Dr Evette van Niekerk is a Senior lecturer in Therapeutic Nutrition at Stellenbosch University. She has worked in the field of nutritional sciences for over 17 years. Dr van Niekerk recently presented a webinar for Medical Chronicle, sponsored by Ascendis Health. The following article is based on her presentation.  

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Dr Van Niekerk addressed: 

  • Food allergy prevalence​ 
  • Food allergy development​ 
  • Development of the microbiome​ 
  • Dysbiosis​ 
  • Driving forces of the microbiome​ 
  • Metabolic mediators​ 
  • Research to prevent and treat allergies. 

The driving forces of the infant microbiota​ 

Maternal diet​ 

Higher maternal nutritional intake of fructose, dietary fibre, folic acid and ascorbic acid was negatively associated with the abundance of unhealthy infant gut microbiomes​.  

Exclusive breastfeeding for six months is considered to provide optimal nutrition, and partial breastfeeding is to be encouraged up to one or two years of life. 

“The diadem of the mother breastfeeding her newborn child is a unique model for understanding the importance of diet in a broader sense, both in terms of prevention and protection. Human milk can prevent many diseases. ​ 

The first moments of life are important for the destiny of an individual: normally this is recognised for the lungs and the first breath, but it is also true for the other organs, in particular for the intestine (‘the first meal is like the first breath’). ​ Journal of Pediatric and Neonatal Individualized Medicine 2015. 

Human milk oligosaccharides​ 

Prebiotics are non-digestible food ingredients that stimulate the growth or activity of bacteria in the digestive system which are beneficial to human health. Human milk contains a unique amount of complex oligosaccharides (5-8g/l).  

Human milk oligosaccharides impact on the intestinal micro-biota​ bifidobacterium bifidum, infantis​. 

Dr Van Niekerk looked at potential effective specific probiotic strains for food allergy prevention and treatment​. 

Probiotics as adjuvant for oral immunotherapy​ 

  • In 2001 in a double-blind, randomised placebo-controlled trial with Lactobacillus rhamnosus GG (LGG) 
  • LGG was administered prenatally to mothers who had at least one first-degree relative with atopic diseases, and postnatally for six months to their infants 
  • The frequency of atopic eczema at two years of age in the probiotic group was half that of the placebo group. LGG seemed then effective in the prevention of early atopic disease in children at high risk​. 

Probiotics in prevention of IgE-associated eczema​ 

Lactobacillus reuteri​ was used at 36 weeks’ gestation and administered to infants during the first year of life. ​N=188 ​The cumulative incidence of eczema was similar, 36% in the probiotic and 34% in the control group. ​There was significantly less IgE-associated eczema in the second year of life. However, it was found in the probiotic group (8 vs 20%; P = 0.02). ​ 

Skin-prick test reactivity was also less common in the probiotic group (14 vs 31%; P = 0.02).​(Abrahamsson et al. J of Aller & Clin Immunol. 2007.) 

Study conclusion ​ 

  • Results inconsistent ​ 
  • Demonstrated that probiotics may have the potential to reduce the risk of infant AD or eczema when administered to  mothers both during pregnancy and for a period of three-six  months post-partum ​ 
  • Treatment  containing a combination of  lactobacilli and bifidobacteria probiotic strains may be  effective, especially if the child is at a high hereditary risk of  developing an allergic  condition 
  • Further  research should be aimed at the most common bacteria used as probiotics, timing and duration​, and optimal probiotic strains.