Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
Vol
.
4,
N
o
.
4
,
D
ecem
b
er 20
1
5
, pp
. 26
5~
26
8
I
S
SN
: 225
2-8
8
0
6
2
64
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
The Eff
e
cts of
Probioti
c
Lactobacillus casei
in Allergic
Rhinitis Patients
Asti Widuri
1
, Lilis
Sury
a
ni
2
1
Otorrhinolar
y
n
golog
y
Depar
t
ment, Facu
lty
of
M
e
dicin
e
and
H
eal
th S
c
i
e
nc
e,
M
uham
m
a
di
y
a
h
Univers
i
t
y
of Yog
y
ak
art
a
,
Indonesia
2
Microbiolog
y
D
e
partment, Faculty
of
M
e
d
i
c
i
ne
a
nd Heal
th S
c
ien
ce,
M
uham
m
a
diyah
Univers
i
t
y
o
f
Yog
y
akart
a
,
Indonesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Aug 8, 2015
Rev
i
sed
Sep
21
, 20
15
Accepted Oct 23, 2015
Allergi
c
rhin
itis
is inf
l
am
m
a
tor
y
reactions
m
e
diat
ed b
y
im
m
unoglobulin
E,
after
exposure to allergens
.
Allergic rh
initis
can be
alleviated
b
y
the use of
s
p
ecifi
c probiot
i
c
s
to confer im
m
une effe
cts
.
Th
e
s
p
ecifi
c s
t
rains
us
ed in this
stud
y
were selected bas
e
d on their
an
ti-in
fla
m
m
a
tory
prop
er
ties and a
n
expected in promoting a Th1 ty
pe of
immune response. To review the
benefits of probiotics of Lactob
acillu
s
cas
e
i
in
prevent
i
ng al
ler
g
y
a
tta
cks
which inhibit th
e production of IgE, IL-4 and in reducing the s
y
m
p
toms. The
stud
y
d
e
sign was quasi-exp
erimental with
pre and
post test
design. Th
e
subjects were 45
patients who ha
d a hist
or
y
of al
l
e
rgic rhin
itis an
d filled out
the questionnair
es to ge
t th
e
allergic s
y
mptoms. The blood samples were
taken for examin
ing the IgE and IL-4 le
vels then after giving milk containin
g
probiotics
for 1
m
onth, the res
e
a
r
cher did th
e s
a
m
e
exam
ination
.
The m
ean
IgE and I
L
-4 levels decr
eased
before
and after
probiotics supplementation
from 291.88 IU /L and 22.48 p
g
/ml to
141.43
IU/L and 17.83
pg/ml. The
result of the stat
istica
l
ana
l
y
s
is paired t-
test test
was p = 0.00 on IgE level
and p=0
,
056 o
n
IL-4 l
e
vel.
The
all
e
rgic rh
initis s
y
m
p
tom
s
decr
eased
significantly
, th
e patients who
had
persisten
t
s
y
mptom reduced from 28
patients to 2 patients
.
Based on
the Wilcoxon
signed rank test showed a
significance v
a
lue of P = 0.00. Probio
tics is useful in preven
ting aller
g
y
att
acks
th
at
inhi
bit th
e
produ
ctio
n of IgE,
IL-4
an
d reduces th
e s
y
mptoms.
Keyword:
IgE
Prob
i
o
tics
Rh
in
itis allerg
i
c
sym
p
to
m
s
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Asti W
i
d
u
ri,
Depa
rtem
en ENT Me
dical Fa
culty and Healt
h
Scie
nce,
Mu
h
a
mm
ad
iya
h
Un
i
v
ersity
Yo
g
y
ak
arta.
E-m
a
i
l: astiwid
u
r
i@g
m
ail.co
m
1.
INTRODUCTION
Allergic
rhi
n
itis is defi
ned cli
n
ically by the s
y
m
p
to
m
s
caus
e
d by im
m
unologi
cally m
e
diated (m
ostly
IgE
-
depe
n
d
ent
)
i
n
fl
am
m
a
ti
on aft
e
r t
h
e e
x
pos
u
r
e
of t
h
e
nasal
m
u
cous
m
e
m
b
ranes t
o
of
fe
ndi
ng al
l
e
rge
n
s
.
