活力藥師網

也不知道是不是這市場太好賺，自從第一個益生菌品牌樂亦康上市以後，陸續就有許多的廠牌出現在市面上，大部分的廠牌都要號稱是許清祥博士研發或者是指導，好像沒有沾上許清祥博士的話，這益生菌就算不得準，另外益生菌都要強調自己是活菌，似乎只要強調活菌就可以賣上很高的價錢!!!我們就來介紹一下幾個常見的廠牌吧!!

樂亦康

可以說是益生菌的始祖，當初由許清祥博士創立景岳和光惠這兩家公司，景岳打算走生物科技代工平台，光惠負責銷售 ；計畫相當不錯，經過了幾年的銷售以後，在市場上已經有相當的知名度了．

益敏康(康敏)

益敏康算是跟樂亦康有點親戚關係，這東西還是許清祥博士發明的，他創立了景岳以後，因為一些原因，居然跟Apple的賈伯斯一樣，被趕出了董事會，只好流浪到淡水，到了東宇公司以後，又重新做了益敏康這個品牌．

說起這益生菌，市場上可說是五花八門，但不是所有的菌種都有一樣的效果，所以今天高藥師就來介紹一下益生菌的菌種

Lactobacillus paracasei，也就是LP菌，益生菌的先鋒，市場上第一個打益生菌的樂亦康，就是主要添加LP菌，但是在LP菌的這麼多菌株中，並不是每一菌株都有效，經過長時間的實驗，才確定Lactobacillus paracasei 33，這一株菌，有最棒的效果，稱之為Lp33，也因為良好的效果，統一集團才把這個Lp33菌加入他們的優酪乳裡面，你到7-11都可以買到。

Lactobacillus Fermentum，也就是LF菌，根據一篇2005年的醫學報導，Lactobacillus Fermentum用於治療異位性皮膚炎之效果相當優良，實驗中有26個病患服用LF菌，27個服用安慰劑。

Clin Exp Allergy. 2005 Dec ;35 (12):1557-64 16393321
Clinical effects of probiotics are associated with increased interferon-gamma responses in very young children with atopic dermatitis.
Background We recently demonstrated that administration of probiotics resulted in significant clinical improvement in very young children with moderate-to-severe atopic dermatitis (AD). The purpose of this study was to determine the underlying immunological effects that are associated with these apparent clinical benefits. Methods Peripheral blood mononuclear cells (PBMC) were isolated from children (n=53) at baseline and at the end of an 8-week supplementation period during which they received a probiotic (Lactobacillus fermentum PCCtrade mark) (n=26) or a placebo (n=27). A further sample was collected at 16 weeks (8 weeks after ceasing the supplement). Cytokine (IL-5, IL-6, IL-10, IL-13, IFN-gamma and TNF-alpha) responses to allergens (egg ovalbumin (OVA), beta lactoglobulin (BLG), house dust mite (HDM)), vaccines (tetanus toxoid (TT)), diphtheria toxoid (DT)), intestinal flora (heat-killed Lactobacillus (HKLB)), heat-killed Staphylococcus aureus (HKSA), Staphylococcus aureus enterotoxin B (SEB) and mitogen (phytohaemaglutinin (PHA)) were compared. Results The administration of probiotics was associated with a significant increase in T-helper type 1(Th1-type) cytokine IFN-gamma responses to PHA and SEB at the end of the supplementation period (week 8: P=0.004 and 0.046) as well as 8 weeks after ceasing supplementation (week 16: P=0.005 and 0.021) relative to baseline levels of response. No significant changes were seen in the placebo group. The increase in IFN-gamma responses to SEB was directly proportional to the decrease in the severity of AD (r=-0.445, P=0.026) over the intervention period. At the end of the supplementation period (week children receiving probiotics showed significantly higher TNF-alpha responses to HKLB (P=0.018) and HKSA (P=0.011) but this was no longer evident when supplementation ceased (week 16). Although IL-13 responses to OVA were significantly reduced in children receiving probiotics after 8 weeks (P=0.008), there were no other effects on allergen-specific responses, and this effect was not sustained after ceasing supplementation (week 16). There were no effects on vaccine-specific responses, or on responses to any of the stimuli assessed. Conclusion The improvement in AD severity with probiotic treatment was associated with significant increases in the capacity for Th1 IFN-gamma responses and altered responses to skin and enteric flora. This effect was still evident 2 months after the supplementation was ceased. The lack of consistent effects on allergen-specific responses suggests that the effects of probiotics may be mediated through other independent pathways, which need to be explored further.

