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Paul Forsythe, PhD
Author and Funding Information

From McMaster University, Department of Medicine, Brain Body Institute, St. Joseph’s Healthcare.

Correspondence to: Paul Forsythe, PhD, McMaster University, Department of Medicine, Brain Body Institute, St. Joseph’s Healthcare, 50 Charlton Ave E T3302, Hamilton, ON, L8P1X6, Canada; e-mail: forsytp@mcmaster.ca


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1100-1101. doi:10.1378/chest.11-1249
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To the Editor:

I thank Dr Das for the interesting points raised in his letter. I should state at the outset that my recent article in CHEST1 in no way meant to discount the potential for probiotic therapy in asthma. Dr Das rightly highlights the association between rhinitis and asthma. Rhinitis may contribute to inflammation of the lower airway, is an independent risk factor for the development of asthma, and is associated with poor control of the disease.2 Thus, the benefits derived from probiotic treatment in rhinitis may lead to asthmatic symptom improvement in patients with both disorders, just as the indirect benefits of probiotics may be derived from the reduction in respiratory infections known to exacerbate asthma.

However, the fact remains that there is no evidence of direct therapeutic or preventive effects of probiotic treatment in asthma alone. Indeed, in one of the probiotic trials highlighted by Dr Das, the authors themselves reach the conclusion that “long-term consumption of fermented milk containing a specific Lactobacillus casei may improve the health status of children with allergic rhinitis but appear to do not [sic] exercise significant effect in children with asthma.”3

Studies that indicate the beneficial effects of probiotics in patients with allergic rhinitis are in line with data from clinical trials that demonstrate positive effects in other allergic conditions such as atopic dermatitis,4 making the lack of evidence of direct preventive or therapeutic effects of probiotics in asthma all the more conspicuous. This interesting disparity in therapeutic effects of current probiotic treatment strategies between asthma and other allergic disorders deserves further investigation. Unfortunately, there remains the possibility that this may have more to do with differences in the pathophysiology of the human diseases than an incorrect choice of probiotic strain or dose.

Simply conducting more clinical trials with candidate probiotic strains based on vague or poorly understood immunomodulatory parameters will have limited chances for success. However, given the evidence that probiotic treatment can modulate immune responses in the lung1 and, in particular, the encouraging indications that microbial stimulation of the gut can enhance the T regulatory response in the airway,5 I agree wholeheartedly with the need for more research aimed at understanding the mechanisms underlying the beneficial effects of probiotics. In particular, identification of the key immunoregulatory components of bacteria, and evidence that results obtained in animal models translate into human models, will be critical to the selection of strains and treatment strategies that are most likely to meet with success in preventing or treating asthma.

Forsythe P. Probiotics and lung diseases. Chest. 2011;1394:901-908 [CrossRef] [PubMed]
 
Compalati E, Ridolo E, Passalacqua G, Braido F, Villa E, Canonica GW. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol. 2010;63:413-423 [CrossRef] [PubMed]
 
Giovannini M, Agostoni C, Riva E, et al; Felicita Study Group Felicita Study Group A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containingLactobacillus caseiin pre-school children with allergic asthma and/or rhinitis. Pediatr Res. 2007;622:215-220 [CrossRef] [PubMed]
 
Isolauri E. Dietary modification of atopic disease: use of probiotics in the prevention of atopic dermatitis. Curr Allergy Asthma Rep. 2004;44:270-275 [CrossRef] [PubMed]
 
Strickland DH, Judd S, Thomas JA, Larcombe AN, Sly PD, Holt PG. Boosting airway T-regulatory cells by gastrointestinal stimulation as a strategy for asthma control. Mucosal Immunol. 2011;41:43-52 [CrossRef] [PubMed]
 

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References

Forsythe P. Probiotics and lung diseases. Chest. 2011;1394:901-908 [CrossRef] [PubMed]
 
Compalati E, Ridolo E, Passalacqua G, Braido F, Villa E, Canonica GW. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol. 2010;63:413-423 [CrossRef] [PubMed]
 
Giovannini M, Agostoni C, Riva E, et al; Felicita Study Group Felicita Study Group A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containingLactobacillus caseiin pre-school children with allergic asthma and/or rhinitis. Pediatr Res. 2007;622:215-220 [CrossRef] [PubMed]
 
Isolauri E. Dietary modification of atopic disease: use of probiotics in the prevention of atopic dermatitis. Curr Allergy Asthma Rep. 2004;44:270-275 [CrossRef] [PubMed]
 
Strickland DH, Judd S, Thomas JA, Larcombe AN, Sly PD, Holt PG. Boosting airway T-regulatory cells by gastrointestinal stimulation as a strategy for asthma control. Mucosal Immunol. 2011;41:43-52 [CrossRef] [PubMed]
 
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