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  Amazing if this holds up in larger studies - a treatment for peanut allergy! As the researchers said -  the treatment (2 grams of peanut protein plus a specific strain of the probiotic Lactobacillus rhamnosus daily for 18 months) provided "persistent suppression of the allergic immune response to peanuts 4 years" after the treatment had ended This was a nicely done multi-year study in children - a randomised, double-blind, placebo-controlled trial (to eliminate biases).

The researchers also wrote in the Discussion section of the study: "PPOIT [combined probiotic and peanut oral immunotherapy] was associated with long-lasting peanut tolerance 4 years after stopping treatment. Two-thirds of PPOIT treated participants were able to continue regular peanut ingestion, and more than half were ingesting moderate to-large amounts of peanut on a regular basis, compared with only one (4%) of 24 placebo-treated participants. Allergic reactions from intentional peanut ingestion were uncommon and all reactions were mild, suggesting that those who achieved PPOIT-induced sustained unresponsiveness can safely continue peanut ingestion." In other words - WOW! (Other posts on peanut allergies - here and here, and earlier progress report of this study.) From Medical Xpress:

Australian researchers in peanut allergy breakthrough

Australian researchers have reported a major breakthrough in the relief of deadly peanut allergy with the discovery of a long-lasting treatment they say offers hope that a cure will soon be possible. In clinical trials conducted by scientists at Melbourne's Murdoch Childrens Research Institute, children with peanut allergies were given a probiotic along with small doses of a peanut protein over an 18-month period. When the experiment ended in 2013 some 80 percent of the kids were able to tolerate peanutsThe research, published Wednesday in medical journal The Lancet, found that four years on, about 70 percent could still eat peanuts without an adverse reaction.

"The importance of this finding is that these children were able to eat peanuts like children who don't have peanut allergy and still maintain their tolerant state, protected against reactions to peanut," lead researcher Mimi Tang said. "These findings suggest our treatment is effective at inducing long-term tolerance, up to four years after completing treatment, and is safe. Food allergy affects one in 20 children and about two in 100 adults, with seafood, cow's milk, eggs and peanuts among the most typical triggers. Peanuts are one of the most common foods to cause anaphylaxis, a potentially fatal allergic reaction.

The researchers said the Murdoch study provides the "strongest evidence yet that a cure may be possible for peanut allergy"..... Ten-year-old Olivia May suffered a reaction when she tried to eat a peanut butter sandwich seven years ago. "We visited the allergist the first time [and] he said 'sorry, you're going to have to go home and empty your pantry out, clear it of all nuts, anything with nuts in it'," Oliver's mother Tanya told the Australian Broadcasting Corporation. But after taking part in the trial, Oliva no longer suffers from her allergy.

Fifty-six children completed the study, with half receiving a placebo and half receiving the treatment, which encourages the immune system to develop a tolerance to the allergy. Researchers are now aiming to confirm the results with a larger study of the treatment they say "holds important implications for attacking the modern food allergy epidemic". [Original study.]

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 A wonderful journal article from March 17, 2015 by E.K. Cope and S.V. Lynch (one of the original L. sakei - sinusitis researchers) in which they discuss various probiotic (beneficial bacteria) species that might have some benefit in treating chronic sinusitis, which they refer to as chronic rhinosinusitis (CRS). They discuss bacteria that have have been (somewhat) studied in humans or mice and could have potential in sinusitis treatment: Lactobacillus sakei, Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus johnsonii, and Staphylococcus epidermidis. [NOTE: So few studies (almost none) have been done with probiotics in CRS  that the odds are really good that other species of bacteria, or combinations of bacteria, will also prove to be beneficial.]

It seems that a nasal spray with a mixture of beneficial bacteria may ultimately work the best because the bacterial diversity of the sinus microbiome is depleted in persons with chronic sinusitis, and there is "enrichment of sinus pathogens" (bacteria that can cause disease). As I've mentioned in other posts, S.V. Lynch is involved in developing a nasal probiotic spray containing L. sakei and other Lactobacillus species to treat sinusitis, but it is unknown when that will be available.

