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Year : 2011  |  Volume : 134  |  Issue : 1  |  Page : 134-135

Microbial - Host interaction: Tolerance versus Allergy

Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014, India

Date of Web Publication29-Jul-2011

Correspondence Address:
Ramnath Misra
Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226 014
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Misra R. Microbial - Host interaction: Tolerance versus Allergy. Indian J Med Res 2011;134:134-5

How to cite this URL:
Misra R. Microbial - Host interaction: Tolerance versus Allergy. Indian J Med Res [serial online] 2011 [cited 2020 Jul 8];134:134-5. Available from:

Microbial - Host interaction: Tolerance versus Allergy, (Nestle Nutrition Institute Workshop Series: Pediatric Program, vol. 64), P. Brandtzaeg, E. Isolauri & S.L. Prescott, editors (S. Karger AG, Basel, Switzerland) 2009. 272 pages. Price: CHF 228.00 / EUR 163.00 / US$ 228.00

ISBN 978-3-8055-9167-6

This book is devoted to understanding the pathogenesis of allergic diseases due to environmental factors and food, particularly in children. The title of the book was the theme of the 64 th Nestle Nutrition Institute Workshop Pediatric Program held in Sydney during November 2-6, 2008. The 16 presentations captured in equal number of chapters bring forth the latest information in the field.

Allergic diseases are on the rise in developed and developing world. These include bronchial asthma, allergic rhinitis/conjunctivitis, atopic dermatitis, eczema, food allergy and related autoimmune diseases like celiac disease, inflammatory bowel diseases. The initial five chapters are devoted to understanding the basic aspects such as microbial role in shaping our immune system, organization and function of mucosal immunology, role of gut microbiota in shaping the immune system, hygiene hypothesis, innate and adaptive immune tolerance pathways to tolerance, and induction of mucosal tolerance in experimental models of allergic diseases. In subsequent sections, diseases related to food allergy such as obesity, celiac disease, eosinophillic esophagitis and microbel-host interactions of inflammatory diseases are presented. Finally, through a series of presentations on induction of mucosal tolerance to food antigens, scope for new approaches through nutritional therapies such as probiotics, prebiotics, modified proteins, long-chain polyunsaturated fatty acids and antioxidants, and the current status of such therapies are covered.

The importance of colonization of microbes in the intestinal tract in subsequent development of normal host immune system is underscored throughout the initial chapters. The first chapter unravels the tolerance at molecular level. A capsular polysaccharide molecule, Polysaccharide A (PSA) of Bacteroides fragilis, a Gram-negative bacterium that resides in the terminal ileum and colon as a commensal is instrumental in developing tolearance in mice through active immunosuppression. The validity of hygiene hypothesis, and protective effect of infections on the development of allergy disesase are challenged in the second chapter with a number of clinical studies.

The cellular and molecular basis of development of innate and adaptive tolerance to food and environmental antigens is featured in two presentations. A lucid presentation of the structure and function of the cells of the mucosal immune system, interaction of microbial pattern recognition receptors with TLR ligands present on the epithelial cells, DC, mast cells, NK cells which forms the basis of immune homeostasis with commensals is detailed. The mechanisms underlying the development of adaptive tolerance through induction of inducible CD25+ T regulatory cells and cytokines TGF beta, IL-10 and the emerging cytokines thymic stromal lymphopoietin (TSLP) completes the section on the immune basis of tolerance.

Adminstration of recombinant Bet V1 allergen, a major birch pollen allergen, resulted in successful tolerance in a mice model of Type I allergen; it was concluded that immunosuppression was due to induction of TGF-beta and IL-10 and expression of Fox P3. New adjuvant systems such as chlora toxin B subunit as mucosal adjuvant and scope of immunomodulation by lactic acid bacteria and parasites are discussed.

The relations of food with development of allergy and autoimmunity have been dealt with in presentations of obesity, celiac diseases, Chron's disease and eosinophilic oesophagitis. Like the 3 billion organisms that infest our gut, every day the immune system is exposed to 200 g of foreign dietary proteins. Robust mechanisms operate so that the mucosa remains inert to these proteins. An interesting hypothesis is propounded to explain obesity as a result of disturbance of the gut microbiota in early neonatal period; extending the hygiene hypothesis supported by experimental studies.

Two examples of human diseases which are classic examples of dietary antigens leading to autoimmune diseases are discussed, the IPEX syndrome (Immune dysregulation polyendocrinopathy) and celiac disease. The role of vitamin A as a key regulator in immune tolerance is interesting. Eosinohilic oesophagitis, which has many features of gastroesophageal reflux disease (GERD) but differentiated from it by accumulation of eosinophils in oesophageal biopsies is being increasingly recognized and is an example of allergic diseases of the upper GI tract treated with elimination diets and corticosteroids. The microbel-host interaction in inflammatory bowel disease is yet another example of disequilibrium of microbes and host tolerance. Mechanisms of Chron's disease (CD) and ulcerative colitis are explained through appropriate experimental models of colitis. In CD, the role of invasive, intracellular commensal bacteria inducing a Th1 and Th17 response in genetically susceptible individuals having innate immune defects is described. Dysbiosis or imbalance of beneficial to detrimental bacteria causing intestinal inflammation in animal models of experimental colitis, is an active area of investigations in IBD.

Food allergy occurs in up to 6 per cent of young children and 2 per cent of adults, and thus the importance of understanding its mechanisms, novel therapeutic approaches using allergens, allergens avoidance approach and immunomodulatory approach to develop oral tolerance was a major theme in this workshop. A chapter is devoted to the development of tolerance to food antigens which is an active immunoregulation and relies on the cross-talk between innate and adaptive immune system. The immune system is programmed before birth and during a critical period after birth to be tolerised to the vast array of food antigens. The mechanisms include transfer of maternal cell and antibody, cytokines along with antigens and allergens through placenta. This is enhanced by the microbes that populate the gut soon after the birth within a critical period called the "window of programming".

The present status of subcutaneous immunotherapy and specific oral tolerance induction in allergic diseases is critically assessed. The scientific method of avoidance of allergens as a therapeutic approach in food allergy management is presented and this is an important resource for management for babies with cow milk allergy. The next review explores the potential effects of early dietary and nutritional factors in tolerising the immune system. In this context, the role of breast milk, food allergens, dietary factors that promote optimal colonization with health promoting microbes (Bifidobacteria and Lactobacillus species), anti-inflammatory properties of dietary fatty acids (n-3 polyunsaturated fatty acids) and the immunomodulatory role of antioxidants, are discussed.

The role of probiotics and prebiotics in the microbial host interactions is focused in two chapters. The chapter reviews the role of a healthy gut microbiota and how the deviation of these microbiota very early in the life precedes the development of allergy. Search for new probiotic strains (genus Bifidobacterium are potential candidates) and the models of preclinical and clinical testing of probiotics are discussed. Scope of new prebiotics that could potentially be used to prevent allergic disesease in infants and children is reviewed. Another presentation deals with the current status of clinical studies on probiotics and prebiotics in allergic diseases detailing the results of randomized controlled clinical trials on allergic diseases, particularly eczema. The final presentation examines the scope of modified proteins in prevention of allergic disease. Induction of oral tolerance through food proteins, hydrolysed infant formula both extensively hydrolysed formula (eHF) and partially hydrolysed formula (pHF), are discussed.

On the whole, this book makes an interesting reading and is recommended for postgraduate students, research fellows, clinicians in the field of paediatric allergic diseases. The discussion of each presentation through questions and answers by authorities in their respective fields makes the presentation lively.


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