Lactobacillus Rhamnosus GG，也就是LGG菌，是相當有名的一隻菌株，是屬於鼠李糖乳酸桿菌的菌種，醫學上對於它的研究資料相當的多。芬蘭的科學家曾經在世界知名的Lancet研究期刊l發表了重要的研究成果，他們選定具有異位性體質家族病史的159位孕婦，其中治療組孕婦在生產前2-4週就需每日服用二顆內含一百億單位的LGG菌，產後如有餵母奶的婦女仍需繼續服用，若沒餵母奶的嬰兒則開始餵食LGG菌至嬰兒六個月大。結果共有132位孕婦完成研究並追蹤直到其小孩滿二歲為止，研究發現，餵食益生菌治療組的64位婦女的小孩中只有15位在二歲前出現異位性皮膚炎的症狀；而對照組68位婦女的小孩則有31位在二歲前出現異位性皮膚炎，因此服用LGG菌似乎具有顯著的預防異位性皮膚炎發生的效果。

Lactobacillus johnsonii，也就是LJ菌，我稍微搜尋一下，並沒有國際醫學上的發表，但是在國內台大有做實驗，只是不知道這樣的報告能不能算數。不過在我的臨床經驗，對於蕁麻疹，異位性皮膚炎還不錯。

Lactobacillus paracasei Collins et al. 1989, sp. nov.
Type strain: strain ATCC 25302 = CCUG 32212 = CIP 103918 = DSM 5622 = IFO (now NBRC) 15889 = JCM 8130 = LMG 13087 = NCIMB 700151 (formerly NCDO 151).
Reference: COLLINS (M.D.), PHILLIPS (B.A.) and ZANONI (P.): Deoxyribonucleic acid homology studies of Lactobacillus casei, Lactobacillus paracasei sp. nov., subsp. paracasei and subsp. tolerans, and Lactobacillus rhamnosus sp. nov., comb. nov. Int. J. Syst. Bacteriol., 1989, 39, 105-108.

—> Lactobacillus paracasei nom. rejic.
Reference: DICKS (L.M.T.), Du PLESSIS (E.M.), DELLAGLIO (F.) and LAUER (E.): Reclassification of Lactobacillus casei subsp. casei ATCC 393 and Lactobacillus rhamnosus ATCC 15820 as Lactobacillus zeae nom. rev., designation of ATCC 334 as the neotype of L. casei subsp. casei, and rejection of the name Lactobacillus paracasei. Int. J. Syst. Bacteriol., 1996, 46, 337-340.
Original article in IJSEM Online

Note 1: According to Rule 56a of the International Code of Nomenclature of Bacteria (1990 revision), only the Judicial Commission can place a name on the list of rejected names. Therefore, this proposal is provisional and needs to be awarded by the Judicial Commission.

