Childhood Eczema and the Gut Microbiome

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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.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

A mother smiling at her developing baby.
A mother smiling at her developing baby.

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 ClostridiaE 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

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A pregnant woman having a healthy snack that feeds the beneficial bacteria in her gut.

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

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A mother with her young, healthy children.

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.

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Omni-Biotic PandA: A Prenatal and Infant Probiotic

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.

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