Sym
p
tom
s
of allergic rhi
n
itis incl
udi
ng rhinorrhea, nasal
obstruction
or
bl
ockage
, na
sal itching, sneezing, and
p
o
s
t
n
asal d
r
i
p
rev
e
rse
spo
n
t
an
eou
s
ly o
r
after
treatm
e
n
t
.Allerg
ic
rh
in
itis is a co
mm
o
n
ch
ron
i
c inflammato
ry
di
so
rde
r
wi
t
h
a
n
i
n
c
r
easi
n
g t
r
end
o
f
p
r
e
v
al
ence w
o
rl
d
w
i
d
e
ove
r t
h
e
l
a
st
f
e
w dec
a
des
be
com
e
a gl
obal
heal
t
h
p
r
ob
lem
,
affectin
g
app
r
ox
imately 1
0
to
2
5
%
of th
e
pop
u
l
ation
[1
]. Man
y
o
f
treat
men
t
m
o
d
a
liti
es are
e
m
ployed to c
ont
rol t
h
e symptom
s
but t
h
ere is no c
u
re
because t
h
ey do
not act
t
h
rough m
odification
of
inflammatory pathways whi
c
h underlie
s the pat
h
ophysiologic basic
of th
e
disease [2]. Recently, in vitro
expe
ri
m
e
nt
s sug
g
est
t
h
at
l
a
c
t
i
c
aci
d bact
er
i
a
(LAB
) ca
n
i
nhi
bi
t
T
h
2 cy
t
oki
ne
p
r
o
d
u
ct
i
on
by
m
ono
n
u
cl
ear
cells fro
m
p
a
tien
t
s with allerg
ies [3
]. Moreo
v
e
r, a land
m
a
rk a
r
ticle demonst
r
ated t
h
at
LAB
was effe
ctive in
pre
v
e
n
t
i
ng ea
r
l
y
at
opi
c di
sea
s
e i
n
hi
gh
-ri
s
k
chi
l
d
re
n
[4]
.
W
i
t
h
these
encoura
g
ing re
ports, t
h
e effica
cy of
p
r
ob
io
tics f
o
r
t
h
e m
a
n
a
g
e
m
e
n
t
o
f
aller
g
ic
d
i
sease h
a
s
b
e
gun to
b
e
h
i
g
h
l
y ap
pr
eciated
.
W
e
so
ugh
t to
ascer
t
ain
whet
her t
h
e i
m
m
unol
o
g
i
c
b
e
nefi
t
s
o
f
p
r
o
b
i
o
t
i
c
s co
ul
d
t
r
ansl
at
e i
n
t
o
cl
i
n
i
cal
im
provem
e
nt
.The cur
r
ent
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Th
e
Effects o
f
Prob
io
tic La
ct
o
b
a
c
illu
s ca
sei
in
Allerg
ic Rh
i
n
itis Pa
tien
t
s (
A
sti Wid
u
r
i)
26
5
u
n
d
e
rstand
ing
su
gg
ests th
at th
e p
r
ob
io
tic o
r
g
a
n
i
sm
s rev
e
rse in
creased
in
t
e
stin
al p
e
rm
ea
b
ility, en
h
a
n
c
e g
u
t
-
speci
fi
c I
g
A r
e
sp
onses
, p
r
o
m
ot
e gut
barri
er f
unct
i
o
n t
h
r
o
u
g
h
rest
orat
i
on
of
n
o
rm
al
m
i
crobes, a
n
d
enha
nce
t
r
ans
f
o
r
m
i
ng g
r
o
w
t
h
fact
o
r
b
e
t
a
and
i
n
t
e
rl
e
uki
n-
1
0
p
r
od
u
c
t
i
on as
wel
l
a
s
cy
t
oki
ne
s t
h
a
t
pr
om
ot
e pr
od
uct
i
o
n
of
I
g
E a
n
t
i
b
o
d
i
e
s [
5
]
,
[
6
]
.
