For World Allergy Week, 13 – 19 June, we chat with Dr Amanda Cox who is part of the Griffith University team undertaking research trials examining the effect of probiotic supplements on hay fever (allergic rhinitis) symptoms.
In this Q&A, Dr Cox discusses these research trials and their real life benefits, as well as the value of people engaging with clinical trials and becoming more health aware.
Q & A:
What sparked your interest in immunology?
What continues to hold my interest, and what I like about my job, is that there is always something new to learn, particularly for the immune system. Even in the span of my career there are things that we now think about differently and understand better than 20 years ago. It is a privilege to be able to continue to learn and understand better.
I think of the immune system as the centre of all disease—a lot of the key diseases that are impactful for humans involve an aspect of immune system function. And immunology always will be part of the future and human disease; no matter how much we know, and how much we think we know, we are still struggling to manage people’s health conditions in efficient and meaningful ways.
‘It is a privilege to be able to continue to learn and understand better.’
What is the connection between the immune system, probiotics and these research trials?
The immune system is just so special and we are interested in why it sometimes gets confused and responds to non-harmful things, as it does in allergies, in the same way it responds to harmful things such as bacteria, viruses and disease-causing organisms. Our work is particularly focused on the mucosal immune system, where the body interfaces with the environment such as the airways and the gastrointestinal tract.
Over the years we have conducted several studies with probiotic supplements: preparations of good bacteria which are thought to have positive health effects particularly in relation to immune- mediated conditions such as allergies. It is thought that probiotics can help to educate or refocus the immune system and stop its confused response, getting it back in balance.
The other part of the story is about all the millions of bacteria living in our gut and the important role they play in talking to, and directing, the immune system. Some of our prior work showed that the gut bacteria in adults with a history of hay fever was different to the gut bacteria in adults with no history of allergy. This observation contributed to our thinking that if we give a probiotic and modulate the composition of the gut bacteria then the resulting shift in balance may help dampen down or tighten up some of those immune pathways that are responding inappropriately in people with allergies.
For the first study we recruited a modest 48 people who met our eligibility criteria, namely people allergic to particular grasses, and partnered with a large international probiotic company to trial a probiotic supplement. Of these participants, 60% reported that over the eight weeks they were taking the probiotic supplement they thought that their hay fever symptoms had improved. This was a strong outcome which encouraged us to investigate further with a controlled study—our current allergic rhinitis study.
The unique part of the current study is that it is a randomised placebo-controlled trial, the gold standard of clinical trials. Where the first trial was open label, so everyone knew they were getting the probiotic, the second study is more rigorously designed and requires more people to be randomly allocated to either an active or a placebo group. Naturally, we are blinded to the groups.
Currently we are at a holding point as we are not in peak pollen period so have no active participants in the trial. Our next step is to decide whether to close recruitment, finalise the data set and move onto analysing the findings or to continue for another allergy season and recruit some more people.
‘For allergies, there is a misconception that hay fever is just a bit of a runny nose and some sneezing. We need to recognise that for some people allergies can be quite debilitating …’
What is the impact of your studies?
Our studies have real life benefits. Hay fever is so difficult for people to manage: they can’t simply lock themselves away in a bubble and avoid environmental pollens for weeks, sometimes months. And for some people their dependence on over-the-counter allergy medicines is significant—and costly. So having an alternative management strategy, where a probiotic can modulate the gut bacteria and dampen down their responsiveness, can mean that they don’t have to take antihistamines multiple times a day, that their sleep isn’t disrupted or that they don’t feel constantly unwell. It is meaningful.
What role can the public play?
I think everyone can improve their health awareness, their understanding of their own body and learn how to make choices to manage their health.
For allergies, there is a misconception that hay fever is just a bit of a runny nose and some sneezing. We need to recognise that for some people allergies can be quite debilitating and, if we want to take it to the extreme, for people who have the severe type of allergic reactions called anaphylactic reactions, these have the potential to be a life threatening situation.
The lesson we take away from all our clinical studies is how invaluable the people participating in our studies are: they are making a difference to progressing science, medicine and better health. All the medicines being bought off the shelves have been tested, regulated and evaluated through rigorous research and development activities. It is only through the public’s willingness to engage that we are able to run these types of studies; these people have volunteered themselves to allow medicines to be available for everyone.