The authors also made the point that probiotics (beneficial bacteria) may work several ways in the sinus microbiome (a community of microbes living in the sinuses). This "niche" with its own ecosystem or community of species can be altered, with some bacteria species wiped out, perhaps by illness and/or repeated courses of antibiotics. Therefore, think of the different microbial species in the sinus microbiome as having different functions: as a keystone (a species that has a very large effect on the community), pioneer (species that are the first to colonize the niche after a disruption), or dominant species found in a healthy state (species with a relatively high abundance in a niche).

They also discuss what are the main pathogens found in chronic sinusitis, but they also mention that bacteria that we think of as pathogenic (the bad bacteria) are also present in healthy persons - just at a lower level than in chronic sinusitis sufferers. Also, these diverse microbial communities can vary between healthy individuals - that is, the healthy microbial communities are a little different among people. Common pathogenic bacteria found in CRS are: Staphylococcus aureus, Pseudomonas aeruginosa, Corynebacterium tuberculostearicum (normally a harmless skin bacteria), and Streptococcus species. Remember, healthy sinuses have greater bacterial diversity than sinusitis sufferers, and CRS patients have "substantial microbiome dysbiosis" (microbial communities out-of-whack), with "microbiome community collapse" and "enrichment of specific sinus pathogens". In other words, the microbial sinus communities in CRS are in bad shape and need to get good bacteria in there.

For information on how some people are already successfully using probiotics such as L. sakei for sinusitis treatment, read The One Probiotic That Treats Sinusitis (products, brands, and methods).

When reading the following, remember that dysbiosis means "the microbial community is out of whack". Some excerpts from the Cope and Lynch article from Current Allergy and Asthma Reports:

Novel Microbiome-Based Therapeutics for Chronic Rhinosinusitis

The human microbiome, i.e. the collection of microbes that live on, in and interact with the human body, is extraordinarily diverse; microbiota have been detected in every tissue of the human body interrogated to date. Resident microbiota interact extensively with immune cells and epithelia at mucosal surfaces including the airways, and chronic inflammatory and allergic respiratory disorders are associated with dysbiosis of the airway microbiome. Chronic rhinosinusitis (CRS) is a heterogeneous disease with a large socioeconomic impact, and recent studies have shown that sinus inflammation is associated with decreased sinus bacterial diversity and the concomitant enrichment of specific sinus pathogens.

Similar to other chronic inflammatory diseases, including inflammatory bowel disease and asthma, evidence is emerging for the role of the sinus microbiome in defining upper airway health.....two trends in the literature are evident. First, all three studies that have examined the microbiota of healthy subjects demonstrate the presence of a diverse microbiome that includes bacterial groups classically considered as causative agents of respiratory disease, including Pseudomonas, Staphylococcus, and Streptococcus. Second, substantial sinonasal microbiome dysbiosis is associated with CRS. In one example, Abreu and colleagues demonstrated microbiome community collapse in the maxillary sinuses of CRS patients compared to healthy controls characterized by the outgrowth of Corynebacterium tuberculostearicum. In another study, nasal lavage specimens from CRS patients revealed microbiome collapse coincident with Staphylococcus enrichment.

Immune responses in individuals with CRS vary considerably across patients.... While the underlying processes contributing to a patient’s immune response are not well understood, there is evidence for microbial stimulation. Staphylococcus aureus exotoxins are associated with a Th2 inflammatory response characterized by eosinophilia and enterotoxin-specific IgE , and the Th2 cytokines IL-4 and IL-13 have been associated with S. aureus outgrowth in other inflammatory diseases. Another common sinus pathogen, Pseudomonas aeruginosa, can induce antimicrobial nitric oxide production by host recognition of bacterial quorum sensing molecules through stimulation of the bitter taste receptor T2R38. There is clearly heterogeneity across patients with CRS; thus, future therapeutic microbiome manipulation strategies must be targeted to the specific microbiome perturbation and immune dysfunction of the patient.