T
h
e
rol
e
of
T-
hel
p
e
r
1
(T
h
1
)
en
ha
ncem
ent
and
T
-
hel
p
er
2
(T
h2
) re
d
u
ct
i
o
n
re
m
a
i
n
s
t
o
be pr
o
v
en
. Pro
b
i
o
t
i
c
s are percei
ved t
o
e
x
ert
be
nefi
ci
al
effects in
th
e p
r
ev
en
tio
n
an
d treat
m
e
n
t
o
f
allerg
ic
diseases
via modi
fying the
gut ecosystem
.
The ai
m
of t
h
i
s
st
udy
was t
o
assess w
h
et
he
r i
n
gest
i
on
o
f
ferm
ent
e
d m
ilk co
nt
ai
ni
n
g
La
ctob
a
c
illus
casei
L Sh
i
r
o
t
a strain
can
i
m
p
r
o
v
e
th
e
q
u
ality o
f
life o
f
th
e p
a
tien
t
s
with
allerg
ic rh
in
itis sy
m
p
to
m
s
an
d
red
u
ce
o
n
bl
o
o
d
i
m
m
unol
ogi
c
pa
ram
e
t
e
rs al
lergi
c
(I
gE,
IL
-
4
)
.
2.
R
E
SEARC
H M
ETHOD
Th
e stud
y w
a
s p
e
rf
or
m
e
d
f
r
om Jan
u
a
r
y
2
013
thr
oug
h
March
201
3.Th
e patien
t
s w
e
r
e
r
e
cr
u
ited
f
r
o
m
th
e stu
d
e
n
t
s of
Facu
lty o
f
Med
i
cin
e
and H
ealth
Science, Mu
h
a
mm
a
d
iyah
U
n
iver
sity o
f
Y
ogyak
a
r
t
a,
In
d
onesi
a.
The
st
udy
desi
g
n
was
qua
si
-ex
p
e
ri
m
e
nt
al
wi
t
h
pre
an
d
po
st
t
e
st
desi
g
n
. T
h
e s
u
b
j
ect
s
w
e
re
4
0
stude
nts; the diagnosis of allergic rh
initis wa
s
m
a
de accordi
ng to a hist
ory
of allergic rhinitis and positif
ski
n
p
r
ick
test resu
lt and
filled
ou
t th
e qu
estio
nn
aires
t
o
g
e
t the allerg
ic sym
p
to
ms. Befo
re and after
p
r
ob
io
ticssupple
m
en
tatio
n
,
a
b
l
oo
d sam
p
le fo
r an
alysis
o
f
I
g
E in seru
m
(
s
I
g
E)
and
I
L
4 w
a
s dr
awn
,
Ser
u
m
IgE
an
d
IL-
4
w
a
s anal
y
zed
by
usi
n
g EL
IS
A.
The
no
rm
al
reference
i
n
t
e
r
v
al
sI
gE l
e
vel
was
0 t
o
1
0
0
kI
U/
L an
d
IL-
4
l
e
vel
was
0-
6
5
pg/
m
l
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
In
itially, 4
5
st
u
d
e
n
t
swho
were in
clud
ed
in
th
e stud
y filled o
u
t
the qu
estio
nn
aires t
o
g
e
t th
e allerg
ic
sym
p
t
o
m
s
and bl
o
od sam
p
l
e
f
o
r
IgE i
n
ser
u
m
(sIgE
)
an
d I
L
4 anal
y
s
i
s
.T
here
were
fi
ve
st
ude
nt
s
w
h
o d
i
d n
o
t
p
a
rticip
ate for
the second bl
ood sam
p
le becau
se they were sick.T
hus,
t
h
e di
st
ri
b
u
t
i
on of
ch
aracteristic
resp
o
nde
nt
s
a
n
d thei
r clinical
characte
r
istics
degree
of symptom
s
are s
h
own on
Table
1.
Tab
l
e
1
.
C
h
aracteristics o
f
Resp
ond
en
ts
Variable
Nu
m
b
e
r
Percentage
(%)
Gender
Male
Fe
m
a
le
11
29
27.
50
72.
50
Atopic
Yes
No
31
9
77.
50
22.
50
Fa
m
i
l
y
Yes
No
20
20
50.
00
50.
00
IL-4
Nor
m
al
Increase
36
4
90.
00
10.
00
Ig
E
Nor
m
al
Increase
18
22
45.
00
55.
