Childhood Eczema and the Gut Microbiome

Eczema or atopic dermatitis (AD) dramatically impacts children’s health and the quality of life of the family as a whole. Although the exact cause of eczema is somewhat unclear, we do know there are multiple factors at work including genes, environment, immune function, skin sensitivities, and the developing gut microbiome.¹ According to the Centers for Disease Control and Prevention (CDC) and the World Allergy Organization, the frequency of both food (~5%) and respiratory (~17%) childhood allergies in the United States has increased in recent years.^2,3 But none so much as eczema, which is currently estimated to affect up to 30% of American children (or approximately 10 million), one-third of whom experience significant symptoms and prolonged disease.^4,5

Eczema: Early-Life Risk Factors

Mode of delivery: Cesarean-section (C-section) birth rates have tripled since 1990 and show no sign of slowing down. Studies have shown that children delivered by C-section harbor less Bifidobacteria and Bacteroidesspecies in their gut and more potentially problematic Clostridia, E coli, and S aureus species compared to children delivered vaginally. These children are also more likely to develop immune disorders including asthma and allergies.^6,7

Breastfeeding: Extended breastfeeding is very helpful in mitigating the microbial impact of C-section births. Although 84% of U.S. mothers begin breastfeeding, nearly 20% supplement with formula by day two after birth, and only 58% of U.S. babies are breastfeeding at six months of age.⁸

Antibiotic exposure: Antibiotic use has become common in modern obstetric/neonatal practice. But there is increased evidence that links early-life antibiotic exposure with inflammatory bowel disease, diabetes, obesity, and immune-modulated disease.⁹

Infant Immune and Microbiome Development: Mother Matters

The pregnant mother’s microbiome is consistently different compared to non-pregnancy. It also evolves during the course of pregnancy, helping to make immune adaptations so that the growing fetus is not rejected by the mother.^10,11

At the same time, mother’s antibodies and growth factors help instruct the developing infant’s immune system. And, despite the fact that commensal maternal microbes begin to migrate across the placenta in the last trimester to help seed the infant microbiome,¹⁵ it is the mode of birth that has the greatest initial impact on infant microbiome development.¹⁶

Vaginal birth is associated with enrichment of Bacteriodes and Bifodobacterium species in the early weeks of life, whereas infants born by C-section are primarily exposed to bacteria from the mother’s skin (eg. Staphylococcus spp).¹⁷

Although lack of Bacteriodes and Bifidobacterium is associated with the development of allergic and immune conditions, breastfeeding can help mitigate these risks. In fact, from 13 weeks, diet becomes the most important factor influencing infant microbiome development.⁶ Given our cultural trends toward shorter-term breastfeeding, it is important to keep in mind that a premature end to breastfeeding is also linked to a higher risk of eczema and asthma.⁶

Related Reading

• Can You Take Probiotics While Pregnant?

Support for the Developing Microbiome

It is clear that the microbiome profile of children suffering from eczema is distinctive compared to their healthy counterparts.¹⁸ This has led researchers to investigate the impact of the largest surface in the human body, where microbes and their products interact with the immune system: the gut-associated lymphoid tissue (GALT).

The primary proposed mechanisms of action focus on the ability of microbes to modulate immune response. Because deeply researched probiotic species including Bifidobacterium and Lactobacillus are often both found at lower concentrations in these children,^19,20 the potential benefits of probiotic supplementation for prevention and treatment have been evaluated.

However, the results are mixed due to differences in clinical trial design, probiotic species, probiotic concentration, manufacturing process, and other factors.

Selecting a Probiotic Formulation for Best Outcomes

Strain Significance: Over the years, research has taught us that our gut microbes play a strong role in immune system development and function. In eczema cases, specifically, children are found to have impaired gut barrier integrity (a.k.a. leaky gut) and less than optimal production of nourishing short chain fatty acids. Both of which can be supported by a high-quality probiotic.

But these functional capabilities are highly strain-specific. It is therefore critical to identify the right probiotic blend, containing strains that perform the right jobs and in the right combination, to address a specific condition.

Synergistic Performance: Beyond the individual strains, it is crucial to demonstrate that the entire probiotic blend performs as expected. Researcher Niers and team demonstrated this with OMNi-BiOTiC® PandA probiotic.

In their study, it was shown that mothers and infants taking Omni-Biotic PandA as directed demonstrated a significantly lower risk of developing childhood eczema.²⁶ An additional, follow-up study analyzing the children’s feces showed that there was a distinctive difference in the levels of microbial metabolic products between the healthy group and those who later developed eczema.²⁷ These finding illustrate what probiotic activity is actually driving performance.

In summary, select probiotic strains and formulations offer promise in the prevention and management of atopic dermatitis. However, not all strains or available probiotic formulations will perform at similar levels of impact. Understanding how a formulation was developed, what strains are used and why, and how the final formulation tested in a specific condition through published clinical trials defines the difference between a general probiotic and one built for performance.

