This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. A basis of the allergic response to a food is uptake of allergens across hyperpermeable intestinal mucosa. It is hypothesized that lactobacillus GG, by sealing the desmosomes of bowel, will prevent allergen leakage, resulting in improvement of atopic dermatitis in patients with food allergies. Pediatric patients ages 1-8 (a total of 24 evaluable patients to be studied) with severe eczema and multiple food allergies will be recruited. Severity of atopic dermatitis will be measured using the SCORAD Index. Intestinal permeability will be analyzed by high performance liquid measurement of sucrose, lactulose and mannitol excretion. Patients will present fasting and consume a weight based volume of mannitol/lactulose/sucrose with a subsequent five hour urine collection for determination of urinary excretion of each. Patients will then be randomly assigned to either a weight based daily ingestion of lactobacillus GG or placebo for six weeks, afterwards they will return after overnight fasting for a repeat sucrose/lactulose/mannitol ingestion and urinary excretion evaluation. It is anticipated that lactobacillus GG, by colonizing bowel flora and promoting endogenous barrier mechanisms will prove to be a useful tool in treating atopic dermatitis that has a food allergy etiology and that a correlation will exist between changes in intestinal permeability and clinical improvement of atopy.
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