00
S
y
mp
t
o
ms
mild intermittent
moderate intermittent
severeintermittent
mildpersistentmod
erate persistent
severepersistent
11
6
0
20
8
24.
44
13.
33
00.
00
44.
44
17.
78
Sou
r
ces:
Prim
a
r
y
d
a
ta
Th
e av
erag
e Ig
E lev
e
ls b
e
fo
re th
e in
terv
en
tio
n w
a
s 29
1.88I
U
/
L, and
af
ter
pr
ob
io
tics
sup
p
l
e
m
e
nt
at
i
on was 1
4
1
.
4
3
I
U/
L. The
red
u
c
t
i
on o
f
Ig
E l
e
vel
aft
e
r t
h
e p
r
obi
ot
i
c
sup
p
l
e
m
e
nt
at
i
on i
s
show
n o
n
Fi
gu
re
1.
T
h
i
s
res
u
l
t
i
s
di
ffe
rent
fr
om
anot
her
st
u
d
y
whi
c
h st
at
ed
t
h
at
t
h
e
effects of
prob
io
tics t
o
mo
du
late
bl
o
od/
i
m
m
uno
l
ogi
c par
a
m
e
t
e
rs are asso
ciat
ed
with
allerg
i
c
sy
m
p
to
m
s
. In
so
m
e
studies, the beneficial effects
on
cl
i
n
i
cal
pa
r
a
m
e
t
e
rs are
fo
un
d
wi
t
h
out
si
gni
fi
cant
c
h
an
ge i
n
t
h
e i
m
m
unol
ogi
c
pa
ram
e
t
e
rs.
Th
e av
erag
e IL-4
lev
e
l b
e
fore th
e p
r
ob
io
tic su
pp
lem
e
n
t
ati
o
n
was2
91
.88
I
U/L and
after th
e prob
i
o
tic
su
pp
lem
e
n
t
atio
n
was 141
.4
3IU/L. Th
e
reductio
n
of IL-4
lev
e
l after th
e
p
r
ob
io
tic su
pp
l
e
m
e
n
t
atio
n
is sh
own
on
Fi
g
u
r
e 2.
Thi
s
phe
n
o
m
e
no
n s
h
ow
s t
h
e
causal
rel
a
t
i
o
n
s
hi
ps
bet
w
een
m
i
crobes a
n
d a
l
l
e
rgy
chal
l
e
n
g
e
s an
d
hel
p
s
to
d
e
fi
n
e
th
e li
mits o
f
T H1
/TH2
relev
a
nce to
th
es
e diseases. The
original pa
ra
digm of a reciprocal
rel
a
t
i
ons
hi
p
be
t
w
een
TH
1
an
d T
H
2
m
i
ght
onl
y
be
rel
e
va
nt
t
o
i
m
m
une d
e
vel
o
pm
ent
be
fo
re t
h
e est
a
bl
i
s
hm
ent
o
f
t
h
ese
d
i
seases. Th
is is consisten
t
with
n
u
mero
u
s
stud
ies wh
ich
d
o
c
u
m
e
n
tin
g th
e in
crease o
f
T
H1
and
TH2
cells in
allerg
i
c
airways. In
testin
al micro
f
l
o
ra can
co
n
t
r
i
bu
te to th
e pr
o
c
ess of
fo
od
antig
en
s i
n
t
h
e
gu
t an
d
pr
o
b
i
o
t
i
c
s co
ul
d m
odi
fy
t
h
e
st
ruct
ure
o
f
pot
e
n
t
i
a
l
ant
i
g
e
n
s a
n
d
re
d
u
ce t
h
ei
r
im
m
unoge
ni
ci
t
y
[7]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
264 – 268
26
6
Sou
r
ces:
Prim
a
r
y
d
a
ta
Fig
u
re
1
.
Serum
Ig
E test resultsb
e
forean
d
a
ft
er th
e prob
io
ticsu
pp
lem
e
n
t
atio
n
Sou
r
ces:
Prim
a
r
y
d
a
ta
Fig
u
re
2
.
Serum
IL-4
test resu
lts b
e
fore and after t
h
e
p
r
ob
io
tic supp
lem
e
n
t
atio
n
Th
e clin
ical man
i
festation
s
of allerg
ic rh
in
it
is b
e
fo
re th
e
prob
io
tics supp
l
e
m
e
n
t
atio
n
were classified
as fo
llows:
p
e
rsisten
t
m
o
d
e
rate was (17
.
