Allergologia et Immunopathologia

Allergologia et Immunopathologia

Volume 48, Issue 2, March–April 2020, Pages 107-115
Allergologia et Immunopathologia

Original Article
Gut microbiota of children with atopic dermatitis: Controlled study in the metropolitan region of São Paulo, Brazil

https://doi.org/10.1016/j.aller.2019.08.004Get rights and content

Abstract

Background

It is possible that imbalances in the composition of the gut microbiota or the relationship of the microbiota with the host may be implicated in the origin of allergy. Therefore, we studied the intestinal microbiota of children with atopic dermatitis (AD).

Methods

Cross-sectional study with 81 children aged 5–11; 23 with AD and 58 controls. Surveys were conducted to obtain demographic, socioeconomic and neonatal data. Diagnosis of AD was made based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Eubacteria, Bacteroidetes, Firmicutes, B. fragilis, E. coli, Lactobacillus spp., S. aureus, E. faecalis, Salmonella spp., M. smithii, Bifidobacterium spp., C. difficile and C. perfringens were quantified using real-time PCR.

Results

The analysis showed an association between presence of C. difficile (OR: 5.88; 95 % CI: 1.24; 27.98), greater abundance of bifidobacteria (OR: 11.09; 95 % CI: 2.14; 57.39) and a lower abundance of lactobacilli (OR: 0.07; 95 % CI: 0.01; 0.51) in the gut microbiota of children with AD. Counts of Eubacteria (0,05 × 103 and 8.49 × 103), B. fragilis (0.72 × 109 and 4.5 × 109), Lactobacillus spp. (0.02 × 108 and 0.38 × 108), E. coli (0.13 × 109 and 1.52 × 109) and M. smithii (0.02 × 108 and 0.31 × 108) were lower in children with AD (P < 0.05).

Conclusions

This study confirmed that children living in the metropolitan area of São Paulo (Brazil) with AD have a different microbiota pattern with higher prevalence of C. difficile, lower abundance of Lactobacillus and greater abundance of bifidobacteria, regardless of socioeconomic status.

Introduction

Atopic dermatitis (AD) is one of the most common skin diseases among children in Western countries, and its prevalence is apparently rising.1 Studies carried out2 in phase three of the International Study of Asthma and Allergies in Childhood (ISAAC) protocol revealed a prevalences of 8.2 % for flexural eczema in Brazilian children aged 6–7.

AD may have a major impact on the quality of life of a child and his/her family, producing a negative influence on social and educational development. When AD starts during the first year of life, it is often associated with a family history of atopic diseases.3 An epidemiological study conducted in Poland with 18,617 individuals from eight cities and one rural area has shown AD to be present in 3.9 % of the individuals. AD has been associated with female sex, living in urban areas, paternal history of atopy, higher level of education and higher economic status.4

The etiology of AD is not fully understood, and probably involves an interaction of multiple genetic and environmental factors.5 Studies performed over the last decades have shown that possible imbalances in the composition of the gut microbiota or the relationship of the microbiota with the host may be implicated in the origin of allergic diseases.6 This has led to projects to elucidate the relationship between the development of allergic diseases and the composition and function of the gut microbiota.7 Most such studies are being performed on infants.8 The few studies on children with AD older than five have shown a low prevalence of bifidobacteria and a high proportion of clostridia in the gut microbiota of allergic children.9 These studies have also revealed a higher prevalence of Bifidobacterium adolescentis and lower prevalence of Bifidobacterium catenulatum, as well as lower bacterial diversity in patients with AD.10

Considering the small number of studies on the composition of the gut microbiota in school-age children with atopic dermatitis, and the complete absence of studies on this topic performed in Latin America, the present study was carried out to compare the gut microbiota of Brazilian school-age children with and without atopic dermatitis.

Section snippets

Study design

This is a cross-sectional study carried out with school-age children living in the city of Osasco, in the Metropolitan Region of São Paulo, Brazil. The children admitted into the study were either residents of two slums or enrolled in two private schools. Community leaders from the slums and the schools’ pedagogical coordinators invited families with children aged between five and eleven to take part in the research. This resulted in 184 children assessed for the study. We obtained demographic

Results

Six of the 23 children with AD (26.1 %) also had active asthma, three (13.1 %) had rhinoconjunctivitis and one (4.3 %) had both active asthma and rhinoconjunctivitis. Age was similar (p = 0.210) between the AD and control groups, with medians of 7.5 years (25th and 75th percentiles: 6.7 and 9.4) and 7.9 years (25th and 75th percentiles: 7.0 and 9.3), respectively.

Demographic, socioeconomic, family and neonatal data for the two groups are shown is Table 1. AD has been found to be more frequent in

Discussion

The multiple logistic regression analysis performed in our study has shown that higher prevalence of Clostridium difficile, greater abundance of Bifidobacterium spp. and lower abundance of Lactobacillus spp. in the gut microbiota are associated with AD in school-age children. The bivariate analysis has revealed a higher prevalence of Clostridium difficile and Salmonella spp. in the AD group. Regarding bacterial abundance, lower counts of Eubacteria, Bacteroides fragilis, Lactobacillus spp.,

Conclusion

We found that the profile of the gut microbiota of children with AD is different when compared to that of children without allergic diseases. Specially, C. difficile was associated with AD. Moreover, the microbiota of AD children is characterized by a lower abundance of Lactobacillus and greater abundance of bifidobacterial, regardless of socioeconomic status. Further research must be performed do know the mechanisms by which intestinal microbes interfere with immune system.

Acknowledgement

This study was financed by the Fundação de Apoio à Pesquisa do Estado de São Paulo - Brasil (FAPESP) - Finance code 2009/18458-8.

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