title: Effect of Lactobacillus rhamnosus GG and vitamin D supplementation on the immunologic effectiveness of grass-specific sublingual immunotherapy in children with allergy.
abstract: BACKGROUND
  An important issue in sublingual immunotherapy (SLIT) is how to improve efficacy.
  
  
  OBJECTIVE
  To compare the clinical and immunologic efficacy of SLIT given alone and, to enhance clinical efficacy, given with probiotic or vitamin D supplementation.
  
  
  METHODS
  One hundred children, ages 5-12 years, sensitive to grass pollen, with allergic rhinitis participated in a 5-month prospective, randomized, double-blind, placebo-controlled trial. Children received 5-grass SLIT 300 IR tablets with either vitamin D 1000 IU daily supplementation, probiotic, or placebo. The control group included children with allergy who did not qualify for immunotherapy. Primary end points included a symptom-medication score, lung function, and exhaled nitric oxide concentration. The secondary end point was the immunologic efficacy measured by the following: CD4(+)CD25(+)Foxp3(+) (forkhead box P3) cells, Toll-like receptor (TLR) 4, interleukin (IL) 1, IL-6, tumor necrosis factor, IL-10, and transforming growth factor β-1 levels in cell culture supernatants.
  
  
  RESULTS
  Reduction in the symptom-medication score and improvement in lung function as well as a significant increase in the percentage of CD4(+)CD25(+)Foxp3(+) in children who received SLIT in all the groups were observed compared with control group. In the SLIT-probiotic group, between-group analysis showed significantly higher CD4(+)CD25(+)Foxp3(+) induction compared with the SLIT group and higher reduction in the percentage of TLR-positive cell group compared with the SLIT-vitamin D group (Fig. 1). An increase in CD4(+)CD25(+)Foxp3(+) induction, reduction in TLR-positive cells recruitment and an increase in transforming growth factor β-1 production were independently associated with a better clinical effect of SLIT in children.
  
  
  CONCLUSIONS
  We demonstrated the clinical and immunologic effect of probiotic and vitamin D supplementation on SLIT. Probiotic supplementation showed better clinical and immunologic response in children with allergic rhinitis.
authors.affiliation: Department of Social Pediatrics and Allergy, N Copernicus Hospital, Medical University of Lodz, Lodz, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Jerzynska
authors.forename: Wlodzimierz
authors.initials: W
authors.lastname: Stelmach
authors.forename: Joanna
authors.initials: J
authors.lastname: Balcerak
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Woicka-Kolejwa
authors.forename: Blazej
authors.initials: B
authors.lastname: Rychlik
authors.forename: Andrzej
authors.initials: A
authors.lastname: Blauz
authors.forename: Marcin
authors.initials: M
authors.lastname: Wachulec
authors.forename: Piotr
authors.initials: P
authors.lastname: Stelmach
authors.forename: Pawel
authors.initials: P
authors.lastname: Majak
authors.forename: Iwona
authors.initials: I
authors.lastname: Stelmach
mesh_terms: D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D052201:Lacticaseibacillus rhamnosus; D008297:Male; D006109:Poaceae / Q000009:adverse effects*; D011058:Pollen / Q000276:immunology; D019936:Probiotics / Q000008:administration & dosage; D011379:Prognosis; D012129:Respiratory Function Tests; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D012621:Seasons; D063729:Sublingual Immunotherapy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage*
chemical_list: D000485:Allergens; D015415:Biomarkers; D014807:Vitamin D