7
8
%), th
e p
e
rsisten
t
m
i
ld
(44
.
44
%), th
e i
n
termit
ten
t
m
o
d
e
rate was
(13
.
33
%), and
th
e in
term
it
ten
t
m
i
ld
was (2
4.4
4
%). Mean
wh
ile after th
e prob
io
tic supp
lemen
t
atio
n
,
th
e
resu
lts
were classified as fo
llo
ws: the p
e
rsisten
t
mo
d
e
rate
was (0%), th
e p
e
rsisten
t
mild
(4
.4
4%), th
e in
term
itten
t
m
o
d
e
rate (2
.22%), and
th
e in
t
e
rm
i
tten
t
mild
(93
.
33
%).
After b
e
ing
testedwith
th
eW
ilcox
on
sign
ed
rank
test,
the res
u
lt s
h
owed a
significance value
o
f
P=
0.
00
as s
h
ow
n
on
Ta
bl
e 2
.
Tab
l
e
2
.
Th
e effect of
p
r
ob
io
tic supp
lem
e
n
t
at
io
n
t
o
c
lin
ical man
i
festatio
n
allerg
ic
rh
in
itis (in
p
e
rcen
tag
e
)
Interm
it
en Persisten
p
Mild Moderate
Severe
Mild
Moderate
Severe
Befor
e
24.
44
13.
33
0
44.
44
17.
78
0
0.
00
After
93.
33
2.
22
0
04.
44
0
0
3.
1.
Discussion
Pro
b
i
o
t
i
c
s ha
v
e
bee
n
use
d
t
o
red
u
ce
t
h
e
r
i
sk a
llergy s
u
c
h
as
atopic ec
ze
m
a
, fre
quent
l
y the first
allerg
ic sym
p
t
o
m
to
m
a
n
i
fest itself in
ch
il
d
r
en
.
Prev
iou
s
in
terv
en
tion
stu
d
i
es sho
w
i
n
g
risk
redu
ctio
n for
ecze
m
a
have
failed to
re
duce
the
risk
of anothe
r allergic
disease likes
respiratory a
llergies.
This
m
a
y be
due
to strain and
host s
p
ecific c
h
aracteristics [8].
In
fact
,
i
n
v
i
t
r
o st
u
d
i
e
s
usi
n
g
h
u
m
a
n m
o
no
n
u
cl
ear cel
l
s
ha
ve
in
d
i
cated th
at
th
ere are
strain
-d
ep
end
e
n
t
d
i
fferen
ces
i
n
th
e ab
ility o
f
lactic acid b
acteria t
o
i
n
du
ce
Before
Af
ter
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Th
e
Effects o
f
Prob
io
tic La
ct
o
b
a
c
illu
s ca
sei
in
Allerg
ic Rh
i
n
itis Pa
tien
t
s (
A
sti Wid
u
r
i)
26
7
im
m
unore
gul
at
ory
m
ono
ki
nes
suc
h
as i
n
t
e
rl
euki
n.C
ont
ri
bu
t
i
on
of t
h
e s
p
eci
es an
d st
rai
n
-s
peci
fi
c
nat
u
re o
f
lactic acid bact
eria on t
h
e e
ffi
cacy of im
pr
oving allergic sy
m
p
to
m
s
shoul
d bec
o
nsidere
d
[9
].
In t
h
i
s
st
u
d
y
,
we f
o
un
d a si
gni
fi
cant
o
v
e
r
al
l
chang
e
i
n
i
m
m
unol
o
g
i
c
p
a
ram
e
t
e
rs i
n
the p
r
obi
ot
i
c
s
g
r
ou
p.
The a
v
erage
IgE le
ve
ls before the s
u
pplem
e
nta
tio
n
was
29
1.88
IU/L, and
after th
e sup
p
l
em
e
n
tatio
n
w
a
s
14
1.43
IU
/
L
and th
e av
er
ag
e I
L
-4
levels b
e
f
o
r
e
t
h
e
su
pp
lem
e
n
t
atio
n
w
a
s
29
1.8
8
IU
/L,
and
af
ter
th
e
su
pp
lem
e
n
t
atio
n
was 141
.4
3IU/L. Th
e resu
l
t
o
f
th
e statisti
cal an
alysis p
a
ired
t-test test was
p
= 0.00
on
Ig
E
l
e
vel
an
d p=
0,
05
6 o
n
IL-
4
l
e
vel
.
