[CIS PIDD] [cis-pidd] IgA deficiency and Probiotics

[Soheil Chegini]

There is a paucity of published information about the safety of probiotics in patients suffering from various immunodeficiency disorders. Given the widespread use of probiotics, one would expect to find at least some published reports or anecdotal evidence to the contrary. I can only recall having this discussion with a couple of patient with CVID, who did not have any intestinal involvement. I did a search and found only a handful of case reports of rather loose association rather than definitive causation of lacobacillemia or abscess formation. However, I could not find any substantial evidence in the literature, which supported the assumption that probiotics containing lactobacilli or bifidobacteria increase the risk of opportunistic infection in immunodeficient patients. Hence, I could not recommend against using probiotics. I suggested to those patients starting with a single, well established organism, i.e. lactobacillus rhamnosus GG, and so far they have done OK. It is difficult to know, whether they are any better off now taking that.

I would be a lot more concerned, if she were born and raised in a germ-free environment, and were naive to lactobacilli and bifidobacteria. By all likelihood in her 16 years she has already had yogurt that is chuck full of probiotics. Any woman would be at risk of vaginal candidiasis, if her vagina were not naturally colonized with lactic acid producing lactobacilli and bifidobacteria, which actually is a well recognized side effect of antibiotic therapy. Much the same human intestine naturally harbors those organisms, and it would be unusual to live for 16 years without natural encounter with them. For that reason, I would believe that the purported benefits would outweigh the risk, even in somebody with a leaky gut and IgA deficiency, who actually would stand to benefit more from it.
I hope learn more about this issue when others on this forum, who take care of other more troubling PID would share their experience.
Best regards,sc
Soheil Chegini, MDExton Allergy & Asthma Associates656 West Lincoln HwyExton, PA 19341

      From: "Church, Joseph" <JChurch at chla.usc.edu>
 To: CIS-PIDD <cis-pidd at lyris.dundee.net> 
 Sent: Wednesday, April 15, 2015 7:16 PM
 Subject: [cis-pidd] IgA deficiency and Probiotics
   
 <!--#yiv8753170621 _filtered #yiv8753170621 {font-family:Calibri;panose-1:2 15 5 2 2 2 4 3 2 4;}#yiv8753170621 #yiv8753170621 p.yiv8753170621MsoNormal, #yiv8753170621 li.yiv8753170621MsoNormal, #yiv8753170621 div.yiv8753170621MsoNormal {margin:0in;margin-bottom:.0001pt;font-size:11.0pt;font-family:"Calibri", "sans-serif";}#yiv8753170621 a:link, #yiv8753170621 span.yiv8753170621MsoHyperlink {color:blue;text-decoration:underline;}#yiv8753170621 a:visited, #yiv8753170621 span.yiv8753170621MsoHyperlinkFollowed {color:purple;text-decoration:underline;}#yiv8753170621 span.yiv8753170621EmailStyle17 {font-family:"Arial", "sans-serif";color:windowtext;}#yiv8753170621 .yiv8753170621MsoChpDefault {font-family:"Calibri", "sans-serif";} _filtered #yiv8753170621 {margin:1.0in 1.0in 1.0in 1.0in;}#yiv8753170621 div.yiv8753170621WordSection1 {}-->Colleagues:    I follow a 16yo F with IgA deficiency (IgA repeatedly <7mg/dL), specific antibody deficiency and inflammatory bowel disease.    She and her parents asked if a particular brand of probiotics (25 billion cfu’s of various lactobacilli and bifidobacteria) is “safe.”     Given her leaky gut and IgA deficiency, I am hesitant to respond in the affirmative.    Any thoughts or experiences you would be willing to share are most welcome.    Joe Church Children’s Hospital Los Angeles 
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