- Clinical efficacy and immunomodulatory effect of allergen specific immunotherapy with prolonged course of probiotics for atopic dermatitis in children
Clinical efficacy and immunomodulatory effect of allergen specific immunotherapy with prolonged course of probiotics for atopic dermatitis in children
SOVREMENNAYA PEDIATRIYA.2018.6(94):34-40; doi 10.15574/SP.2018.94.34
Mochulska O. M., Dyvak A. M.
Horbachevsky Ternopil State Medical University, Ukraine
Objective: to optimize the treatment of children with atopic dermatitis (AD) by induction of immunological tolerance to allergens as a comprehensive management using allergen specific immunotherapy and a prolonged course of probiotics.
Materials and methods. A comparative efficiency evaluation of the conventional and improved comprehensive management of children with AD older than 5 years was conducted. A conventional therapy included hypoallergenic diet and housing conditions control, antihistamine drug of the second generation, mast cell stabilizer, leukotriene receptor antagonist, emollient, topical glucocorticoids, topical calcineurin inhibitors. The improved comprehensive therapy included allergen specific immunotherapy using non-infectious allergens in a standard parenteral manner for one year with the additional prolonged course of multiprobiotic (a powder of lyophilized bacteria for oral solution at a dose: for children aged 5 to 12 years — 1.95×109 CFU of Lactobacillus acidophilus, Bifidobacterium twice a day, aged 13 to 18 years — 3.90×109 CFU of Lactobacillus acidophilus, Bifidobacterium twice a day during meals) for eight weeks. In the study, clinical, general clinico-laboratory tests, and immunoassays of cellular and humoral components with the detection of lymphocyte subpopulations (CD3, CD4, CD8, CD16, CD19), immunoglobulins (IgA, IgE, IgG), interleukins (IL-2, IL-4, IL-6, IL-10), interferon gamma (INF- γ), serum histamine concentration, instrumental examinations (dermatoscopy, skin ultrasound) were used, as well as the international scoring system SCORAD and statistical techniques for the study outcomes evaluation.
Results. The proposed comprehensive management using allergen specific immunotherapy and prolonged course of probiotics in contrast to the conventional therapy showed the obvious better clinical outcome in children with AD. The use of a prolonged course of probiotics contributed to the rapid induction of immunological tolerance to allergens, indicating the immunomodulatory processes activation in this management in children with AD. Allergen specific immunotherapy combined with prolonged probiotic therapy can improve AD management in children, showing an immunomodulatory effect on cellular and humoral components of immunity, cytokine status, induces immunological tolerance, accompanied by a rapid improvement of clinical symptoms, a decrease in the frequency and duration of exacerbations, and clinical remission prolongation.
Conclusions. In this study, it has been clinically tested and demonstrated that allergen specific immunotherapy in combination with prolonged probiotic therapy is efficient in the management of children with AD aged 5 years and above. All children tolerated treatment well; there was a rapid positive trend in the main clinical manifestations, laboratory and instrumental indices.
Key words: atopic dermatitis, allergen specific immunotherapy, probiotics.
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Article received: Apr 13, 2018. Accepted for publication: Oct 05, 2018.