1. Dharmage SC, Lowe AJ, Matheson MC, et al. Atopic dermatitis and the atopic march revisited. Allergy. 2014; 69:17-27.
2. Centers for Disease Control and Prevention. Trends in Allergic Conditions Among Children: United States, 1997–2011. Number 121, May 2013. Last reviewed November 6, 2015. CDC Web site. https://www.cdc.gov/nchs/products/databriefs/db121.htm. Accessed February 7, 2021.
3. Pawankar R, Holgate ST, Canonica RW, et al, eds. White Book on Allergy: Update 2013. World Allergy Organization. WAO Web site. https://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf. Accessed February 7, 2021.
4. National Eczema Association. Eczema Stats. Available at: https://nationaleczema.org/research/eczema-facts/. Accessed February 7, 2021.
5. Kim BS. What is the global prevalence of atopic dermatitis (eczema)? June 3, 2020. Medscape Web site. https://www.medscape.com/answers/1049085-4692/what-is-the-global-prevalence-of-atopic-dermatitis-eczema. Accessed February 7, 2021.
6. Galazzo G, van Best N, Bervoets L, et al. Development of the Microbiota and Associations With Birth Mode, Diet, and Atopic Disorders in a Longitudinal Analysis of Stool Samples, Collected From Infancy Through Early Childhood. Gastroenterology. 2020;158(6):1584-1596.
7. Lee SY, Lee E, Park YM, Hong SJ. Microbiome in the Gut-Skin Axis in Atopic Dermatitis. Allergy Asthma Immunol Res. 2018;10(4):354-362.
8. Centers for Disease Control and Prevention. Breastfeeding Report Card: United States, 2020. Last reviewed September 17, 2020. CDC Web site. https://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed February 7, 2021.
9. Eck A, Rutten NBMM, Singendonk MMJ, et al. Neonatal microbiota development and the effect of early life antibiotics are determined by two distinct settler types. PLoS One. 2020;15(2):e0228133.
10. Borzychowski AM, Croy BA, Chan WL, et al. Changes in systemic type 1 and type 2 immunity in normal pregnancy and pre-eclampsia may be mediated by natural killer cells. Eur J Immunol. 2005;35(10):3054-3063.
11. Reinhard G, Noll A, Schlebusch H, et al. Shifts in the TH1/TH2 balance during human pregnancy correlate with apoptotic changes. Biochem Biophys Res Commun. 1998;245(3):933-938.
12. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259-1260.
13. Bloomfield SF, Stanwell-Smith R, Crevel RW, Pickup J. Too clean, or not too clean: the hygiene hypothesis and home hygiene. Clin Exp Allergy. 2006;36(4):402-425.
14. Strannegård O, Strannegård IL. The causes of the increasing prevalence of allergy: is atopy a microbial deprivation disorder? Allergy. 2001;56(2):91-102.
15. Walker RW, Clemente JC, Peter I, Loos RJF. The prenatal gut microbiome: are we colonized with bacteria in utero? Pediatr Obes. 2017;12 Suppl 1(Suppl 1):3-17.
16. Robertson RC, Manges AR, Finlay BB, Prendergast AJ. The Human Microbiome and Child Growth - First 1000 Days and Beyond. Trends Microbiol. 2019;27(2):131-147.
17. Dominguez-Bello MG, Costello EK, Contreras M, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010;107(26):11971-11975.
18. Kalliomäki M, Salminen S, Arvilommi H, et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357(9262):1076-1079.
19. Zheng H, Liang H, Wang Y, et al. Altered Gut Microbiota Composition Associated with Eczema in Infants. PLoS One. 2016;11(11):e0166026.
20. Melli LCFL, Carmo-Rodrigues MSD, Araújo-Filho HB, et al. Gut microbiota of children with atopic dermatitis: Controlled study in the metropolitan region of São Paulo, Brazil. Allergol Immunopathol (Madr). 2020;48(2):107-115.
21. Huang R, Ning H, Shen M, et al. Probiotics for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Cell Infect Microbiol. 2017;7:392.
22. Panduru M, Panduru NM, Sălăvăstru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol. 2015;29(2):232-242.
23. Rosenfeldt V, Benfeldt E, Valerius NH, et al. Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis. J Pediatr. 2004;145(5):612-616.
24. Yan F, Polk DB. Probiotics and immune health. Curr Opin Gastroenterol. 2011;27(6):496-501.
25. Kim NY, Ji GE. Effects of probiotics on the prevention of atopic dermatitis. Korean J Pediatr. 2012;55(6):193-201.
26. Niers L, Martin R, Rijkers G, et al. The effects of selected probiotic strains on the development of eczema (the PandA study). Allergy. 2009;64(9):1349-1358.
27. Kim HK, Rutten NB, Besseling-van der Vaart I, et al. Probiotic supplementation influences faecal short chain fatty acids in infants at high risk for eczema. Benef Microbes. 2015;6(6):783-790.