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Dangerous liaisons: Bacteria,antimicrobial therapies,and allergic diseases |
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| Authors: | Gerdien Tramper-Stranders Dominika Ambrożej Alessandra Arcolaci Marina Atanaskovic-Markovic Cristina Boccabella Matteo Bonini Aspasia Karavelia Ervin Mingomataj Liam O' Mahony Milena Sokolowska Eva Untersmayr Wojciech Feleszko the EAACI Task Force on Conscious and Rational use of Antibiotics in Allergic Diseases |
| Institution: | 1. Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands;2. Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
Doctoral School, Medical University of Warsaw, Warsaw, Poland;3. Immunology Unit, University of Verona and General Hospital Borgo Roma Hospital, Verona, Italy;4. Faculty of Medicine, University of Belgrade, University Children's Hospital, Belgrade, Serbia;5. Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy;6. Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy National Heart and Lung Institute (NHLI), Imperial College London, London, UK;7. Department of Ear-Nose-Throat surgery, General Hospital of Kozani, Kozani, Greece;8. Department of Allergology & Clinical Immunology ‘Mother Theresa’ School of Medicine, Tirana, Albania;9. Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland;10. Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland;11. Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria;12. Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland |
| Abstract: | Microbiota composition and associated metabolic activities are essential for the education and development of a healthy immune system. Microbial dysbiosis, caused by risk factors such as diet, birth mode, or early infant antimicrobial therapy, is associated with the inception of allergic diseases. In turn, allergic diseases increase the risk for irrational use of antimicrobial therapy. Microbial therapies, such as probiotics, have been studied in the prevention and treatment of allergic diseases, but evidence remains limited due to studies with high heterogeneity, strain-dependent effectiveness, and variable outcome measures. In this review, we sketch the relation of microbiota with allergic diseases, the overuse and rationale for the use of antimicrobial agents in allergic diseases, and current knowledge concerning the use of bacterial products in allergic diseases. We urgently recommend 1) limiting antibiotic therapy in pregnancy and early childhood as a method contributing to the reduction of the allergy epidemic in children and 2) restricting antibiotic therapy in exacerbations and chronic treatment of allergic diseases, mainly concerning asthma and atopic dermatitis. Future research should be aimed at antibiotic stewardship implementation strategies and biomarker-guided therapy, discerning those patients that might benefit from antibiotic therapy. |
| Keywords: | allergy antibiotics bacterial lysates microbiota probiotics |