Allergy Asthma Immunol Res.  2018 Nov;10(6):575-590. 10.4168/aair.2018.10.6.575.

Probiotics as a Potential Immunomodulating Pharmabiotics in Allergic Diseases: Current Status and Future Prospects

• Sharma G
• Im SH

• KMID: 2441810
• DOI: http://doi.org/10.4168/aair.2018.10.6.575

Abstract

The prevalence of allergic disorders has dramatically increased over the past decade, particularly in developed countries. Apart from gastrointestinal disorders, neoplasia, genital and dermatological diseases etc., dysregulation of gut microbiota (dysbiosis) has also been found to be associated with increased risk of allergies. Probiotics are increasingly being employed to correct dysbiosis and, in turn, to modulate allergic diseases. However, several factors like strain variations and effector metabolites or component of them in a bacterial species can affect the efficacy of those as probiotics. On the other hand, host variations like geographical locations, food habits etc. could also affect the expected results from probiotic usage. Thus, there is a glaring deficiency in our approach to establish probiotics as an irrefutable treatment avenue for suitable disorders. In this review, we explicate on the reported probiotics and their effects on certain allergic diseases like atopic dermatitis, food allergy and asthma to establish their utility. We propose possible measures like elucidation of effector molecules and functional mechanisms of probiotics towards establishing probiotics for therapeutic use. Certain probiotics studies have led to very alarming outcomes which could have been precluded, had effective guidelines been in place. Thus, we also propose ways to secure the safety of probiotics. Overall, our efforts tend to propose necessary discovery and quality assurance guidelines for developing probiotics as potential immunomodulatory "˜Pharmabiotics.'

Keyword

Asthma; atopic dermatitis; food hypersensitivity; pharmabiotics; probiotics

MeSH Terms

Asthma
Dermatitis, Atopic
Developed Countries
Dysbiosis
Food Habits
Food Hypersensitivity
Gastrointestinal Microbiome
Glare
Hand
Hypersensitivity
Prevalence
Probiotics*

Figure

• 

  Fig. 1 Factors affecting the diversity of intestinal microbiota. Intestinal microbial composition can vary with several factors including mode of delivery, age, dietary patterns, life style, use of antibiotics and probiotics. Microbial diversity can affect immune system maturation and has been linked with allergy incidences.4

• 

  Fig. 2 Overview of mechanisms of action of probiotics in allergic diseases. Primary mode of action of probiotics includes restoration of Th1/Th2 cytokine balance13 and induction of CD4+Foxp3+ Treg38 cells. Other specific mechanisms include reduction in allergen specific IgE3852 and increased SCFA5657 levels. Probiotics also aids in constant homeostasis by maintaining intestinal epithelial integrity, increased anti-microbial production and competitively inhibiting survival of pathogens. Th2, type 2 helper T cell; Th1, type 1 helper T cell; Treg, regulatory T cell; IgE, immunoglobulin E; SCFA, short-chain fatty acid.

• 

  Fig. 3 Strategy for the development of probiotics as prophylactic and therapeutic microbial agent. More stress should be laid on strain specificity and identification of effector molecules derived from probiotics in the assessment of preclinical efficacy of probiotics. Preclinical safety assessment should include studies in healthy and immunocompromised animals. Clinical community should develop standardized protocols to avoid heterogeneity in studies and allow pooling of data and generalization of results obtained. We recommend qualitative and quantitative assessments for the post-production aspects of probiotics before marketing, to ensure uniformity in marketed products. Future research should focus on these aspects to improvise the current methods to find a balance between safety and efficacy while maintaining quality of product delivered.

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