Since CRS is immunologically and microbiologically diverse, it is not surprising that current treatment strategies using corticosteroids alone or in combination with antibiotics are variably successful. Some patients recover completely without recurrence, although 10–25 % of patients require repeated treatment....Patients who do not respond to medical management are candidates for functional endoscopic sinus surgery (FESS). The goal of FESS is to remove polypoid tissue and open ostia to facilitate sinus drainage. While some patients rebuild their native, healthy microbial communities and epithelium following FESS, many patients require revision sinus surgeries. Importantly, these therapies only manage chronic airway diseases and, in many cases, do not address the underlying source of disease, e.g., dysregulated microbiota. Since it is clear that the microbiome plays a fundamental role in respiratory health, it is essential to begin to define the interaction between pathogens or pathobionts in the context of the healthy host microbiota.

As discussed above, the most common route of probiotic delivery (oral) takes advantage of the GI-respiratory axis. In the only clinical trial of probiotic use in chronic rhinosinusitis, Mukerji and colleagues reported that oral administration of L. rhamnosus R0011 improved patient-reported symptoms of rhinosinusitis in the short term (<4 weeks), but not the long term (8 weeks). These results suggest a potential role for GI microbiome manipulation to affect the sinus immune response; however, there has not been a follow-up study to further elucidate this role. Repeated dosing or inoculation with mixed species could improve these results.

Several variables should be considered when designing probiotics for potential treatment of sinus disease. The first consideration, the route of administration, will determine the mechanism of action of the probiotic. Oral probiotic supplements primarily affect the respiratory tract through translocation of microbial metabolites, cytokines, or immune cells to the airways via systemic circulation, while local delivery via sprays or nasal lavage will affect the sinonasal microbiota and local immune responses...This first variable, route of administration, will determine which probiotic species are used. A second consideration for probiotic development is whether to supplement with a single species or a mixed-species consortium. Single species or species mixtures can be selected based on how best to leverage the healthy microbiome. From an ecological perspective, the potential role of the probiotic(s) should be considered. For example, the specie(s) may function as keystone (a species that has a disproportionately large effect on the community), pioneer (species that are the first to colonize the niche after a disruption), or dominant species found in a healthy state (species with a relatively high abundance in a niche).

Animal models are powerful tools for exploring the relationship of the host-microbiome to health and disease.... In malnourished mice, nasal instillation of Lactobacillus casei can confer protection against pathogens by enhancing host innate immune response....Live L. casei had additional benefits of temporarily colonizing the respiratory mucosa to competitively exclude S. pneumonia. Intranasal administration of Lactobacillus plantarum DK119 protected mice from lethal loads of influenza A virus through modulating host immunity of alveolar dendritic cells and macrophages. Similarly, intranasal administration of L. rhamnosus GG protected mice from H1N1 influenza infection by activating lung natural killer cells..... They also show that this protection can be achieved through feeding a single species L. johnsonii, which was enriched in the cecum of mice fed house dust.... In a sinusitis model, Abreu and colleagues demonstrated that intranasal administration of Lactobacillus sakei, identified using 16S rRNA phylogenetic microarray analysis of healthy human sinuses, protects against C. tuberculostearicum-induced sinusitis. A similar murine study showed that Staphylococcus epidermidis can protect against S. aureus-induced sinusitis. Together, these studies show promise for microbiome based therapeutics in sinusitis. However, we must think critically about the species or community used for sinus protection, administration methods, as well as the timing for microbial intervention

Probiotic administration can influence the host-microbiome composition and function directly through production of antimicrobials, changing the pH, or through competitive colonization within a niche. Bacteriocins are antimicrobial peptides produced by bacteria with a wide range of activity, either narrow spectrum (active against similar species) or broad spectrum (active across genera). Lactic acid bacteria are well-established producers of bacteriocins. The protective species identified by Abreu and colleagues, L. sakei, is known to produce several bacteriocins with a wide range of characteristics and putative modes of action, although the best characterized bacteriocin from this species is sakacin. Sakacin has antimicrobial activity against Gram positive taxa, including Listeria spp. and Enterococcus spp., but not Gram-negative bacteria.

