They are bacteria that can lead to benefits to the large bowels when taken in an appropriate amount.⁣

❓But are all Probiotics good?⁣

📝For me to have a better idea about that, I went to find the evidence behind it.⁣

✴There are over 2.5k articles focusing on 22 different probiotics.⁣
✴From those articles, I found 249 RCTs (𝘳𝘢𝘯𝘥𝘰𝘮𝘪𝘻𝘦𝘥 𝘤𝘰𝘯𝘵𝘳𝘰𝘭𝘭𝘦𝘥 𝘵𝘳𝘪𝘢𝘭𝘴), with most of them being sponsored by the company selling them.⁣
✔So take their conclusions with a pinch of salt…⁣

✅The most effective use for them is diarrhoea, IBD (𝘐𝘯𝘧𝘭𝘢𝘮𝘮𝘢𝘵𝘰𝘳𝘺 𝘉𝘰𝘸𝘦𝘭 𝘋𝘪𝘴𝘦𝘢𝘴𝘦) and IBS (𝘐𝘳𝘳𝘪𝘵𝘢𝘣𝘭𝘦 𝘉𝘰𝘸𝘦𝘭 𝘚𝘺𝘯𝘥𝘳𝘰𝘮𝘦).⁣

⚠️This image shows the conditions for which probiotics are helpful and the evidence's strength.⁣
(𝘊𝘩𝘰𝘰𝘴𝘪𝘯𝘨 𝘢𝘯 𝘢𝘱𝘱𝘳𝘰𝘱𝘳𝘪𝘢𝘵𝘦 𝘱𝘳𝘰𝘣𝘪𝘰𝘵𝘪𝘤 𝘱𝘳𝘰𝘥𝘶𝘤𝘵 𝘧𝘰𝘳 𝘺𝘰𝘶𝘳 𝘱𝘢𝘵𝘪𝘦𝘯𝘵: 𝘈𝘯 𝘦𝘷𝘪𝘥𝘦𝘯𝘤𝘦-𝘣𝘢𝘴𝘦𝘥 𝘱𝘳𝘢𝘤𝘵𝘪𝘤𝘢𝘭 𝘨𝘶𝘪𝘥𝘦. 𝘩𝘵𝘵𝘱𝘴://𝘥𝘰𝘪.𝘰𝘳𝘨/𝟷𝟶.𝟷𝟹𝟽𝟷/𝘫𝘰𝘶𝘳𝘯𝘢𝘭.𝘱𝘰𝘯𝘦.𝟶𝟸𝟶𝟿𝟸𝟶𝟻 𝘋𝘦𝘤𝘦𝘮𝘣𝘦𝘳 𝟸𝟼, 𝟸𝟶𝟷𝟾)⁣






















❇This means, not all probiotics have any evidence based effect on your health.

➡️And the helpful ones are disease specific.⁣

❗At least, from all of them, we know there are no absolute contraindications to their use.⁣

✅Other benefits found are that they:⁣
▶️Stimulate the immune system
▶️Can decrease the inflammatory response⁣
▶️Can improve vaccine response⁣

✅Where are they found:⁣
▶️Fermented milk drinks⁣
▶️Some yoghurts⁣
▶️Supplements⁣
▶️Examples: kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread, some cheeses (Cheddar, Parmesan, and Swiss cheeses are soft cheeses that contain a decent amount of probiotics. Gouda is the soft cheese that delivers the most probiotics of all)


✅How to take them⁣⁣:
▶️There is scant evidence comparing which type of formulation may be more effective.⁣⁣
▶️The choice of formulation may be based on shelf-life, in that lyophilized capsules maintain high concentrations longer than probiotics in dairy products and enteric-coated capsules show higher survival rates than non-enteric coated capsules.⁣⁣
▶️Probiotic capsules requiring refrigeration are heat-dried (not lyophilized) and thus not stable at room temperature, limiting their portability.
▶️Besides, if the patient is lactose-intolerant, yoghurts or other types of fermented dairy products may not be advisable.

‼️Careful with quality control, some will have less than stated.

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⚠️Recently publication showed there are significant 🥜peanut proteins in 🏡household dust.

But what is the relevance of this study, and how does it apply to the development of 🤧allergies?
🔸️It is known that during the 👶first year of life, exposure to allergens will lead to the development of either tolerance or allergy.
🔸️With the loss of the natural skin barrier, the presence of eczema increases the risk of developing sensitization to the allergen that gets in contact with the skin.

The best course of action to deal with eczema, and potentially prevent the development of 🤧allergies, should be:
➡️Apply moisturizers as often as you feel the skin is dry to touch.
➡️If that is not solving the problem, speak to your doctor as the child might need topical steroids as well.
➡️Consider the possibility of an allergy leading to eczema and consider an exclusion diet. That should be guided by a paediatric allergist and a paediatric allergy dietitian.

