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

Thu Apr 16 09:56:23 EDT 2015

Hi Joe,

Unfortunately, I don't remember off the top of my head.  It might have been leukemia.

Tom

Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
email: boyce.thomas at mayo.edu
phone: 507-255-8464
fax: 507-255-7767

From: Church, Joseph [mailto:JChurch at chla.usc.edu]
Sent: Thursday, April 16, 2015 8:22 AM
To: CIS-PIDD
Subject: RE: [cis-pidd] IgA deficiency and Probiotics

Thank you.

Tom, what was your patient's underlying problem?

JC

From: Boyce, Thomas G., M.D. [mailto:Boyce.Thomas at mayo.edu]
Sent: Thursday, April 16, 2015 5:50 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] IgA deficiency and Probiotics

We have seen lactobacillus bloodstream infection in a patient receiving it as a probiotic. There are a handful of similar reports in the literature. In addition, the benefits of probiotics are dubious.

Tom

On Apr 15, 2015, at 11:21 PM, Soheil Chegini <schegini at yahoo.com<mailto:schegini at yahoo.com>> wrote:
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, MD
Exton Allergy & Asthma Associates
656 West Lincoln Hwy
Exton, PA 19341

________________________________
From: "Church, Joseph" <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>>
To: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Sent: Wednesday, April 15, 2015 7:16 PM
Subject: [cis-pidd] IgA deficiency and Probiotics

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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