Other Lactobacillus species that are potential probiotics for the airways act through the production of alternative antimicrobial compounds. Lactobacillus reuteri produces the protein reuterin, which acts as an antimicrobial compound by inducing oxidative stress in competing bacteria. Reuterin production is increased in the presence of E. coli, suggesting that the effects of this protein are aimed at eliminating competing microbes, giving L. reuteri an advantage in adherence and colonization of host mucosa. Lactobacillus spp. also commonly produce acetic acid and lactic acid, thereby lowering the pH of their niche and inhibiting the growth of acid-intolerant taxa. Finally, probiotic species can compete for growth substrates or receptor binding sites. L. johnsonii competes with several known pathogens for adhesion receptors, which are either glycoproteins or glycolipids. One such receptor is gangliotetraosylceramide (asialo-GM1), a glycolipid that is abundant in pulmonary tissue.

Probiotic intervention for respiratory diseases is an area of active investigation, particularly in light of recent microbiome findings. While the field is still relatively nascent, the potential for probiotic manipulation of the sinus microbiome to treat or prevent CRS is great. However, our current understanding of the healthy sinus microbiome and, thus, how best to manipulate it in a disease state are not well defined. Whether to use mixed versus single species and strain inocula, specific species used, mode of delivery, inoculum concentration, and determining the frequency of supplementation are some of the factors that need to be addressed in optimizing probiotic effects. Most of the studies discussed in this article have focused on the gut microbiome and effects at distal sites because these interactions have formed the focus of the majority of stduies to date. However, the murine [mouse] studies discussed here suggest that local administration of probiotics to the sinuses can affect the dynamics of the sinus microbiome.

Lactobacillus_sakei Lactobacillus sakei Credit: BacMap Genome Atlas

 A study found that a combination of cranberry supplement (120 mg cranberries, with a minimum proanthocyanidin content of 32mg), the probiotic Lactobacillus rhamnosus, and vitamin C (750 mg) three times a day was enough to prevent the recurrence of urinary tract infections (UTIs) for the majority of women in this small (36 patient) study. At 6 months there was a 61% success rate. No side effects were reported.

These are wonderful results, but why aren't more studies also being done on the effective product D-Mannose? The one study (see post) that I found looking at D-Mannose found an 85% success rate at 6 months. It is especially effective against E.coli, which is the cause of the majority of UTIs. But the great news is that finally women have some effective and safe treatments to try, and the wonderful possibility of getting off the vicious cycle of repeated courses of antibiotics. The article abstract from Pubmed.gov (National Library of Medicine):

Effectiveness of a Combination of Cranberries, Lactobacillus rhamnosus, and Vitamin C for the Management of Recurrent Urinary Tract Infections in Women: Results of a Pilot Study.

Urinary tract infections (UTIs) are common in women and many patients with recurrent UTIs do not eradicate the condition albeit being treated with multiple courses of antibiotics. The use of nutritional supplements might reduce the risk of recurrent UTIs. However, the role of supplements taken as single agents appears to be limited. We hypothesized that a combination of cranberries, Lactobacillus rhamnosus, and vitamin C might produce a clinical benefit due to their additive or synergistic effects. We prospectively enrolled 42 consecutive women with recurrent UTIs treated with 120mg cranberries (minimum proanthocyanidin content: 32mg), 1 billion heat-killed L. rhamnosus SGL06, and 750mg vitamin C thrice daily for 20 consecutive days. Patients were advised to stop taking these supplements for 10 d and then to repeat the whole cycle three times. Patients were contacted three mo and six mo following the end of the administration of these supplements and evaluated with a semistructured interview and urinalysis. Responders were defined as the absence of symptoms and negative urinalysis or urine culture. Follow-up data were available for 36 patients. Overall, 26 (72.2%) and 22 patients (61.1%) were responders at the 3-mo and 6-month follow-up. No major side effects were recorded. The administration of cranberries, L. rhamnosus, and vitamin C might represent a safe and effective option in women with recurrent UTIs.

