Sponsored Content Synbiotics may rebalance the gut microbiota in Caesarian-section PREBIOTIC PROBIOTIC infants and reduce severity of atopic dermatitis in infants fibres which live beneficial The results of the JULIUS Study showed that a formula supplemented stimulate the bacteria with synbiotics (scGOS/lcFOS/B. breve M-16V) re-established growth and the delayed colonisation of Bifidobacterium in Caesarian-section Synbiotics – a promising approach activity of delivered infants, from the first days of life and provided the beneficial bacteria SYNBIOTIC physiological conditions for a healthy gut, as observed in vaginally Pre- and born infants. Exploratory data suggested a potential protective for the primary prevention and dietary Probiotic blend effect on adverse events related to skin disorders and atopic management of cow’s milk allergy dermatitis (AD) early in life.21 The SYNBAD Study confirmed the bifidogenic capacity of this synbiotic blend in infants with AD. In addition, the synbiotic (EHF) reduced AD severity within the subgroup of infants with IgE Nutricia presents the final installment in a three-part series of discussions around associated AD, and improved diaper/nappy dermatitis symptoms.12 The 1 year follow-up data also showed reduced prevalence of allergies in early life. This article focuses on synbiotics, a promising approach for 13 Synbiotics can be used to target microbial dysbiosis in the primary asthma-like symptoms and medication use in infants with AD. primary prevention and dietary management of cow’s milk allergy (CMA). prevention and dietary management of cow’s milk allergy. Synbiotics are safe, hypoallergenic and improve the microbiota of PREBIOTIC PROBIOTIC infants with CMA scFOS/lcFOS and Bifidobacterium breve Clinical studies have shown that an AAF with synbiotics is The global rise of allergy scGOS/lcFOS M-16V hypoallergenic, well tolerated and supports normal growth in both 22-24 The prevalence of allergic diseases, such as food allergy, atopic eczema, allergic rhinitis and asthma, is rising healthy and CMA infants. The ASSIGN study investigated the • Feeds the proliferation of • A commonly isolated Bifidobacteria effects of an AAF including synbiotics (scFOS/lcFOS/B. breve M-16V) 1 18 dramatically worldwide. CMA is one of the most common allergies in infants and young children, affecting Bifidobacteria species in human milk on percentages of Bifidobacteria and Eubacterium rectale/Clostridium up to 5% of the world population.2 • Widely studied prebiotic • M-16V, selected among 400 coccoides (ER/CC) in feces from infants with suspected non-IgE mixture in infants different strains mediated CMA. Feces from age matched healthy breastfed reference • Clinically shown to mimic • Safe, free from major allergens19 group were also collected. An eight week intervention with an AAF The importance of the gut microbiota in early life immune modulating and • Clinically shown to have immune- with these specific synbiotics was shown to lead to increased levels of bifidogenic effects modulating effect "infant like" Bifidobacteria and decreased “adult like” ER/CC compared The immune system develops quickly during Environmental factors such as mode of potentially giving rise to allergic diseases.4 17 of human milk to an AAF without synbiotics. These bacterial changes approximated the first 1000 days of life; it is well known delivery, diet and use of antibiotics influence For this reason, targeting the gut microbiota • Has a synergistic effect with GOS/ the levels in the healthy breastfed group. This supports the hypothesis that both the establishment and maintenance the infant gut and immune system. These is suggested to be important in reducing FOS, FOS/FOS modulating the gut microbiota19 that an AAF with synbiotics improves the fecal microbiota of infants of an optimal microbial community is factors can cause an imbalance of the gut the risk or persistence of allergic diseases with suspected non-IgE medicated CMA.14 important for the development of the microbiota known as dysbiosis, which impairs like CMA.5 immune system and essential to maintain the development of the immune system, The ongoing PRESTO study includes infants with confirmed health, especially in infants and children.3 resulting in a state of inflammation and Scientific substantiation of the synbiotic IgE-mediated CMA, randomly allocated to receive the same AAF concept for allergy management with or without synbiotics for 12 months and will assess cow’s milk tolerance acquisition over 12, 24 and 36 months. This trial will inform The synbiotic concept Nutricia has undertaken an extensive clinical research programme to future studies primarily focusing on the clinical outcomes in the Synbiotics are a combination of pre- and healthy infants.9 