🔜(In due course, I will publish more information regarding eczema and the best way to take care of it.)


















(Main article – “Mass spectrometry confirmation that clinically important peanut protein allergens are in household dust”; Helen A. Brough, Elizabeth Naomi Clare Mills, Kerry Richards, Gideon Lack, Philip E. Johnson; 04 October 2019)

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A US study suggests that, though camps will accept 🧒 children with allergies, most are not prepared to act if something happens as often they don’t have or request individualized action plans.

🏕It seemed camps that had faced anaphylactic events in previous years were better trained and able to recognize it than others who didn’t.
Despite that, one-third of camp leaders did not think most staff would be able to act appropriately.

Though this study was not done in the UK, I would suggest👫 parents need to be aware of the possibility of the same happening in summer camps here or any other country where they might send their children to.

⚠️The main lessons to take from this study are:
🔹️Enquire if the staff at the summer camp is trained to deal with allergic conditions, mainly anaphylaxis.
🔹️See what policies and emergency measures they have in place, e.g. contacts for local ambulance service, GP or Hospital.
🔹️Provide action plans specifically for your child. If you don’t have one, ask your Paediatric Allergist to provide a BSACI action plan.
🔹️See if your child’s medication did not expire and take them to the camp, in a clearly marked container, potentially with a photo of your child outside it.
🔹️You don’t stand to lose anything by asking if the food your child is allergic to is excluded from the camp, and other children cannot bring it with them there.

🏫As more and more nurseries/schools are becoming nuts free, it would not be a bad idea for summer camps to follow suit.

(Many Summer Camps Unprepared for Allergic Campers - Medscape - Dec 10, 2019)

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⚠️Simple Food Protein Induced Enterocolitis Syndrome (𝐅𝐏𝐈𝐄𝐒) or Food Protein Induced Proctocolitis (𝐅𝐏𝐈𝐏) is often mistaken for a viral infection causing vomiting and diarrhoea, with occasional blood in stool.⁣

‼️Often, and not wrongly, it may be diagnosed as a 𝘯𝘰𝘯-𝘐𝘨𝘌 𝘢𝘭𝘭𝘦𝘳𝘨𝘺, with the most common being CMPA.
✅This is because it normally tends to have mild symptoms.⁣

⁉️Important to note that severe 𝐅𝐏𝐈𝐄𝐒 is relatively rare and less common than Anaphylaxis!⁣
















✴𝐅𝐏𝐈𝐄𝐒 most common triggers:⁣
▶️Milk⁣
▶️Soy⁣
▶️Rice⁣#
▶️But can be associated with a long list of food proteins⁣

🧒👧Most children will be able to tolerate the food causing the reaction by the age of 2 or 3 years old.⁣ In some cases, it may persist throughout life.⁣

❗Children with recurrent episodes may suffer from poor growth and weight loss - failure to thrive.⁣

✅Usually children will recover very fast from an episode of 𝐅𝐏𝐈𝐄𝐒, as long as appropriate diagnosis and treatment is made.⁣

🔴For severe cases, the best treatment is fluid resuscitation.⁣
⚠️What does not work to treat them:⁣
➡️Adrenaline auto-injector⁣
➡️Antihistamines⁣
➡️Steroids⁣
➡️Antibiotics⁣

Though you will often see all of them being used due to the worry it is either Anaphylaxis or Sepsis.⁣

✴In the case of 𝐅𝐏𝐈𝐏, most symptoms tend to resolve by 6 months of age (50%) or 9 months of age (95%).⁣

✳The advice is to reintroduce the causing food into the mother's diet after an exclusion period of 6 months or give it to the child when reaching 12 months of age.⁣

⚠️For both cases, if the child is formula fed be aware that:⁣
1️⃣Medical and dietetic advice needs to be sought before a restriction diet is done⁣
2️⃣It might take 2 weeks for improvement to be seen⁣
3️⃣The child will need and Extensively Hydrolysed Formula (EHF - first choice) or eventually an Amino Acid Formula (AAF - second choice)⁣

❗In the case of a breastfeeding mother, a restriction diet needs to be guided by a dietitian.⁣
✅This is to be sure appropriate nutrition (focusing on protein and calcium) is achieved.⁣

‼️For 𝐅𝐏𝐈𝐄𝐒, there seems to be a 30% chance of people involved to develop either 𝘢𝘵𝘰𝘱𝘪𝘤 𝘥𝘦𝘳𝘮𝘢𝘵𝘪𝘵𝘪𝘴 (eczema), 𝘢𝘴𝘵𝘩𝘮𝘢 or 𝘩𝘢𝘺𝘧𝘦𝘷𝘦𝘳 (allergic rhinitis).

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