Note 2: In a previous paper, Dellaglio et al. 1991 [1] requested that ATCC 334 be designated in place of ATCC 393 as the neotype of Lactobacillus casei subsp. casei and that Lactobacillus paracasei be rejected as a synonym of Lactobacillus casei, as the latter would be defined by the proposed neotype. The Judicial Commission concluded that there is not enough basis for concern about confusion leading to serious consequences in industrial microbiology to justify awarding an exception to the Rules and voted to deny the request [2].
References:
1 DELLAGLIO (F.), DICKS (L.M.T.), Du TOIT (M.) and TORRIANI (S.): Designation of ATCC 334 in place of ATCC 393 (NCDO 161) as the neotype strain of Lactobacillus casei subsp. casei and rejection of the name Lactobacillus paracasei (Collins et al., 1989). Request for an opinion. Int. J. Syst. Bacteriol., 1991, 41, 340-342.
2 WAYNE (L.G.): Actions of the Judicial Commission of the International Committee on Systematic Bacteriology on requests for opinions published between January 1985 and July 1993. Int. J. Syst. Bacteriol., 1994, 44, 177-178.

Note 3: The proposal of Dicks et al. 1996, is sustained by Mori et al. 1997 [1], and by the Subcommittee on the taxonomy of Bifidobacterium, Lactobacillus and related organisms [2, 3].
References:
1 MORI (K.), YAMAZAKI (K.), ISHIYAMA (T.), KATSUMATA (M.), KOBAYASHI (K.), KAWAI (Y.), INOUE (N.) and SHINANO (H.): Comparative sequence analyses of the genes coding for 16S rRNA of Lactobacillus casei-related taxa. Int. J. Syst. Bacteriol., 1997, 47, 54-57.
Original article by Mori et al. 1997 in IJSEM Online
2 BIAVATI (B.): International Committee on Systematic Bacteriology. Subcommittee on the taxonomy of the Bifidobacterium, Lactobacillus and related organisms. Minutes of the meetings, 26 and 29 August 1996, Budapest, Hungary. Int. J. Syst. Evol. Microbiol., 2001, 51, 257-258.
Original article by Biavati 2001 in IJSEM Online (PDF Format)
3 KLEIN (G.): International Committee on Systematic Bacteriology. Subcommittee on the taxonomy of Bifidobacterium, Lactobacillus and related organisms. Minutes of the meetings, 22 and 23 September 1999, Veldhoven, The Netherlands. Int. J. Syst. Evol. Microbiol., 2001, 51, 259-261.
Original article by Klein 2001 in IJSEM Online (PDF Format)

Note 4: Dellaglio et al. request that the strains of Lactobacillus casei and Lactobacillus paracasei Collins et al. 1989 be united into a single taxon, Lactobacillus casei.
Reference: DELLAGLIO (F.), FELIS (G.E.) and TORRIANI (S.): The status of the species Lactobacillus casei (Orla-Jensen 1916) Hansen and Lessel 1971 and Lactobacillus paracasei Collins et al. 1989. Request for an Opinion. Int. J. Syst. Evol. Microbiol., 2002, 52, 285-287.
Original article in IJSEM Online

Lactobacillus paracasei subsp. paracasei Collins et al. 1989, subsp. nov.
Type strain: strain ATCC 25302 = CCUG 32212 = CIP 103918 = DSM 5622 = IFO (now NBRC) 15889 = JCM 8130 = LMG 13087 = NCIMB 700151 (formerly NCDO 151).
Reference: COLLINS (M.D.), PHILLIPS (B.A.) and ZANONI (P.): Deoxyribonucleic acid homology studies of Lactobacillus casei, Lactobacillus paracasei sp. nov., subsp. paracasei and subsp. tolerans, and Lactobacillus rhamnosus sp. nov., comb. nov. Int. J. Syst. Bacteriol., 1989, 39, 105-108.

Note: The taxon Lactobacillus paracasei subsp. paracasei Collins et al. 1989, encompasses the type strain of Lactobacillus casei subsp. alactosus Mills and Lessel 1973 (Approved Lists 1980) and the type strain of Lactobacillus casei subsp. pseudoplantarum Abo-Elnaga and Kandler 1965 (Approved Lists 1980).

