The Use of Probiotics in Respiratory Allergy


Probiotics, respiratory allergy, allergic rhinitis, asthma.

How to Cite

Gemma Vilà-Nadal, Elsa Phillips-Anglés, & Javier Domínguez-Ortega. (2016). The Use of Probiotics in Respiratory Allergy . Journal of Pharmacy and Nutrition Sciences, 6(3), 89–94.


There is a high and steadily increasing prevalence of respiratory allergy throughout the world, especially in paediatric population and in industrialized and developing countries. A complex interplay between genetic and environmental factors has been implicated to explain this dramatic increase in prevalence of allergic diseases. It has been suggested that exposure to microbes plays a critical role in the development of the early immune system and may contribute to allergic diseases through their effect on mucosal immunity. Probiotics, microorganisms exerting beneficial effects on the host, are used in a great number of paediatric and adult diseases, mainly gastrointestinal disorders, but they have been proposed to be beneficial also in allergic diseases. Different trials have been published finding benefits in the use of probiotics in prevention and treatment of atopic dermatitis, but to date, studies have yielded inconsistent findings to support a protective association between their use on prevention of allergic rhinitis or asthma. However, probiotics may be beneficial in improving symptoms and quality of life in patients with allergic rhinitis although it remains limited due to study heterogeneity and variable outcome measures. As a result of these controversies, future investigations with a better standardization are needed. In this review, we summarize recent clinical research to elucidate the mechanisms of probiotics and their effect in respiratory allergy. According to published data, probiotics could emerge as a novel, complementary treatment option for allergic rhinitis but not for asthma.


Asher MI, Montefort S, Björkstén B, et al. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733-43.

Bjerg A, Hedman L, Perzanowski M, Wennergren G, Lundbäck B, Rönmark E. Decreased importance of environmental risk factors for childhood asthma from 1996 to 2006. Clin Exp Allergy 2014; 45: 146-53.

Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhinosinusitis in Europe: an underestimated disease. A GA²LEN study. Allergy 2011; 66: 1216-23.

Holt PG, Sly PD. Viral infections and atopy in asthma pathogenesis: new rationales for asthma prevention and treatment. Nat Med 2012; 18: 726-35.

Ursell LK, Haiser HJ, Van Treuren W, et al. The intestinal metabolome: an intersection between microbiota and host. Gastroenterology 2014; 146: 1470-6.

Prescott SL, Bjorksten B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol 2007; 120: 255-62.

Hakansson A, Molin G. Gut microbiota and inflammation. Nutrients 2011; 3: 637-82.

Yatsunenko T, Rey FE, Manary MJ, et al. Human gut microbiome viewed across age and geography. Nature 2012; 486: 222-7.

Blaser MJ, Falkow S. What are the consequences of the disappearing human microbiota? Nat Rev Microbiol 2009; 7: 887-94.

Björkstén B, Naaber P, Sepp E, Mikelsaar M. The intestinal microflora in allergic Estonian and Swedish 2-year-old children. Clin Exp Allergy 1999; 29: 342-6.

Arrieta MC, Stiemsma LT, Dimitriu PA, et al. Early infancy microbial and metabolic alterations affect risk of childhood asthma. Sci Transl Med 2015; 7: 307ra152.

Sjogren YM, Jenmalm M, Böttcher MF, Bjorkstén B, Sverremark-Ekströn E. Altered early infant gut microbiota in children developing allergy up to 5 years of age. Clin Exp Allergy 2009; 39: 518-26.

Adlerberth I, Strachan DP, Matricardi PM, et al. Gut microbiota and development of atopic eczema in 3 European birth cohorts. J Allergy Clin Immunol 2007; 120: 343-50.

Melli LCFL, Do Carmo-Rodrigues MS, Araujo-Filho HB, Solé D, De Morais MB. Intestinal microbiota and allergic diseases: A systematic review. Allergol Immunopathol (Madr) 2015.

Scott KP, Antoine JM, Midtvedt T, Van Hemert S. Manipulating the gut microbiota to maintain health and treat disease. Microb Ecol Health Dis 2015; 26: 25877.

Dutton RJ, Turnbaugh PJ. Taken a metagenomic view of human nutrition. Curr Opin Nutr Metab Care 2012; 15: 448-54.

Kalliomäki M, Salminen S, Poussa T, Arvilomni H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomized placebo-controlled trial. Lancet 2003; 361: 1869-71.

Foolad N, Brezinski EA, Chase EP, Armstrong AW. Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA Dermatol 2013; 149: 350-5.

Pelucci C, Chatenoud L, Turati F, et al. Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis. Epidemiology 2012; 23: 402-14.

Dang D, Zhou W, Lun ZJ, Mu X, Wang DX, Wu H. Meta-analysis of probiotics and/or prebiotics for the prevention of eczema. J Int Med Res 2013; 41: 1426-36.

Zuccotti G, Meneghin F, Aceti A, et al. Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy 2015.

Fiocci A, Pawankar R, Cuello-García C, et al. World Allergy Organization-McMaster university guidelines for allergic disease prevention (GLAD-P): Probiotics. World Allergy Organ J 2015; 8: 4.

Technological and commercial applications of lactic acid bacteria: health and nutritional benefits in dairy products.

Smith-Norowitz TA, Bluth MH. Probiotics and diseases of altered IgE regulation: a short review. J Immunotoxicol 2015; May 15: 1-5.

Campeotto F, Suau A, Kapel N, et al. A fermented formula in pre-term infants: clinical tolerance, gut microbiota, down-regulation of faecal calprotectin and up-regulation of faecal secretory IgA. Br J Nutrit 2011; 105: 1843-51.

