Studies by Traditional Plate Culture Methods

The first reports associating allergy with characteristic microbial composition in the gut appear to be from studies in the former Soviet Union in the early1980s (38-40). One of these studies, reported also in English, involved an assessment of 60 under one-year-old infants with food allergy and atopic eczema. It was claimed that the severity of the disease was in direct correlation with the stage of aberrancy in the fecal microbiota. This aberrancy was characterized as low prevalence of bifidobacteria and lactobacilli and high prevalence of Enterobactericeae, pathogenic species of staplylococci and streptococci as well as Candida species (39). Indication that such differences may persist beyond infancy was provided a few years later by Ionescu and co-workers (1986) who studied 10- to 45-year-old subjects. Subjects with atopic eczema (n = 58) were shown to have lower prevalence of lactobacilli, bifidobacteria, and enterococci species than the healthy subjects (n = 21) but higher prevalence of Klebsiellae, Proteus, Staphylococcus aureus, Clostridium innocuum and Candida species (41,42). Supporting findings were later published by this group from a comparison of the fecal microbiota of 30 healthy subjects and 110 subjects with atopic eczema (43).

Although these early studies have not received wider acknowledgment in the scientific community, they are well in agreement with later studies that began to accumulate a decade later. In one study Klebsiellae species were again found more frequently in the feces of 6-month-old infants with atopic eczema (n = 27) and the presence of Streptococcus species was less frequent than in the healthy controls (n=10) (44). Collectively, the predominant anaerobic and facultatively anaerobic microbiota of allergic infants has been characterized by significantly lower prevalence of gram-positive species. In a study by Bjorksten and co-workers (1999), colonization by lactobacilli was shown to be less common in both Estonian and Swedish two-year-old children with food allergies (n = 27) than in the age compatible healthy children (n = 36), whilst the opposite was true for coliforms and

S. aureus (45). In addition, their results indicated that Bacteroides comprised a larger proportion of the whole microbiota in healthy compared to allergic infants. They later studied the development of microbiota in a prospective follow-up. Surprisingly, lactobacilli were significantly more frequently present during the neonatal period in the feces of infants who at 2 years had atopic eczema and/or positive skin prick test (n = 18) than in the feces of infants who remained symptom free and had negative skin prick test (n = 26) (46). The rest of the characteristics that were associated with allergy were in concordance with the previous studies with less frequent presence of bifidobacteria and enterococci during the neonatal period. Later in the first year of life, a relatively high prevalence of S. aureus and numbers of clostridia and relatively low numbers of Bacteroides were associated with allergic eczema (46). The putative differences in the bifidobacteria! microbiota were studied at species level by Ouwehand and co-workers (2001) and they found that the feces of 2 to 7-month-old infants with atopic eczema (n = 7) contained more frequently B. adolescentis and less frequently B. bifidum than the feces of healthy infants (n = 6) (47).

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