Kimchi on trial as eczema therapy. Not convinced

Those of you who are fans of probiotics, especially kimchi, will be thrilled to know that scientists recently reported the results of a trial testing kimchi-extracted bacteria as a treatment for eczema.

The researchers, led by Jihyun Kim at Sungkyunkwan University School of Medicine in Seoul, conducted a randomized, double-blind, placebo-controlled test of a strain of Lactobacillus plantarum in 118 eczema patients. L. plantarum is apparently a major species of bacteria found in Korean pickled cabbage, or kimchi, and a previous study showed that it had promise in a mouse model of eczema.

The idea behind probiotics is the hygiene hypothesis: in short, that being dirty is good for you (I'm pretty sure that most research shows that, if this is true, it holds only for kids during the first few years when their immune systems are developing). Proper balance of gut flora might tilt your immune system more toward a type 1 helper T cell-run operation rather than one dominated by type 2 Th cells, which are possibly over-represented in eczema patients. So: eat friendly bugs and reduce your chances of developing allergic disease.

The scientists split their subjects into a test group and a control group. From what I can tell they did as good a job as anyone could to make sure the results were not biased by expectation.

However, while they present their data openly in the paper, they claim it shows that L. plantarum clearly reduced symptoms of eczema, as measured by self-assessed quality of life as well as lab-quantified levels of immune cells and signaling molecules.

When I look at their data it says no such thing. In fact, it says that within experimental bounds, L. plantarum does nothing at all. I am surprised the journal editors allowed them to make those claims--but as always, maybe I'm missing something.

The trial was published in the journal Pediatric Allergy and Immunology, and paid for by the CJ Cheiljedang Corporation, which manufactures probiotic capsules of L. plantarum.

Thanks to reader K.M.O. for the tip.

The holiday challenge begins

Tomorrow in America, the first wave of the great tide of holiday craziness will wash over us-- beginning with the inevitable turkey dinner. I'm not a native-born American, so although I have come to love Thanksgiving, I'm still not used to the idea of the entire month of December being given over to overeating and indulgence. At work, the holiday parties start the Monday after next. It's almost impossible to avoid eating or drinking all kinds of things that trigger eczema: chocolates, booze, spices. More booze. And eggnog. I used to like eggnog--in fact, I still do--but a few years ago, after having had a skin prick test that showed I reacted to raw egg white, I suddenly realized that eggnog has RAW EGGS in it, and that's why I was always scratching like a monkey after a glass or three. (Sometimes the eggnog has booze in it, too.)

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I'm always interested when there's a story in the news about someone with eczema. Here's a recent one from Scotland, about a five-year-old girl in Linlithgow (outside Edinburgh).

Despite being so young, Gaelle, a primary one pupil, has used her experiences of atopic dermatitis to educate her classmates and teachers, who have to help her apply her skin cream and bandages every day at school.

She even used her birthday party to fundraise for the cause.

At five years old, she can't have come up with these ideas on her own. She's got some parents who are taking the offensive. It's a good idea. When the kids in Gaelle's class are older and start to cast about for others to tease, they'll at least have had some hands-on experience with eczema and some understanding of what it means to someone who lives with it, and they may not be so quick to treat her as an alien.

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Another news item: UAS Labs, a probiotics company in Minnesota has won an award for "Probiotic Customer Value Enhancement." Thrilling stuff, you will agree. What caught my attention was that UAS makes five "formulations" of live bacteria for specific conditions, and one of them is atopic dermatitis. What's in the AD formulation? A mix of Lactobacillus acidophilus (the yogurt bacterium) and Bifidobacterium lactis. Both are common gut bacteria, but also common probiotics. UAS worked with a scientist in Ukraine on a study to explore how their formulation might improve AD in kids aged one to three. It's not clear whether UAS funded the study; I expect they did, because otherwise there'd be no need for someone in Ukraine to obtain UAS's formulation. Still, the results of the study--presented at a symposium, not published in a journal--showed that eczema symptoms were reduced by 34% on a standard scale for kids taking the probiotics, versus being reduced 19% for kids taking placebo.

If these results are real, which is not at all certain, then it's interesting to think how intestinal bacteria could help reduce eczema. Are they helping the body digest milk proteins or sugars that would otherwise cause an inflammatory response that, in susceptible people, manifests in the skin? Lactose intolerance is widespread. Perhaps it's linked to milk reactions in eczema. I don't know at this point.

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And a novel topical anti-inflammatory cream/ointment is entering phase 2 trials in eczema patients. Anacor is a San Francisco Bay Area company that makes drugs based on its trade secret, a "boron chemistry" platform. Phase 2 is VERY early in drug discovery, but it's interesting to watch this sort of thing emerge. They seem to have a good idea of what their drug is doing to reduce inflammation.

I'll be off tomorrow. We may be lucky and hear from Dr. Sib. She's Canadian and had her Thanksgiving about a month and a half ago. Unless she's working the midnight-to-8 am ER shift, what possible excuse could she have for not writing?