Isailovic N, Daigo K, Mantovani A, Selmi C. Interleukin 17 and innate immunity in infections and chronic inflammation. J Autoimmun 2015; 60: 1-11.

Marlow G, Han DY, Wickens K, et al. Differential effects of two probiotics on the risks of eczema and atopy associated with single nucleotide polymorphisms to Toll-like receptors. Pediatr Allergy Immunol 2015; 26: 262-71.

Wassenberg J, Nutten S, Audran R, et al. Effect of Lactobacillus paracasei ST11 on a nasal provocation test with grass pollen in allergic rhinitis. Clin Exp Allergy 2011; 41: 565-73.

Perrin Y, Nutten S, Audran R, et al. Comparison of two oral probiotic preparations in a randomized crossover trial highlights a potentially beneficial effect of Lactobacillus paracasei NCC2461 in patients with allergic rhinitis. Clin Transl Allergy 2014; 4: 1.

Costa DJ, Marteau P, Amouyal M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind placebo-controlled trial (GA2LEN Study). Eur J Clin Nut 2014; 68: 602-7.

Peng GC, Hsu CH. The efficacy and safety of heat-killed Lactobacillus paracasei for treatment of perennial allergic rhinitis induced by house-dust mite. Pediatr Allergy Immunol 2005; 16: 433-8.

Wang MF, Lin HC, Wang YY, Hsu CH. Treatment of perennial allergic rhinitis with lactic acid bacteria. Pediatr Allergy Immunol 2004; 14: 152-8.

Yonekura S, Okamoto Y, Okawa T, et al. Effects of daily intake of Lactobacillus paracasei strain KW3110 on Japanese cedar pollinosis. Allergy Asthma Proc 2009; 30: 397-405.

Lue KH, Sun HL, Lu KH, et al. A trial adding Lactobacillus johnsonii EM1 to levocetirizine for treatment of perennial allergic rhinitis in children aged 7-12 years. In J Pediatr Otorhinolaryngol 2012; 76: 994-1001.

Ouwehand AC, Nermes M, Collado MC, Rautonen N, Salminen S, Isolauri E. Specific probiotics alleviate allergic rhinitis during the birch pollen season. World J Gastroenterol 2009; 15: 3261-8.

Dölle S, Berg J, Rasche C, Worm M. Tolerability and clinical outcome of coseasonal treatment with Escherichia coli Strain Nissle 1917 in grass pollen-allergic subjects. Int Arch Allergy Immunol 2014; 163: 29-35.

Xiao JZ, Kondo S, Yanagisawa N, et al. Effect of probiotic Bifidobacterium longum BB536 in relieving clinical symptoms and modulating plasma cytokine levels of Japanese cedar pollinosis during the pollen season. A randomized double-blind placebo-controlled trial. J Investig Allergol Clin Immunol 2006; 16: 86-93.

Vliagoftis H, Kouranos VD, Betsi GI, Falagas ME. Probiotics for the treatment of allergic rhinitis and asthma: systematic of randomized controlled trials. Ann Allergy Asthma Immunol 2008; 101: 570-9.

Zajac AE, Adams AS, Turner JH. A systematic review and meta-analysis of probiotics for the treatment of allergic rhinitis. Int Forum Allergy Rhinol 2015; 5: 524-32.

Peng Y, Li A, Yu L, Qin G. The role of probiotics in prevention and treatment for patients with allergic rhinitis: A systematic review. Am J Rhinol Allergy 2015; 29: 292-5.

Kuitunen M, Kukkonen K, Juntunen-Backman K, et al. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivery children but not in the total cohort. J Allergy Clin Immunol 2009; 123: 335-41.

Abrahamsson TR, Jacobsson T, Björkstén B, Oldaeus G, Jenmalm MC. No effect of probiotics on respiratory allergies: a seven-year follow-up of a randomized controlled trial in infancy. Pediatr Allergy Immunol 2013; 24: 556-61.

West CE, Hammarström ML, Hernell O. Probiotics in primary prevention of allergic disease: follow-up at 8-9 years of age. Allergy 2013; 68: 1015-20.

Giovannini M, Agostoni C, Riva E, et al. A randomized prospective double-blind controlled trial on effects on long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res 2007; 62: 215-20.

Simpson MR, Dotterud CK, Storrø O, et al. Perinatal probiotic supplementation in the prevention of allergy related disease: 6 year follow up of a randomized controlled trial. BMC Dermatol 2015; 15: 13.

Loo EX, Llanora GV, Lu Q, et al. Supplementation with probiotics in the first 6 months of life did not protect against eczema and allergy in at-risk Asian infants: a 5-year follow-up. Int Arch Allergy Immunol 2014; 163: 25-8.

Bertelsen RJ, Brantsæter AL, Magnus MC, et al. Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases. J Allergy Clin Immunol 2014; 133: 165-71.

Rose MA, Stieglitz F, Köksal A, et al. Efficacy of probiotic Lactobacillus GG on allergic sensitization and asthma in infants at risk. Clin Exp Allergy 2010; 40: 1398-405.

Drago L, De Vecchi E, Gabrieli A, De Grandi R, Toscano M. Immunomodulatory effects of Lactobacillus salivarius LS01 and Bifidobacterium breve BR03 alone and in combination, on peripheral blood mononuclear cells of allergic asthmatics. Allergy Asthma Immunol Res 2015; 7: 409-13.

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Copyright (c) 2016 Gemma Vilà-Nadal, Elsa Phillips-Anglés , Javier Domínguez-Ortega