Th
e pro
cess o
f
allerg
ic resp
on
ses
i
n
t
h
e n
a
sal
cav
ity
is allerg
en
sen
s
itizatio
n
t
h
at an
tig
en
p
r
esen
ting
cells (APCs)
en
gu
lf allerg
en
s upo
n
t
h
e en
coun
ter. Th
e allerg
en
s are th
en
b
r
o
k
en
d
o
wn
in
to
pep
tid
e
seg
m
en
ts, wh
ich
are later
p
r
esen
ted
t
o
n
a
tive T cells (Th0
cells) on
ce th
e
APCs m
i
g
r
ate in
to
th
e ly
m
p
h
n
o
d
e
s.
Th
is in
teraction
b
e
tween
APCs an
d
Th0
cells lead
s to
the m
u
l
t
i
p
l
i
cat
ion a
nd
di
ffe
re
nt
i
a
t
i
on o
f
Th
0 cel
l
s
,
g
i
v
i
ng
rise to
eith
er Th
1 or
Th
2
cells.
Th
2 cells
h
a
v
e
th
e ab
ility to
b
i
nd
with
B cells, trig
g
e
ring th
eir
tran
sform
a
t
i
o
n
in
to
p
l
asm
a
cells th
at can
produce a
n
d s
ecret IgE int
o
bl
o
o
d
ci
rc
ul
at
i
on. T
h
e si
gn
i
f
i
cant
redu
ction
o
f
Ig
E lev
e
l after
p
r
ob
io
ticsup
p
l
e
m
en
tatio
n
in
th
is stud
yshowed
th
at the effects
o
f
prob
iotics to
m
odul
at
e bl
oo
ds/
i
m
m
unol
ogi
c al
l
e
rgi
c
par
a
m
e
t
e
r, cont
ra
ry
t
o
pre
v
i
o
us
st
udi
es t
h
at
rep
o
rt
n
o
st
at
i
s
t
i
cal
di
ffe
re
nce was
fou
n
d
at
basel
i
n
e or at
1
2
m
ont
hs o
f
p
r
obi
o
t
i
c
s i
n
t
e
rvent
i
o
n bet
w
ee
n i
n
t
e
rve
n
t
i
o
n an
d cont
rol
gr
o
ups
f
o
r
any
exam
i
n
ed i
m
mun
o
l
o
gi
c
para
m
e
t
e
r [1
0]
.
Th1
cells were id
en
tified
with
CD4
+
,
IFN-
γ
+, and
IL4-,
wh
ile Th2
cells were i
d
en
tified with
CD4
+
,
IFN
-
γ
-, a
nd
IL
-4+
.
The cytokine profile of
Th2 cells is
pro allerge
n
ic, prim
arily because IL-4 prom
otes the
cl
ass swi
t
c
hi
n
g
of i
m
m
unog
l
o
b
u
l
i
n
s i
n
B
cel
l
s
, gi
vi
n
g
ri
se t
o
t
h
e sy
nt
h
e
si
s of al
l
e
rge
n
-s
peci
fi
c I
g
E
[8]
t
h
e
study re
port the decreasing of IL-4
level after sup
p
l
em
en
tat
i
o
n
prob
i
o
tic b
u
t
n
o
statistical
sig
n
i
fican
t. Si
milar
t
o
p
r
e
v
i
o
us st
u
d
i
e
s [
1
1]
,[
12]
pr
o
b
i
o
t
i
c
t
h
e
r
a
p
y
was
acc
om
pani
e
d
by
o
n
l
y
m
oderat
e
cha
nge
s i
n
p
r
o
d
u
c
t
i
on
of
t
h
e
cy
t
oki
nes IL-
4
, IF
N-
γ
IL
-
1
0
,
an
d
IL-
2
.
IL-
4
st
i
m
ul
at
es B
l
y
m
phocy
t
es t
o
p
r
o
d
u
ce
IgE
.
