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patients who do not respond to, or have respectively). Finally, no significant Treatment with lactobacillus resulted
toxic side-effects from, a single chelating difference in the number of children in prevention of atopic eczema. The
drug. with positive skin-prick tests was noted frequencies of skin-prick test reactivity,
George J Kontoghiorghes in either group (ten in the probiotic however, were comparable between the
Postgraduate Resaerch Institute of Science, group versus nine in the placebo group). groups. The same distinction between
Technology, Environment, and Medicine, Would, therefore, a diagnosis of eczema early antigen-specific IgE response and
Limassol 3021, Cyprus rather than atopic eczema, be more atopic disease has been noted in
appropriate in this instance? If so, the childhood asthma.4 Lau and colleagues
1 Nisbet-Brown E, Olivieri N F, Giardina PJ, findings would suggest that treatment postulated that “the induction of
et al. Effectiveness and safety of ICL670 in with lactobacillus results in a reduction specific IgE responses and the
iron-loaded patients with thalassaemia: a in the rate of non-atopic eczema, a development of childhood asthma are
randomised, double-blind, placebo-
controlled, dose-escalation trial. Lancet 2003; conclusion that would lend support to determined by independent factors”.4
361: 1597–1602. the notion that not all eczema is Our observations on atopic eczema,
2 Olivieri NF, Koren G, Hermann C, et al. characterised by atopy. another form of atopic disease, lend
Comparison of iron chelator L1 and Further studies should be done before support to this suggestion. Moreover,
desferrioxamine in iron loaded patients.
Lancet 1990; 336: 1275–79.
firm conclusions are drawn on the there is a considerable overlap in
3 Agarwal MB, Gupte SS, Viswanathan C, preventive effect of lactobacillus in high- antigen-specific IgE concentrations
et al. Long term assessment and safety of L1, risk infants with respect to development between healthy children and those with
an oral iron chelator, in transfusion of atopic disease. atopic disease during the first 5 years of
dependent thalassaemia: Indian trial. life.5
Br J Haematol 1992; 82: 460–66. L E M Niers, G Rijkers, E F Knol, Y Meijer,
4 Kontoghiorghes GJ, Neocleous K,
*M O Hoekstra Taken together, these clinical findings
Kolnagou A. Benefits and risks of Centre for Paediatric Allergology, Wilhelmina and the unestablished status of the
deferiprone in iron overload in thalassaemia Childrens Hospital, University Medical Centre definitions of atopic eczema, suggest the
and other conditions. Comparison of Utrecht, Utrecht, PO Box 85090, 3508 AB,
Netherlands effects of lactobacillus on antigen-
epidemiological and therapeutic aspects
with deferoxamine. Drug Safety 2003; 26:
(e-mail: specific IgE and clinical status of
553–84. individuals should be reported
1 Kalliomäki M, Salminen S, Poussa T, separately. We agree that additional
5 Yamamoto RS, Williams GM, Frankel HH,
Arvilommi H, Isolauri E. Probiotics and
Weisburger JH. 8-Hydroxyquinoline: chronic studies to address the role of probiotics
prevention of atopic disease: 4-year follow-up
toxicity and inhibitory effect on the in the prevention of atopic disease are
of a randomised placebo-controlled trial.
carcinogenicity of N-2-fluorenylacetamide.
Lancet 2003; 361: 1869–71. warranted.
Toxic Appl Pharmacol 1971; 19: 687–98.
2 Kalliomäki M, Salminen S, Arvilommi H,
*M Kalliomäki, S Salminen, H Arvilommi,
Kero P, Koskinen P, Isolauri E. Probiotics in
primary prevention of atopic disease: a
E Isolauri
randomised placebo-controlled trial. Lancet *Turku University Hospital, Department of
2001; 357: 1076–79. Pediatrics, PO Box 52, FI-20521 Turku, Finland
Probiotics for prevention of 3 Anon. Severity scoring of atopic dermatitis :
(MK); Departments of Paediatrics (MK, EI), and
Biochemistry and Food Chemistry (SS), University
the SCORAD index—consensus report of the
atopic disease? European Task Force on Atopic Dermatitis.
of Turku, Turku; National Public Health Institute,
Turku (AH)
Dermatology 1993; 186: 23–31. (e-mail:
Sir—Marko Kalliomäki and colleagues
(May 31, p 1869)1,2 conclude that the 1 Hanifin JM. Atopic dermatitis in infants and
results of their study suggest that the Authors’ reply children. Pediatr Clin North Am 1991; 38:
preventive effect of Lactobacillus 763–89.
rhamnosus strain GG on atopic eczema Sir—L Niers and colleagues have raised 2 Johansson SG, Hourihane JO, Bousquet J,
et al. A revised nomenclature for allergy: an
extends beyond infancy. Although their some points about our study; due to EAACI position statement from the EAACI
study is well designed, we have several limited space available, many details nomenclature task force. Allergy 2001; 56:
comments. had to be left out of our report. 813–24.
First, are there any data on the We did assess the severity of atopic 3 Isolauri E, Turjanmaa K. Combined skin
prick and patch testing enhances
severity of eczema in participants? eczema at age 4 years with the identification of food allergy in infants with
Was, for instance, a SCORAD score3 SCORAD score (mean 17, range atopic dermatitis. J Allergy Clin Immunol
obtained? Such information would 11–26). The score did not differ 1996; 97: 9–15.
contribute to the discussion on the between groups, and was comparable to 4 Lau S, Illi S, Sommerfeld C, et al. Early
indication of probiotics in this specific the findings presented in our original exposure to house-dust mite and cat allergens
and development of childhood asthma: a
group of infants. report of the study in 2001. cohort study. Lancet 2000; 356: 1392–97.
Second, we disagree with Kalliomäki The diagnosis of atopic eczema was 5 Kulig M, Bergmann R, Klettke U, Wahn V,
and colleagues’ conclusion that based on the criteria prepared by Tacke U, Wahn U. Natural course of
treatment with lactobacillus results in Hanifin1 especially for infants and sensitization to food and inhalant allergens
during the first 6 years of life.
prevention of atopic disease; such a firm children. These criteria were the only J Allergy Clin Immunol 1999; 103:
conclusion cannot be drawn on the basis criteria available at the beginning of the 1173–79.
of the data generated by their study. study. Alternative definitions of atopic
Almost 25% of participants were lost to eczema—eg, atopiform dermatitis and
follow-up by age 4 years. Selection bias atopic eczema/dermatitis syndrome DEPARTMENT OF ERROR
cannot, therefore, be excluded. (AEDS)2—have been proposed, since a
Furthermore, among the participants, proportion of patients with atopic Thorpe A, Neal D. Benign prostatic hyperplasia.
Lancet 2003: 361: 1359–67—In this Seminar
there was a non-significant trend eczema do not manifest with skin-prick (April 19), the first two sentences of the
towards an increased rate of atopic test reactivity but do display positive Summary should have read: “In both ageing
disorders in the group treated with patch testing, indicating delayed men and women, there is an increasing
lactobacillus compared with those given reactions to antigens.3 So far, however, a incidence of lower urinary tract symptoms
(LUTS), which have many possible causes—
placebo (ten of 53 and five of 54 universal consensus about these including smooth muscle dysfunction,
developed allergic rhinitis, and three of proposed definitions has not been neurological factors, and benign prostatic
53 and one of 54 developed asthma, reached. hyperplasia”.

496 THE LANCET • Vol 362 • August 9, 2003 •

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