[The results of the use of a combined probiotic (Lactobacillus rhamnosus GG and Bifidobacterium animalis spp. lactis ВB-12) in children with gastrointestinal and skin manifestations of food allergy]

At present, there are sufficient data on the influence of the gut microbiome on the development of food allergy and its progression. Changes in gut microbiome composition could positive impact on the course of allergic diseases by means of regulating the ratio of pro- and anti-inflammatory cytokines, as well as immunoglobulin E level. The purpose of the research was to study the effectiveness of combined probiotic in treatment of food allergies in children. Material and methods. The prospective randomized controlled study included 92 children aged from 4 to 5 years with symptoms of food allergy, involving the skin and gastrointestinal tract. The main group (n=46) took two chewable tablet Bifiform Kids (Lactobacillus rhamnosus GG >1x10⁹ CFU, Bifidobacterium animalis spp. lactis BB-12 >1x10⁹ CFU, thiamine mononitrate 0.40 mg, pyridoxine hydrochloride 0.50 mg per tablet) 2 times per day during 21 days. The control group (n=46) did not take the complex. The dynamics of the severity of food allergy skin symptoms was assessed using the SCORAD index, of gastrointestinal manifestations - on a point scale after 21 days and after 4 and 6 months (visits 2, 3 and 4). The concentration of immunoglobulin E, interleukins IL-17 and IL-10 was determined by enzyme immunoassay in blood serum at the baseline, as well as after 21 days and after 6 months (visits 1, 2 and 4) after the study initiation. Results. The SCORAD index among children from the main group decreased from 12.4±2.3 до 7.6±1.8 (р=<0.05) while taking a combined probiotic. It was significantly lower (р=<0.05) compared to the control group (SCORAD index changed from 12.1±2.4 to 12.2±1.9). On the 21st day, a statistically significant decrease in level of pro-inflammatory IL-17 (by 27%) and a statistically significant increase in the concentration of anti-inflammatory IL-10 (by 38.9%) were recorded. In children from the main group, the severity of such gastrointestinal symptoms as pain, rumbling in the abdomen, belching with air, bloating, gas discharge, increased stool and its unformularity, decreased compare to the control group of patients (р=<0.05), in which the intensity of complaints related to gastrointestinal manifestations did not change. In the main group of patients, the most clinical efficacy was noted immediately after the end of the probiotic intake. In the following five months, the intensity of symptoms increased in individual subjects from the main group, but in general, the intensity of complaints remained significantly lower than before probiotic intake (р=<0.05). Children from the main group showed a significant decrease in IgE level from 184±121 kU/l by 43.5% at visit 2 and by 38.0% at visit 4 (p=<0.05), while in children from the control group its level didn't change, amounting to 176±141, 165±121 and 178±132 kU/l, respectively. Conclusion. The results of the study show the effectiveness of the use of a combined probiotic (Lactobacillus rhamnosus GG, Bifidobacterium animalis spp. lactis ВB-12) with vitamins B1 and B6 in children with mild forms of gastrointestinal and skin manifestations of food allergy, both in relation to the severity reduction of the clinical symptoms of the disease (skin manifestations, pain, rumbling in the abdomen, belching with air, bloating, gas discharge, increased stool and its unformularity), and in relation to the dynamics of biochemical parameters - a decrease in the level of IgE.

[The effectiveness of BIFIFORM KIDS in the prevention of the incidence of acute respiratory infections in children]

Probiotics are widely used as a means of dietary correction of the intestinal microbiota in patients not only with alimentary, but also with allergic and inflammatory diseases. They have systemic effects on the human organism. However, the diversity of the composition of probiotic complexes complicates the determination of the beneficial effects of specific microorganisms on the human body. These circumstances call for more research. Investigation of the effect of probiotic intake on the levels of various cytokines may explain the mechanisms of the beneficial effect of probiotic intake on the functioning of the immune system. Objective - to study the effectiveness of the probiotic Bifiform Kids for the prevention of respiratory infections in children with recurrent respiratory infections with gastrointestinal allergy symptoms. Material and methods. The prospective randomized controlled trial included 92 children aged from 4 to 5 years who suffers from more than 5 episodes of respiratory infections per year with gastrointestinal allergy symptoms. Patients from the main group (n=46) were prescribed 2 chewable tablets Bifiform Kids (Lactobacillus rhamnosus GG not less than 1×109 CFU, Bifidobacterium animalis spp. lactis not less than 1×109 CFU, thiamine mononitrate 0.40 mg, pyridoxine hydrochloride 0.50 mg in each) twice per day within 21 days. Patients from the control group (n=46) were prescribed no probiotics during the study period. The study included the measurement of blood serum levels of immunoglobulins A, M, G (by immunoturbodimetry) and E, as well as the concentration of cytokines IL-17, IL-10 (by enzyme immunoassay). Measurements were performed at the 1st day of the study, at the 21st day of the study, and 6 months after the study initiation. The microbiota composition was determined by sequencing the bacterial 16S rRNA genes in DNA preparations isolated from stool samples collected at the start of the study and after 21 days. The Shannon index was calculated for the species of detected bacteria to determine the diversity of the microbiome. The effectiveness of disease prevention was measured by calculating the prevention index and the efficiency coefficient based on the incidence of respiratory infections in both groups during the observation period (6 months). Results. In the main group, the volume of the commensal flora decreased 3 weeks after the study initiation: Enterobacter from 18.3±19.3 to 10.5±18.1%; Enterococcus from 8.7±16.1 to 3.1±10.0%; Clostridium from 3.1±8.1 to 0.5±2.2%. There was a statistically significant increase in the proportion of representatives of the genus Bifidobacterium by 2.2 times (from 16.9±26.4 to 36.5±31.5%, p=0.0017) and a decrease in the Shannon index from 1.1±2.1 up to 0.4±1.1 (p<0.05). In the control group, there were no statistically significant changes in the microbiota content. In the main group, after 21 days, the blood IL-10 level increased from 11.3±15.4 to 15.7±13.4 pg/ml, and the IL-17 concentration decreased from 8.9±7.7 to 6.5±7.1 pg/ml (p=<0.05) while maintaining this trend by the 6th month of observation. There were no changes in these indicators in children from the control group. The main group demonstrated a significant (р=<0.05) decrease in the level of IgE from 184±121 to 104±67 and 114±54 kU/l, and a significant increase in IgA from 0.73±0.45 to 1.33±0.65 and 1.21±0.57 g/l after 3 weeks and at the end of the probiotic intake, respectively. The level of IgA in the main group remained higher during the study compared to the control group. The main group demonstrated a 3-fold decrease in the incidence of respiratory infections in comparison with the control group. The efficiency index was 3.21, the therapeutic response was 69%. Conclusion. The results of the study show the effectiveness of the complex probiotic for the respiratory infections prevention in children with gastrointestinal allergy symptoms.

[Coexistence of pulmonary sarcoidosis and primary Sjögren's syndrome]

The paper describes a case of a rare coexistence of primary Sjögren's syndrome (PSS) and sarcoidosis in a 41-year-old female with histologically verified lung and locomotor system diseases and keratoconjunctivitis sicca. PSS was diagnosed based on the 2012 ACR classification criteria, in the framework of which serological, histological, and gland function tests and instrumental diagnostic methods were performed. The diagnosis of sarcoidosis was based on clinical, radiographic, and histological findings.