PATIENT SUMMARY: We evaluated the effectiveness of cranberries, Lactobacillus rhamnosus, and vitamin C thrice daily for 20 consecutive d monthly for 3 mo for the management of recurrent urinary tract infections in women. Our results show that this approach might represent a safe and effective option.

 Very exciting research IF it pans out - the idea of treating (some) cancers with probiotics (beneficial bacteria). This study was done on mice, and some mice started the probiotic mixture one week before they gave the mice the liver cancer, so...more limitations there. But the idea is so tantalizing and wonderful... And what was in the mixture of bacteria (called probiotic Prohep) that the mice ate that had beneficial results of shrinking liver tumors? The probiotic Prohep is composed of Lactobacillus rhamnosus GG (LGG), Escherichia coli Nissle 1917 (EcN), and heat inactivated VSL#3 (1:1:1).  VSL#3 contains: Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, and Lactobacillus delbrueckii. Note that Lactobacillus rhamnosus and some of the others are already found in many probiotic mixtures. From Medical Xpress:

Probiotics dramatically modulate liver cancer growth in mice

Medical research over the last decade has revealed the effects of the gut microbiome across a range of health markers including inflammation, immune response, metabolic function and weight....Previous studies have demonstrated the beneficial role of probiotics in reducing gastrointestinal inflammation and preventing colorectal cancer, but a new study published in the Proceedings of the National Academy of Sciences explored their immunomodulatory effects on extraintestinal tumors: specifically, in hepatocellular carcinoma (HCC)HCC is the most common type of liver cancer, and though it is relatively uncommon in the United States, it's the second-most deadly type of cancer worldwide and is particularly prevalent in regions with high rates of hepatitis. 

The researchers designed a study in a mouse model of HCC that quantified the immunological effects of a novel probiotic formulation called Prohep. They fed the mice Prohep for a week prior to tumor inoculation, and they observed a 40 percent reduction of tumor weight and size compared with control animals. Further, they established that the beneficial effects of the probiotics were closely related to the abundance of beneficial bacteria promoted by Prohep. These bacteria produce anti-inflammatory metabolites, which regulated pro-inflammatory immune cell populations via crosstalk between the gut and the liver tumor.

Among their findings, the researchers report that the probiotics reduced liver tumor growth by inhibiting angiogenesis, the process by which the body generates new blood vessels from existing ones, which is essential for tumor growth. They found significantly raised levels of hypoxic GLUT-1+, indicating that tumor reductions were due to hypoxia caused by reduced blood flow. Further, the tumors in the treated mice had 52 percent lower blood vessel area and 54 percent fewer vessel sprouts than the untreated mice.

They also determined that Prohep treatment down-regulated IL-17, a pro-inflammatory angiogenic factor. Because HCC is a highly vascularized tumor, the cancer is generally associated with high levels of IL-17 and an immune T-cell called T helper 17 (Th17), which is transported from the gut to HCC tumors via circulation. The researchers believe that reduced Th17 in tumor cells impedes the inflammation and angiogenesis and limits tumor growth. It's not surprising that they also found that probiotics increased the anti-inflammatory bacteria and metabolites present in the guts of treated mice. They conclude that Prohep intake has the capability of inhibiting tumor progression by modulating the gut microbiota.

