Microbiome Modulation
Non-allergen-specific therapies aim to modulate the allergic response to all allergens and keep immunological barriers healthy. A successful therapy maintains a high level of efficacy and safety.
The goal of non-allergen-specific therapies is to allow allergic individuals to live their daily lives without adverse allergic events. If someone is allergic to multiple allergens, the therapy has the potential to relieve all of their allergies, especially when combined with allergen-specific therapies in a dual-therapy approach.
Probiotics
The use of live healthy bacteria, in conjunction with AIT, has been hypothesized to significantly increase safety and efficacy and to enable the tolerance induction that has been so elusive in present-day AIT treatment. Microbiome manipulation also shows promise in treating immunological barrier disorders and other types of allergic diseases.
Performing AIT without manipulating the microbiome is similar to planting seeds in concrete. Most allergic people have a poor microbiome that is not conducive to tolerance induction and led to their allergies in the first place. There is no chance to build tolerance in these people without manipulating the microbiome. If we give these people a healthy microbiome that is conducive to tolerance induction (healthy soil), then tolerance can be induced (seeds can sprout).
Cow’s milk (CM) formula which contained the probiotic Lactobacillus rhamnosus GG was found to accelerate immune tolerance acquisition in children allergic to CM. Similarly, the use of adjuvant probiotics saw 89.7% of the treatment group exhibit desensitization compared to 7.1% of the placebo group. Additionally, a 4-year follow-up showed that 58% of the initial treated group showed sustained unresponsiveness compared to 7% of the placebo group, which is suggestive of a long-lasting clinical benefit of this combined therapy.1
Fecal Microbiota Transplantation (FMT)
FMT is a procedure where stool is collected from a healthy donor and placed into the gastrointestinal tract of a patient in order to shift their microbiome composition. Essentially, FMT is a super probiotic. Placement can be done through a variety of methods such as a colonoscopy, enema, nasogastric tube, or in capsule form (poop pills). FMT is already performed on patients suffering from chronic diarrhea and recurring C. diff infection but also has great potential in treating allergic diseases.
The stool used for FMT contains more live bacteria than any probiotic available today. Healthy donors can be thought of as biological manufacturing machines and are more efficient than anything else. However, there are limitations to FMT treatment today that revolve around data collection and processing. Humanity doesn’t have good ways to evaluate the composition of fecal matter and there isn’t a database detailing every strain of bacteria. We can’t simulate the effects of an FMT treatment in a patient before it is performed, so current-day FMT treatment is similar to gambling; we hope that shifting the microbiome composition will yield healthful results, but that is far from a guarantee.
Fecal microbiota transplantation has been performed on patients with atopic dermatitis and significantly decreased disease severity. Patient stools that became more similar to their healthy donors saw greater improvement in disease severity (lower SCORAD score).13
Here is a graphic detailing the reduction in disease severity over the course of FMT treatment:
