Allergic rhinitis (AR) affects between 10% to 30% of the global population and can greatly impact a person’s quality of life. AR is a chronic disease affecting the upper respiratory system, which is driven by an immunoglobulin E (IgE)-mediated reaction in response to allergen exposure. AR primarily effects the nasal mucosa and manifests symptomatically as rhinorrhea, nasal congestion, sneezing, and pruritus.¹

Mainstream treatment for AR includes strategies to avoid environmental allergens, which is often challenging and impractical, as well as pharmaceutical treatments that mask the symptoms without addressing the drivers of the disease.¹

Probiotics have been shown to be beneficial in the prevention and management of a range of immune driven conditions, including AR. Recent research has found specific probiotic strains can alter the composition of the gut microbiota, modifying the hosts immune system. This includes an ability to influence the development of tolerogenic dendritic cells, stimulate toll-like receptors and promote the immunosuppressive regulatory T cell lineage.¹

A study by Watts et al. 2020 sought to investigate whether a multistrain probiotic supplement could improve symptoms of AR by way of the mini Rhinoconjunctivitis Quality of Life Questionnaire (mRQLQ).¹

Dosing recommendations

• Clinically effective dose: Two million CFUs taken twice daily of a multistrain probiotic formulation containing Bifidobacterium bifidum (W23), Bifidobacterium lactis (W51), Lactobacillus acidophilus (W55), Lactobacillus casei (W56), Lactobacillus salivarius (W57), and Lactococcus lactis (W58),
• The probiotic formula also contained vitamin B2 (35mg/100 g) and biotin (750 mg/100 g).
• Duration: 8 weeks.
• Form: Multistrain probiotic formulation.
• Drug interactions: No known interactions, separate from medications by approximately two hours.
• Safe dosing: Upper level of safety for probiotics has not yet been established.

Discussion

Using a Simon two-stage design, 40 participants consumed a probiotic supplement (containing strains detailed above) twice daily for 8 weeks. The primary outcome measure was based on a change in mRQLQ scores following supplementation. Participants consumed one sachet, twice daily, containing 2 g of the multistrain probiotic supplement.

Participants were also assessed for change in symptoms and medication usage with a twice-weekly symptom and medication diary, nasal congestion by rhinomanometry, and total serum immunoglobulin E (IgE) and specific IgE for Bermuda grass (couch).

Of the 40 participants, a total of 25 had a clinically relevant response to treatment based on mRQLQ assessment (Figure 1).

Figure 1. mRQLQ scores at baseline, midpoint and postsupplementation.

While no significant changes in the concentration of total serum IgE or specific IgE for couch grass were observed, the sum of individual symptom scores and overall symptom scores over the course of treatment was significantly reduced (p=0.036 and p=0.039, respectively). A moderate reduction in frequency of allergy-related medication use in the final four weeks of supplementation period was also observed. The supplement was largely well tolerated by participants at the dose provided.

Multi-strain probiotics for allergies

This study shows that the multistrain probiotic formulation had beneficial outcomes on mRQLQ scores in patients with at least a two-year history of AR and positive allergic response to couch grass. Based on the research provided, practitioners can consider the use of a multistrain probiotic formulation containing the abovementioned strains, taken twice daily to manage symptoms of AR.

Reference

Watts AM, Cox AJ et al. A specifically designed multispecies probiotic supplement relieves seasonal allergic rhinitis symptoms. J Altern Complement Med. 2018;24(8):833-40.