An amazing breakthrough for those suffering from peanut allergies. The bacteria Lactobacillus rhamnosus is added to some yogurts and kefir, but in smaller amounts.From The Telegraph:

Fatal peanut allergies could be cured by probiotic bacteria, say Australian doctors

A strain of probiotic bacteria could offer a cure for potentially fatal peanut allergies, according to scientists in Australia. The breakthrough followed a trial in which a group of children were given increasing amounts of peanut flour, along with a probiotic called Lactobacillus rhamnosus, over an 18-month period. About 80 per cent of the children who had peanut allergies were subsequently able to tolerate peanuts.

Mimi Tang, the lead researcher, said the families involved believed the treatment had "changed their lives". "These findings provide the vital first step towards developing a cure for peanut allergy and possibly for all food allergies," she told Melbourne's Herald Sun.

The randomised trial, involving a group of about 30 children, was conducted by Murdoch Childrens Research Institute in Melbourne. The children, aged one to ten, were given small amounts of peanut flour, gradually building up to two grams, or the equivalent of six or seven nuts.They were also given daily doses of Lactobacillus rhamnosus, which is found in yoghurt but was given in quantities equivalent to the amount found in 44 pounds of yoghurt.

Following the treatment, about 80 per cent of the children were able to tolerate four grams of peanut protein, equivalent to about 14 peanuts. Typically, about four per cent of children would have overcome their peanut allergy during this time.

Rates of peanut allergies have dramatically increased in the past two decades, particularly in developed countries. For most sufferers, the condition is lifelong.

A link to the press release from the Murdoch Childrens Research Institute (their researchers are doing the research), has more:

Oral Therapy Could Provide Treatment For Peanut Allergies

Over 60 peanut allergic children in the study were either given a dose of a probiotic, Lactobacillus rhamnosus, together with peanut protein in increasing amounts, or a placebo over 18 months to assess whether children would become tolerant to peanut.

The probiotic was a fixed daily dose, while the peanut oral immunotherapy was a daily dose of peanut protein starting at very low doses followed by a dose increase every two weeks until the maintenance dose (2 grams peanut protein) was reached. At the end of the treatment, the child's ability to tolerate peanut was assessed by a peanut challenge performed two to five weeks after stopping treatment.

23 of 28 (82.1%) probiotic treated children and one of 28 (3.6%) placebo-treated children were able to include peanut in their diet at the end of the trial. The likelihood of success was high - if nine children were given probiotic and peanut therapy, seven would benefit.

The need for a curative treatment is greatest for peanut allergy since this is usually lifelong, and is the most common cause of fatality due to food induced anaphylaxis. Further research is now required to confirm whether patients can still tolerate peanut years after the study has finished.

Very exciting new way to use probiotics! Huge potential. From Science Daily:

Probiotics protect children, pregnant women against heavy metal poisoning

Yogurt containing probiotic bacteria successfully protected children and pregnant women against heavy metal exposure in a recent study. Canadian and Tanzanian researchers created and distributed a special yogurt containing Lactobacillus rhamnosus bacteria and observed  the outcomes against a control group.

A research team from the Canadian Centre for Human Microbiome and Probiotics, led by Dr. Gregor Reid, studied how microbes could protect against environmental health damage in poor parts of the world. Their lab research indicated that L. rhamnosus had a great affinity for binding toxic heavy metals. Working with this knowledge, the team hypothesized that regularly consuming this probiotic strain could prevent metals from being absorbed from the diet.

Working with the Western Heads East organization, Dr. Reid had already established a network of community kitchens in Mwanza, Tanzania to produce a probiotic yogurt for the local population. Mwanza is located on the shores of Lake Victoria, which is known to be polluted with pesticides and toxic metals including mercury. The team utilized this network to produce and distribute a new type of yogurt containing L. rhamnosus. The special yogurt was distributed to a group of pregnant women and a group of children. The researchers measured the baseline and post-yogurt levels of toxic metals.