Lactobacillus fermentum Beijerinck 1901, species.
Type strain: strain ATCC 14931 = CCUG 30138 = CIP 102980 = DSM 20052 = IFO (now NBRC) 15885 = JCM 1173 = LMG 6902 = NCCB 46038 = NCIMB 11840 (formerly NCDO 1750) = NRRL B-4524.
Synonyms: “Bacillus δ” von Freudenreich 1895, “Bacillus casei δ” von Freudenreich and Thöni 1904, “Lactobacterium fermentum” (Beijerinck 1901) van Steenberge 1920.
Etymology: L. neut. n. fermentum (nominative in apposition), that which causes fermentation, leaven, ferment.
References: SKERMAN (V.B.D.), McGOWAN (V.) and SNEATH (P.H.A.) (editors): Approved Lists of Bacterial Names. Int. J. Syst. Bacteriol., 1980, 30, 225-420. [BEIJERINCK (M.W.): Sur les ferments lactiques de l'industrie. Archives Néerlandaises des Sciences Exactes et Naturelles (Section 2), 1901, 6, 212-243.]

Lactobacillus johnsonii Fujisawa et al. 1992, sp. nov.
Type strain: strain ATCC 33200 = CCUG 30725 = CIP 103620 = DSM 10533 = JCM 2012 = VPI 7960.
Reference: FUJISAWA (T.), BENNO (Y.), YAESHIMA (T.) and MITSUOKA (T.): Taxonomic study of the Lactobacillus acidophilus group, with recognition of Lactobacillus gallinarum sp. nov. and Lactobacillus johnsonii sp. nov. and synonymy of Lactobacillus acidophilus group A3 (Johnson et al. 1980) with the type strain of Lactobacillus amylovorus (Nakamura 1981). Int. J. Syst. Bacteriol., 1992, 42, 487-491.

Lactobacillus rhamnosus (Hansen 1968) Collins et al. 1989, comb. nov.
Type strain: strain ATCC 7469 = CCUG 21452 = CIP A157 = DSM 20021 = IFO (now NBRC) 3425 = JCM 1136 = LMG 6400 = NCAIM B.01147 = NCCB 46033 = NCIMB 6375 (formerly NCDO 243) = NCTC 12953 = NRRL B-442 = VKM B-574.
Basonym: ¤ Lactobacillus casei subsp. rhamnosus Hansen 1968 (Approved Lists 1980).
Reference: COLLINS (M.D.), PHILLIPS (B.A.) and ZANONI (P.): Deoxyribonucleic acid homology studies of Lactobacillus casei, Lactobacillus paracasei sp. nov., subsp. paracasei and subsp. tolerans, and Lactobacillus rhamnosus sp. nov., comb. nov. Int. J. Syst. Bacteriol., 1989, 39, 105-108.

Note: In the paper by Collins et al. 1989, Lactobacillus rhamnosus is proposed as a new species.

下一篇要介紹益生菌常見的廠牌

在介紹治療過敏的健康食品之前，我們得先定義一下所謂的健康食品，在台灣的衛生署將藥品分成處方用藥還有指示用藥，另外對於有臨床實驗支持的非藥品，稱之為健康食品，這是醫學上的定義，但是對於我們一般俗稱的健康食品，是說不是藥品的可能有治療性質的物品，我們稱之為健康食品．

目前治療過敏最有名的就是乳酸菌，而這些乳酸菌為了跟一般的乳酸菌做區別，於是把專門治療過敏的乳酸菌，以益生菌來命名，也就是一種好菌．

下一篇我們將介紹不明原因的過敏

益生菌probiotics，在醫學期刊有許多豐富的資料，我們如果在ＭＥＤＬＩＮＥ上打入”probiotics”一共有3569篇文章，多麼驚人的數字，我沒時間看．．．．．

如果是probiotics+allergy 一共有255篇，(probiotics+urticaria也有三篇)，probiotics+atopic也有121篇，可見益生菌在治療過敏或者是異位性皮膚炎，有一定的效果。

