Probiotics: are they good for eczema?

Six years ago after reviewing several research papers I started recommending probiotics to my eczema patients. Today I read new research which may have changed my mind…

What are probiotics?

Probiotics contain health-promoting bacteria also known as microflora which are naturally found in the gastrointestinal tract of healthy people. Microflora work by adhering to your gut wall and “policing” potentially harmful microbes so they can’t multiply and thrive. Beneficial bacteria promote healthy digestion and they can manufacture some vitamins including the B-group vitamins so they help to decrease the risk of nutritional deficiencies. 

What are probiotics good for?

Probiotics are generally recommended to people after they have taken a course of antibiotics, been ill, had diarrhoea, experienced an adverse reaction to food, or to treat compromised gut function and/or candida albicans fungal infestation.

Different types of probiotics

Generally the beneficial bacteria in probiotics come from two groups, Lactobacillus (often shortened to "L.") and Bifidobacterium (shortened to "B."). Within these groups are different strains such as Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium animalis (B. animalis). What I didn’t realise until now was that Lactobacillus and Bifidobacterium produce amines (more on this shortly).



Probiotics and eczema

Now, according to research the benefits from probiotics are strain-specific. For example the strain L. acidophilus LA5 does not treat eczema (it may help conditions such as candida albicans) but according to a research paper published in 2001, the strain known as L. rhamnosus GG can improve eczema symptoms in up to 50% of children with eczema (Ref. Kalliomäki, 2001). [Note researchers did not say it helped adults with eczema, and the children still had eczema but it was reduced.]

However, when choosing probiotics it is important to look at a wider range of facts. Here is further research to consider:

Eczema research

Research published in the American Journal of Clinical Dermatology found that probiotics can have a positive effect on children with eczema (no one was cured but their eczema SCORAD was reduced). However, the researchers concluded “The immune system in adults and patients with atopic dermatitis seems to be affected differently by probiotic intervention and more research is necessary in this area.” So it may be that probiotics are not as effective for adults with eczema. (ref. Gerasimov, 2010)

Researchers from the Royal Children’s Hospital in Victoria, Australia looked at twelve trials on Probiotics for eczema (with a total of 781 participants) and found that that there was no significant reduction in eczema symptoms with probiotic treatment compared with the placebo (ref. Boyle, 2009).

Probiotics produce amines and glutamates

The research from the RPA Hospital Allergy Unit in Sydney (Australia), made me change my mind about probiotics for eczema. Probiotics - all kinds including freeze dried capsules, in yoghurt, kefir or other fermented products, including probiotic powder supplements - contain high levels of amines, according research from the RPA Hospital Allergy Unit (ref. Dengate). More than 36% of eczema sufferers experience a worsening of eczema symptoms when they eat amine-rich foods. So a third of people with eczema could have adverse reactions to probiotics.

What are amines?

Your body not only makes histamine in response to an allergic reaction, your food also supplies histamines and other amines. According to several research papers, eczema sufferers have elevated histamine levels in the blood combined with a reduced capacity to detoxify these histamines. (refs: Maintz; Ionescu; Loblay)

Glutamates

Amines are not the only problem with probiotics, a common strain of probiotic, Lactobacillus casei, forms free glutamates - a form of MSG flavour enhancer. More than a third, or 35%, of people with eczema have adverse reactions to MSG according to researchers from the RPA Hospital Allergy Unit. (Loblay)

Read our article on MSG sensitivity here >

So if you are sensitive to amines, histamines and/or MSG don't take probiotic supplements. How do you know if you are sensitive to amines, histamines and/or MSG? An elimination diet such as The Eczema Diet is the easiest way. Check the common signs and symptoms to look for:

Adverse reactions to probiotics include:

• worsening of eczema symptoms
• skin rash or hives
• bloating
• increased gas
• diarrhoea or constipation
• stuttering (one case in a child with eczema, stuttering resolved after discontinuing use of probiotics containing L. rhamnosus)

(Symptoms can be caused by other factors. You won't truly know if you are amine-sensitive until you take amines out of your diet for a period of about 8 weeks, then reintroduce them.)

Should you be worried about probiotics?

Probiotics are deemed safe to use for all ages, including during pregnancy and breastfeeding so there is no need for alarm. And if they have helped your digestive problems and so on, keep taking them as recommended by your health care professional. However, if you experience any adverse effects discontinue use.

Probiotics and eczema

In light of the research these are my health care practitioner recommendations for people with eczema: If probiotics are not visibly helping your eczema then avoid taking probiotics while on The Eczema Diet. Especially if you are unsure if you have amine sensitivity as taking the wrong supplements can affect the outcome of the diet. The Eczema Diet is low in amines and it works on its own without the need for probiotics. 

Read about The Eczema Diet here >

Do you have amine sensitivity? Read about amines and histamines via my blog on Rosacea here >

Fish oils contain amines/histamines... more information on our blog >

Probiotics... which brand to choose?

For people who would like to use probiotics to treat other conditions here is a list of uses and brands.

Probiotics for skin problems caused by digestive complaints

Eczema Shield by Ethical Nutrients (contains L. rhamnosus GG)
Gastro Relief by Ethical Nutrients (contains L. rhamnosus GG)
Culturelle (contains L. rhamnosus GG)
IBS Support by Ethical Nutrients (contains L. plantarum 299v)
Symbiotic by Bioceuticals (contains propionibacterium freudenreichii HA-101 and HA-102)
L. johnsonii La1

Probiotics for compromised immune system

Acidophilus Bifidus by Blackmores; Ultra Megadophilus by Bio-Organics; Mega Acidophilus capsules by Natural
Nutrition; Double Strength Acidophilus by Nature’s Own (contains L. acidophilus LA5)
Eczema Shield and Gastro Relief by Ethical Nutrients (contains L. rhamnosus GG)
Culturelle (contains L. rhamnosus GG)
IBS Support by Ethical Nutrients (contains L. plantarum 299v)

Probiotics for candida albicans (skin fungal infection)

Acidophilus Bifidus by Blackmores; Ultra Megadophilus by Bio-Organics; Mega Acidophilus capsules by Natural Nutrition; Double Strength Acidophilus by Nature’s Own (contains L. acidophilus LA5)
Eczema Shield by Ethical nutrients; Culturelle (contains L. rhamnosus GG )
Trenev Trio by Natren (L. acidophilus strain NAS)
Inner Health Immune Boost for Kids and Inner Health Plus by Ethical Nutrients; Ultra Flora and Ultra Flora dairy free by Metagenics (contains L acidophilus NCFM)

Probiotics for allergies

Eczema Shield by Ethical Nutrients (contains L. rhamnosus GG)
Gastro Relief by Ethical Nutrients (contains L. rhamnosus GG)
Culturelle (contains L. rhamnosus GG)
IBS Support by Ethical Nutrients (contains L. plantarum 299v)
L. johnsonii La1

Author: Fischer, Karen, 2015, 'Probiotics: are they good for eczema', www.jolieeskin.com