The team found a significant protective effect of the probiotic against mercury and arsenic in the pregnant women. This is important as "reduction in these compounds in the mothers could presumably decrease negative developmental effects in their fetus and newborns," according to Dr. Reid. While the results obtained in the children studied showed benefits and lower toxin levels, the sample size and duration of treatment did not allow statistical significance.

I spent time this past week searching the medical literature (US National Library of Medicine - Medline/PubMed) for the latest in sinusitis research. I wish I could tell you that amazing research has been happening recently, especially with the sinus microbiome (which could mean treating sinusitis with microbes), but I was disappointed. Really disappointed.

I did four searches: one for "sinusitis" (looked at 600+ studies dating back to summer 2013), then "chronic sinusitis" (going back to fall 2012), then "sinusitis, probiotics", and finally "sinusitis, microbiome". The "sinusitis, probiotics" search turned up 10 studies dating back to 2002. The "sinusitis, microbiome" search turned up a grand total of 13 studies, with the oldest dating back to 2004. Of course the sinus microbiome research by Abreu et al from September 2012  discussing Lactobacillus sakei and which I based my personal (and successful) kimchi sinusitis treatment was on the list (see my Dec. 5 post for a discussion of their research). But none of the other studies looked at Lactobacillus sakei (which is in kimchi).

Some of the findings among the many chronic sinusitis studies: microbial diversity is lower in antibiotic treated chronic sinusitis sufferers (than in healthy controls) and the microbial communities more uneven (meaning some microbes dominated over others), and greater Staphylococcus aureus populations among those with chronic sinusitis. After antibiotic treatment patients typically became colonized by microbes that are less susceptible to the prescribed antibiotics. One study found that Staphylococcus epidermidis (SE) may have some effectiveness against Staphylococcus aureus (SA) in the sinusitis microbiome in mice. Lactobacillus rhamnosus was not found to be effective against sinusitis. A number of studies reported biofilms in the sinuses which are highly resistant to medicines. Some studies found that smoking or exposure to second-hand smoke is linked to chronic sinusitis. (June 2016 UPDATE: I should have said that Lactobacillus rhamnosus (R0011 strain) was not effective against sinusitis when taken orally (a tablet) twice a day for 4 weeks in the study. There have been no further studies since then looking at L. rhamnosus for sinusitis treatment. It is unknown whether spraying or smearing/dabbing L. rhamnosus directly into the nostrils would have a positive effect)

Everyone agreed that state of the art genetic analyses found many more microbial species than older methods (the least effective was the traditional culture method). Several studies suggested that perhaps chronic sinusitis is due to immunological defects and one suggested that it was due to "immune hyperresponsiveness" to organisms in the sinuses. Surprisingly, some studies reported that there are more microbes or microbial species in chronic sinusitis patients than in control patients and that Staphylococcus aureus may be dominant (NOTE: These results may be due to not having been done with state of the art genetic analyses which would have picked up more microbial diversity. Another issue is where in the respiratory tract the samples were taken from, because it seems that the different areas have different microbial communities).

There was frequent mention that chronic sinusitis affects millions of people each year in the US, that little is known about its exact cause, and that there is controversy over appropriate treatment. Originally doctors thought that healthy sinuses were sterile, and it has taken a while to realize that is untrue. It is clear that researchers are only now trying to discover what microbial communities live in healthy individuals compared to those with chronic sinusitis.

But it appeared to me that the majority of the studies from the last 2 years indicated that treatment of chronic sinusitis is still: first try antibiotics, then antibiotics plus inhaled corticosteroids and perhaps nasal saline irrigation, then followed by endoscopic sinus surgery (or sometimes balloon dilation), then perhaps steroid drip implants (steroid-eluting sinus implants), and then there may be revision surgeries.

So I'm sticking with my easy-to-do, inexpensive, and fantastically successful kimchi (Lactobacillus sakei) sinusitis treatment. Of course! (see my Dec. 6, 2013 and Feb. 21, 2014 posts or click on the Sinusitis Treatment link for further information).