotic group was half that of the placebo group ( 15/64 [ 23 % ] vs 31/68 [ 46 % ] ; relative risk 0.51 [ 95 % CI 0.32 - 0.84 ] ) . The number needed to treat was 4.5 ( 95 % CI 2.6 - 15.6 ) . INTERPRETATIONS Lactobacillus GG was effective in prevention of  early atopic disease in children at high risk . Thus , gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics , for prevention of atopic disease Allergic rhinitis and asthma are examples of allergic airways disease . Despite their differing symptomatology , both disorders affect the mucosal lining of the respiratory tract and are linked by common underlying cellular processes , thus , using the ‘ united airways ’ approach , they can be considered part of the same allergic disease . The conditions are often comorbid , and there is evidence to suggest that allergic rhinitis in children is a significant risk factor for subsequent development of asthma . Management strategies that target the underlying cause of allergic rhinitis in children have the potential to offer additional symptom control above that of symptomatic medications , and prevent disease progression . Specific immunotherapy ( SIT ) is the only currently available treatment that is proven to target the disease in this way . SIT affects the underlying cause of allergic rhinitis , producing changes in antibody responses to allergens . It has been shown to be effective in the reduction of  allergic rhinitis symptoms in both children and adults , with effects being sustained for several years after treatment completion . Furthermore , a number of trials provide evidence that SIT may prevent the development of new sensitisations and asthma in children and adults with allergic rhinitis . One such open-label , r and omised controlled study in children/adolescents ( the Preventive Allergy Treatment Study ) showed that significantly fewer patients who received 3 years of  SIT  for grass/birch pollen-induced allergic rhinitis had developed asthma 10 years after treatment initiation versus controls . Some clinical guidelines acknowledge this potential asthma preventive effect in children and the need for additional data from double-blind , placebo-controlled trials to support these findings Background The SQ house dust mite ( HDM ) sublingual immunotherapy ( SLIT ) tablet has been approved in 11 European countries and Japan for patients with HDM‐induced respiratory allergic disease . Objective This trial was conducted to confirm the efficacy and safety of the SQ HDM SLIT tablet in Japanese patients with moderate‐to‐severe HDM‐induced allergic rhinitis ( AR ) . Methods The trial was a r and omized , double‐blind , placebo‐controlled trial including 946 Japanese adults and adolescents ( 12‐64 years ) . Subjects were r and omly assigned to daily treatment with the SQ HDM SLIT tablet at a dose of 10,000 Japanese allergy units ( JAU ) or 20,000 JAU or to placebo ( 1:1:1 ) . The primary end point was the total combined rhinitis score ( TCRS ) , which is composed of AR symptom and medication scores during the efficacy evaluation period . Symptom and medication scores of AR and conjunctivitis , rhinitis quality of life , and symptom‐free and symptom‐severe days were evaluated as secondary end points . Results Analysis of the primary end point demonstrated statistically significant reductions in TCRSs of 1.15 ( 22 % , P < .001 ) in the 10,000‐JAU group and 0.99 ( 19 % , P < .001 ) in the 20,000‐JAU group compared with the placebo group . The statistically significant treatment effect was evident from 12 weeks of treatment onward . All secondary end points , except AR medication score , were statistically significant in favor of active treatment compared with placebo . Post hoc analysis of TCRSs in adolescents showed the same efficacy as in adults ( P < .05 ) . The treatment was well tolerated by both adults and adolescents . Conclusion The trial confirmed the efficacy and safety profile of the SQ HDM SLIT tablet in Japanese adult and adolescent patients with moderate‐to‐severe HDM‐induced AR . These data support the robust efficacy and safety profile of previously reported European data Levocetirizine has been shown in observational studies in the west as an effective and satisfactory therapy for patients with allergic respiratory and skin disease . An open-label , multicentre observational study was conducted to investigate the patients ' perception of levocetirizine in the treatment of allergic rhinitis ( AR ) and urticaria in Taiwanese patients . Three hundred and thirty-three patients ( 236 AR and 97 urticaria patients ) attending out-patient clinics of medical centres across Taiwan were included in the study . Patients were treated with levocetirizine 5 mg once daily ( AR patients for 2 - 4 weeks and urticaria patients for 2 - 6 weeks ) and at the end of treatment , they evaluated for symptoms of disease , perception of change in symptoms , global efficacy and tolerability , global preference over previous antiallergic treatment , change in quality of sleep/daily activities , and safety and adverse events ( AEs ) .  Levocetirizine markedly improved the symptoms of AR and urticaria ; with 70 - 75 % of AR patients and 60 - 80 % of urticaria patients reporting complete or marked improvements in individual symptoms . Asthma symptoms were completely or markedly improved in 44 % of patients with AR and concomitant asthma . A majority of the patients was satisfied with levocetirizine therapy and 50 - 70 % indicated preference for levocetirizine over previous therapy . Overall , 50 - 74 % of all patients perceived improvements in quality of sleep/daily activities and 50 - 65 % of the patients rated the onset of action for levocetirizine  as very rapid or rapid . Somnolence was the most common AE , reported by 7.4 % of AR and 7.0 % of urticaria patients . The results of this study indicated that levocetirizine is an effective and satisfactory therapy for the management of allergic respiratory and skin disease in Taiwanese subjects Epidemiological evidence links T-helper type 2 ( Th2 ) cytokine responses to the pathogenesis of atopy/asthma . It is hypothesized that certain immunizations may induce/amplify Th2 cytokine responses . The objective of this study was to determine whether Th cytokine responses to immunization with tetanus toxoid differ in adults with and without allergic rhinitis ( AR ) . Thirty subjects were enrolled ( 15 AR and 15 non-AR subjects as confirmed by history and allergy skin testing ) . Blood was collected before ( day 0 ) and on days 3 , 7 , 14 , and 28 after immunization with tetanus toxoid . Peripheral blood mononuclear cells ( PMNCs ) were purified and cultured with either PHA or tetanus toxoid for 2 or 6 days , respectively . Supernatants were harvested and assayed for IFN-gamma and IL-13 levels ( pg/mL ) by EIA . Results were normalized by log transformation and analyzed by stepwise regression . Baseline ( day 0 ) cytokine values were similar in both groups . PHA and tetanus-induced IFN-gamma were increased ( p < 0.05 ) in non-AR ( 3.2 + /- 0.3 and 1.4 + /- 0.3 on day 7 , and 3.5 + /- 0.2 and 1.9 + /- 0.2 on day 14 , respectively ) compared with AR subjects ( 2.3 + /- 0.3 and 0.9 + /- 0.3 on day 7 , and 2.7 + /- 0.3 and 1.2 + /- 0.3 on day 14 , respectively ) . PHA-induced , but not tetanus-induced , IL-13 production was increased ( p < 0.05 ) in non-AR compared with AR subjects on day 7 ( p < 0.05 ) . PHA-induced IL-13 production was 3.1 + /- 0.2 in non-AR and 2.6 + /- 0.3 in AR subjects on day 7 . These results indicate differential Th cytokine responses in AR and non-AR subjects after immunization with tetanus toxoid . Future studies are warranted and may result in the identification of potential prevention/treatment strategies for atopy/asthma
Conclusions The current evidence is not sufficiently strong to verify a preventive role of probiotics in AR , but probiotics may improve the overall quality of life and nasal symptom scores .
Background Allergic rhinitis ( AR ) is a disease of respiratory allergy , and probiotics can provide a potential strategy for its management .
The purpose of this study was to carry out a systematic review to investigate the role of probiotics in the prevention and treatment of AR .