Published Online: April 4, 2012
Infantile eczema (atopic dermatitis) is the first manifestation in the so-called atopic march. Although most infants with eczema show a mild to moderate severity of the disease and approximately 65% will lose their symptoms up to the age of three years, quality of life in infants and parents is decreased by intractable itching and disturbance of sleep. Due to the chronic course and unforeseen relapse parents adhere to unnecessary diets, being potentially harmful to their children.
Typically, parents of a child with atopic dermatitis will contact numerous doctors as well as representatives of alternative or complementary medicine, causing tremendous costs.
During the last ten years, several approaches for primary prevention of infantile eczema were performed. Hydrolyzed formula being fed during the first four months of life instead of cow’ s milk formula and some probiotics and prebiotics were found to reduce the prevalence of atopic dermatitis in the first year of life to some extent. Data from the farming community suggested that early contact to life-stock and bacteria are interacting with the immune system early in life and thus are preventive especially in terms of allergic sensitization, allergic rhinitis and asthma.
In The Journal of Allergy & Clinical Immunology (JACI), Lau, Gerhold, and coworkers present a randomized, placebo-controlled trial feeding a lysate of heat-killed bacteria (Escherichia coli and Enterococcus faecalis) to infants at risk for atopy from week five until the end of the seventh month of life. 606 infants with at least one atopic parent were included and were followed until their third birthday. The primary endpoint was atopic dermatitis at the end of the treatment phase and during the follow-up.
Lau et Gerhold observed a 50% reduction in the prevalence of atopic dermatitis during the treatment phase only in those children with one atopic parent, indicating, that the effect was dependent on the genetic risk for atopy. Children with atopic fathers showed the greatest benefit, lasting until 3 years old. There was no difference between the placebo and the active group for allergic sensitization to food or inhalant allergens. The study medication was well tolerated by the infants without any serious side effects. This study shows that early intervention using bacteria influencing the immune regulation may be a promising, safe approach for primary prevention of infantile eczema in a subgroup of infants.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.