Human milk contains human “Synbiotics are clinically support the safety, tolerability and efficacy of the synbiotic concept: specific CMA populations. probiotics.6 Pre- and probiotics can influence milk oligosaccharides (HMOs) and live bacteria the immune system directly, or indirectly, that are provided at a critical stage in the early proven to influence the via the gut microbiota, and therefore they development of the gut microbiota.10 Future of allergy management for CMA patients may play a role in preventing the onset of an gut microbiota, offering The dramatic increase in allergic disease be a new way to reduce the incidence and underway investigating the role of these 7 allergic disease. The objective of combining Given the presence and important role of requires a new focus on strategies for persistence of allergic diseases like CMA. ingredients in the primary prevention and pre- and probiotics is to achieve stronger these naturally occurring pre- and probiotics, important opportunities the primary prevention and dietary dietary management of CMA. positive effects than with either component and recognising that breast feeding is management of food allergy. Increasing Nutricia believes that there is a strong 8 in the management of alone (synergy). not always possible, there is a compelling insights have highlighted the importance rationale to include pre-, pro- and Nutricia continues to collaborate with rationale to combine pre- and probiotic cow’s milk allergy” of the gut microbiota for overall health and synbiotics in the diet of these infants and global experts to further its understanding The gut microbiota of infants with allergic ingredients (synbiotics) in infant formula so targeting the gut microbiota appears to has an extensive clinical trial programme of the impact of nutrition on food allergy. conditions is characterized by low levels of that functionally it more closely resembles Professor Jan Knol Bifidobacteria and Lactobacilli compared with human breast milk. Gut Biology & Microbiology, Nutricia Research For more information visit www.nutriciaresearch.com/allergy/ References: 1. Pawankar R, et al. World Allergy Organisation (WOA): White 10. Walker WA, et al. Breast milk, microbiota, and intestinal 18. Martin, R., et al., Isolation of bifidobacteria from breast book on allergy. Wisconsin: World Allergy Organization, 2011. immune homeostasis. Pediatr Res, 2015; 77(1–2): milk and assessment of the bifidobacterial population by Synbiotics as a promising approach for CMA 2. Fiocchi A, et al. World Allergy Organization (WAO) Diagnosis 220–228. PCR-denaturing gradient gel electrophoresis and quantitative and Rationale for Action against Cow’s Milk Allergy (DRACMA) 11. Boyle R et al. Prebiotic-supplemented partially hydrolysed real-time PCR. Appl Environ Microbiol, 2009. 75(4): p. 965-9. A growing amount of clinical evidence shows Supplementation with specific prebiotic hydrolysates may contribute to the induction Guidelines. Pediatr Allergy Immunol 2010: 21 (Suppl. 21): cow’s milk formula for the prevention of eczema in high-risk 19. Hougee S et al, Oral treatment with probiotics reduces allergic that pre- and probiotics can have beneficial mixtures and probiotic bacteria has been of oral tolerance via controlled exposure to 1–125. infants: a randomized controlled trial. Allergy 2016 Allergy 71 symptoms in ovalbumin-sensitized mice: a bacterial strain 3. Andrew J, Gary H. The microbiome and regulation of mucosal (2016) 701–710. comparative study. Int Arch All IMmunol 2010; 151:107-117. effects in infants at risk of, or living with a logical next step in promoting immune specific peptides of the allergenic protein.16 immunity. John Wiley & Sons Ltd, Immunology 2013; 142: 24–31. 12. Van der Aa LB, Heymans HS, Van Aalderen WM, Sillevis Smitt 20. Schouten B, van Esch BC, Hofman GA, van Doorn S A, Knol J, 11–14 4. Prescott SL. Early-life environmental determinants of JH, Knol J Ben Amor K, Goossens DA, Sprikkelman AB and Nauta AJ, et al. Cow milk allergy symptoms are reduced in mice food allergies. system development and balanced gut allergic disease and the wider pandemic of inflammatory the Synbad Study Group. Effect of a new synbiotic mixture fed dietary synbiotics during oral sensitization with whey. J microbiota as part of strategies for the Recognizing the importance of a balanced noncommunicable diseases. Journal of Allergy and Clinical on atopic dermatitis in infants: a randomized-controlled trial. Nutr 2009; 139: 1398-403. Immunology 2013; 131(1): 23. Clinical & Experimental Allergy, 40, 795–804. 21. Chin Chua M, Ben-Amor K, Lay C, Neo A et al. Effect of Traditional strategies for the dietary nutritional management of CMA. gut microbiota, and building on the 5. Aitoro R, et al. Gut Microbiota