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Published on: September 15, 2020
Dangerous liaisons: Bacteria, antimicrobial therapies, and allergic diseases
Gerdien Tramper-Stranders1,2, Dominika Ambrożej3,4, Alessandra Arcolaci5
1Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Abstract:
Microbiota composition and associated metabolic activities are essential for the education and development of a healthy immune system. Microbial dysbiosis, caused by risk factors such as diet, birth mode, or early infant antimicrobial therapy, is associated with the inception of allergic diseases. In turn, allergic diseases increase the risk for irrational use of antimicrobial therapy. Microbial therapies, such as probiotics, have been studied in the prevention and treatment of allergic diseases, but evidence remains limited due to studies with high heterogeneity, strain-dependent effectiveness, and variable outcome measures. In this review, we sketch the relation of microbiota with allergic diseases, the overuse and rationale for the use of antimicrobial agents in allergic diseases, and current knowledge concerning the use of bacterial products in allergic diseases. We urgently recommend 1) limiting antibiotic therapy in pregnancy and early childhood as a method contributing to the reduction of the allergy epidemic in children and 2) restricting antibiotic therapy in exacerbations and chronic treatment of allergic diseases, mainly concerning asthma and atopic dermatitis. Future research should be aimed at antibiotic stewardship implementation strategies and biomarker-guided therapy, discerning those patients that might benefit from antibiotic therapy.
Insights
The gut microbiota is crucial for immune health. Limiting antibiotic use in early life and for allergic diseases like asthma may help reduce the allergy epidemic.
Area of Science:
- Immunology
- Microbiology
- Allergology
Background:
- Microbiota composition and function are vital for immune system development.
- Microbial dysbiosis is linked to allergic disease development and can lead to irrational antimicrobial use.
- Current evidence on microbial therapies for allergies is limited by study heterogeneity and strain specificity.
Purpose of the Study:
- To review the relationship between microbiota and allergic diseases.
- To examine the overuse and rationale for antimicrobial agents in allergic conditions.
- To summarize current knowledge on bacterial products for allergic disease management.
Main Methods:
- Literature review on microbiota, dysbiosis, and allergic diseases.
- Analysis of antimicrobial agent use in allergic conditions.
- Evaluation of microbial therapies, including probiotics, for allergy prevention and treatment.
Main Results:
- Microbial dysbiosis is a risk factor for allergic diseases.
- Allergic diseases can increase the risk of inappropriate antimicrobial therapy.
- Evidence for microbial therapies in allergies is inconsistent, necessitating further research.
Conclusions:
- Reducing antibiotic therapy in pregnancy and early childhood is recommended to combat the allergy epidemic.
- Restricting antibiotic use in allergic disease exacerbations and chronic management is advised.
- Future research should focus on antibiotic stewardship and biomarker-guided therapies for allergic conditions.
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