先找一篇2007年五月報告發表在The Journal of allergy and clinical immunology

2007 May;119(5):1174-80. Epub 2007 Mar 8.
Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial.
BACKGROUND: An altered microbial exposure may underlie the increase of allergic diseases in affluent societies. Probiotics may alleviate and even prevent eczema in infants. OBJECTIVE: To prevent eczema and sensitization in infants with a family history of allergic disease by oral supplementation with the probiotic Lactobacillus reuteri. METHODS: Double-blind, randomized, placebo-controlled trial, which comprised 232 families with allergic disease, of whom 188 completed the study. The mothers received L reuteri ATCC 55730 (1 x 10(8) colony forming units) daily from gestational week 36 until delivery. Their babies then continued with the same product from birth until 12 months of age and were followed up for another year. Primary outcome was allergic disease, with or without positive skin prick test or circulating IgE to food allergens. RESULTS: The cumulative incidence of eczema was similar, 36% in the treated versus 34% in the placebo group. The L reuteri group had less IgE-associated eczema during the second year, 8% versus 20% (P = .02), however. Skin prick test reactivity was also less common in the treated than in the placebo group, significantly so for infants with mothers with allergies, 14% versus 31% (P = .02). Wheeze and other potentially allergic diseases were not affected. CONCLUSION: Although a preventive effect of probiotics on infant eczema was not confirmed, the treated infants had less IgE-associated eczema at 2 years of age and therefore possibly run a reduced risk to develop later respiratory allergic disease. CLINICAL IMPLICATION: Probiotics may reduce the incidence of IgE-associated eczema in infancy.

下一篇是益生菌菌種的介紹

過敏一直是個令人頭痛的疾病，很多時候你根本無法去避免或者預防，小至於眼睛癢，打噴嚏都是過敏，嚴重到休克死亡也是過敏，除了益生菌以後，效果比較快的就是西藥，接下我們就來介紹治療過敏的西藥。

治療過敏的西藥主要有三大類：抗組織胺、副腎皮質素(類固醇)及其他。如果藥物及環境控制都無法改善症狀才考慮〝減過敏療法〞，但此種療法費時費事，對家屬的心理壓力和經濟壓力都很大，甚至需耗費數年作定期的過敏原注射，故常有患者半途而廢，反而造成醫療資源的浪費。上述治療，除了最費時的減過敏療法有可能根治以外，其 它西藥皆為症狀療法。

抗組織胺：

1. 所有的抗組織胺，或多或少都可能引起嗜睡，即使是FDA通過連飛行員都可以服用的Allegra，臨床上仍有人會嗜睡，當然第一代的抗組織胺大部分的病人幾乎都是會引起嗜睡的副作用。但是大部分的診所藥局因為其價格低廉且效果相當好，仍然大量採用。
2. 第二代的不嗜睡抗組織胺有loratadine和cetirizine，還有從loratadine衍生而來的fexofenadine。

類固醇：

1. 對於使用類固醇的優缺點在此不討論，但是請相信你的醫生。
2. 類固醇的使用，一般可分為下面兩種：

• 全身性（如口服或注射）類固醇：

• 其中注射最常用的藥物為副腎上皮質素Hydrocortisone 以及甲基腎上皮質素Methylprednisolone，比較常用在氣喘急性發作或藥物過敏Anaphylaxis時，如果使用其他藥物治療不彰時可以考慮合併使用，通常不會長期使用；而口服類固醇最常使用的藥物是Prednisolone或者Dexamethasone，如果長期使用或使用不當，就容易引起種種的副作用。

• 局部性（如鼻噴劑、口吸入、皮膚塗抹等）類固醇：
  • 局部使用的類固醇，發生副作用的機率比起口服或者注射會較少；而且近年來噴霧吸入類固醇的的局部抗發炎作用增加，這類藥品的使用也已經成為氣喘及過敏性鼻炎的標準治療，最常使用的有Seretide AccuhalerR(俗稱胖胖魚)；經肝臟的代謝近乎完全，較不會引起全身性的副作用。

看完了西醫的方法，下一篇我們就要介紹中醫治療過敏的方法