M
o
reo
v
e
r
, i
t
i
s
pos
si
bl
e t
h
at
a
l
o
n
g
er
pe
ri
o
d
of t
r
eat
m
e
nt
m
i
ght
be re
q
u
i
r
e
d
t
o
p
r
o
d
u
ce s
i
gni
fi
ca
nt
dec
r
eases i
n
IL-
4
l
e
vel
s
[1
3]
.
In
t
h
e system
at
ic rev
i
ew [2
], treatm
e
n
t
with
p
r
ob
io
tic was
sh
own
to
im
p
r
ov
e th
e
qu
ality o
f
life score
o
f
p
a
tien
t
s with
allerg
ic rh
in
i
tis at
th
e en
d
o
f
treat
m
e
n
t
. Oth
e
r stu
d
i
es sh
owing
im
p
r
ov
em
en
t with
p
r
ob
io
tic
treat
m
e
n
t
d
ecrease in
th
e
num
b
e
r o
f
ep
isodes o
f
rh
in
itis per year.
Po
ol
i
n
g co
ul
d
n
o
t
be
un
de
rt
ake
n
f
o
r m
a
ny
of t
h
e
o
u
t
c
om
es, as st
u
d
i
e
s di
d
not
f
o
l
l
o
w
a st
andar
d
f
o
r
m
at
for re
po
rt
i
ng
of cl
i
n
i
cal
t
r
i
a
l
s
. M
a
ny
re
aso
n
s
coul
d account
for the differe
n
t outc
o
m
e
s am
ong studies
whe
r
e
v
er pooling
was done i
n
these trials and these
are: va
ried
dos
e and intake
period, th
e type an
d sev
e
rity of th
e sym
p
to
ms
in
vo
lv
ed
were d
i
fferen
t, seaso
n
al
v
a
riation
o
f
allerg
ic sym
p
to
ms and
m
o
st i
m
p
o
r
tan
tly
, the s
p
ecies and strai
n
s
of the
probi
o
tics differ.
In
th
is stud
y th
e ou
tco
m
e
measu
r
es were t
h
e ti
m
e
(n
u
m
b
e
r o
f
d
a
ys)
o
f
allerg
ic sy
m
p
to
m
p
r
esen
t at
one
wee
k
a
n
d t
h
e sy
m
p
t
o
m
dist
ur
b
dai
l
y
act
i
v
i
t
y
or
n
o
t
(
A
R
I
A
cl
assi
fi
cat
i
o
n)
.
4.
CO
NCL
USI
O
N
In su
mm
ary, th
e
p
r
ob
io
ticsup
p
l
em
en
tatio
no
f
La
ctob
a
c
illu
sca
s
ei
LS
hi
r
o
t
a
st
rai
n
t
o
st
ude
nt
s
wi
t
h
allerg
ic rh
in
itis sy
m
p
to
m
wa
s asso
ciated
with
a m
o
d
e
rate i
m
p
r
ov
em
en
t
in
th
e clin
ical sev
e
rity of sym
p
to
m
.
In suggesting
a m
o
re pronounced effect
in
allerg
ic patien
t
s,
o
u
r
resu
lts are in acco
r
d
a
nce with resu
lts fro
m
expe
ri
m
e
nt
al
st
udi
es,
as wel
l
as
t
h
ose of
pre
v
i
o
us
cl
i
n
i
cal t
r
ials. Future st
udies
should a
d
dress
the e
ffe
cts of
lo
ng
term
p
r
o
b
io
tic sup
p
l
em
e
n
tatio
n
.
REFERE
NC
ES
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altev P., “
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48-S195, 2001.
[2]
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rgic
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pecifi
c probiotics
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rgic
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rch
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ecem
ber 2015
:
264 – 268
26
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Xiao JZ., Kondo S., Yanagisawa N., et al
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r
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n
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ented
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ilk cont
aining
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e-school
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e
n with
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l
l
e
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a
mura
M.,
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n
a
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.
,
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hana
T.
, Hay
a
ma
M.
,
Ka
ji
mot
o
O
.,
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al
.,
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ffec
t
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tics o
n
all
e
rgi
c
rhin
iti
s
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