***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background / objectives : An imbalance between Th1 and Th2 cells is involved in allergic rhinitis ( AR ) that may be improved by probiotics . To test the efficacy of the probiotic Lactobacillus paracasei subsp . paracasei LP-33 , a double-blind , placebo-controlled , r and omized trial was carried out in patients with AR to grass pollen treated with loratadine and presenting altered quality of life . Subjects/ methods : Subjects with persistent AR , symptomatic during the grass pollen season , and a positive skin test or specific immunoglobulin E to grass pollens were included by general practitioners ( GPs ) . All received loratadine for 5 weeks . The primary end point was the improvement in Rhinitis Quality of Life ( RQLQ ) global score at the fifth week of LP-33 consumption compared with placebo ( in addition to loratadine ) . Secondary end points included nasal and ocular symptoms ( individual and total symptom scores ) , visual analogue scale and time of first exacerbation of the symptoms when loratadine was stopped . Results : A total of 425 subjects were included . Using intent-to-treat analysis , the RQLQ global score decreased significantly more in the LP-33 group than in the placebo group ( P=0.0255 , difference=−0.286 ( 95 % confidence interval ( CI ) : −0.536 ; −0.035 ) ) . No significant differences were noted for the change of the rhinitis total symptom score 5 global score between groups ( P=0.1288 , difference=−0.452 ( 95 % CI : −1.036 ; 0.132 ) ) . Significant differences in ocular symptoms ( RQLQ ) were observed between groups ( P=0.0029 , difference=−0.4087 ( 95 % CI : −0.6768 ; −0.1407 ) ) . Conclusions : This study performed by GPs shows that LP-33 improves the quality of life of subjects with persistent AR who are currently being treated with an oral H1-antihistamine . Whereas nasal symptoms had not changed , ocular symptoms had consistently improved Background : A prospect i ve , cross‐sectional , international survey was conducted among patients and physicians to identify symptom perception and the impact of allergic rhinitis ( AR ) on health‐related quality of life ( HRQoL ) . This paper presents the results from the USA BACKGROUND The gastrointestinal microflora is an important constituent of the gut mucosal defense barrier . We have previously shown that a human intestinal floral strain , Lactobacillus GG ( ATCC 53103 ) , promotes local antigen-specific immune responses ( particularly in the IgA class ) , prevents permeability defects , and confers controlled antigen absorption . OBJECTIVE The aim of this study was to evaluate the clinical and immunologic effects of cow 's milk elimination without ( n = 14 ) and with ( n = 13 ) the addition of Lactobacillus GG ( 5 x 10(8 ) colony-forming units/gm formula ) in an extensively hydrolyzed whey formula in infants with atopic eczema and cow 's milk allergy . The second part of the study involved 10 breast-fed infants who had atopic eczema and cow 's milk allergy . In this group Lactobacillus GG was given to nursing mothers . METHODS The severity of atopic eczema was assessed by clinical scoring . The concentrations of fecal alpha 1- antitrypsin , tumor necrosis factor-alpha , and eosinophil cationic protein were determined as markers of intestinal inflammation before and after dietary intervention . RESULTS The clinical score of atopic dermatitis improved significantly during the 1-month study period in infants treated with the extensively hydrolyzed whey formula fortified with Lactobacillus GG . The concentration of alpha 1-antitrypsin decreased significantly in this group ( p = 0.03 ) but not in the group receiving the whey formula without Lactobacillus GG ( p = 0.68 ) . In parallel , the median ( lower quartile to upper quartile ) concentration of fecal tumor necrosis factor-alpha decreased significantly in this group , from 709 pg/gm ( 91 to 1131 pg/gm ) to 34 pg/gm ( 19 to 103 pg/gm ) ( p = 0.003 ) , but not in those receiving the extensively hydrolyzed whey formula only ( p = 0.38 ) . The concentration of fecal eosinophil cationic protein remained unaltered during therapy . CONCLUSION These results suggest that probiotic bacteria may promote endogenous barrier mechanisms in patients with atopic dermatitis and food allergy , and by alleviating intestinal inflammation , may act as a useful tool in the treatment of food allergy Background : Oral probiotic bacteriotherapy with Lactobacillus rhamnosus has given promising results in small children with food allergy . We studied the effects of similar therapy in teenagers and young adults , who were allergic to birch pollen and apple food and had intermittent symptoms of atopic allergy and /or mild asthma BACKGROUND Japanese cedar pollinosis ( JCPsis ) affects nearly one in six Japanese . Oral administration of Bifidobacterium longum BB536 has been shown to be effective in relieving JCPsis symptoms during the pollen season . METHODS This double- two-way crossover study was design ed to evaluate the efficacy of BB536 on reducing symptoms in JCPsis patients exposed to Japanese cedar pollen ( JCP ) in an environmental exposure unit ( EEU ) outside of the normal JCP season . After a 1-week run-in period , subjects ( n=24 ) were r and omly allocated to receive BB536 powder ( approximately 5x1010 ) or placebo twice a day for 4 weeks . After a 2-week washout period , subjects were crossed over to another 4 weeks of intake . At the end of each intake period , subjects received controlled JCP exposure for 4 hours in the EEU . Symptoms were self-rated 30 minutes before and every 30 minutes during the exposures . From the first day of exposure through the next 5 successive days , participants self-rated their delayed symptoms and medication uses . Blood sample s were taken before the exposures . The mean JCP levels for exposures were 6500 to 7000 grains/m3 air . RESULTS In comparison with placebo , BB536 intake significantly reduced the ocular symptom scores during JCP exposures . Evaluating delayed symptoms after exposures indicated that scores for disruption of normal activities were significantly lower in the BB536 group compared with the placebo group . Prevalence of medication use was markedly reduced by BB536 intake . CONCLUSIONS These results suggest the potential beneficial effect of BB536 in relieving symptoms of JCP allergy Live Lactobacillus paracasi 33 ( LP33 ) may effectively improve the quality of life for patients with perennial allergic rhinitis . It has been demonstrated that heat-killed lactic acid bacteria ( LAB ) suppress specific immunoglobulin E synthesis and stimulate interleukin-12 production in animals . The aim of this study was , therefore , to evaluate the efficacy of heat-killed LP33 in the treatment of allergic rhinitis induced by house-dust-mite in human subjects . A total of 90 patients were enrolled in a r and omized , double blind , placebo-controlled trial and assigned to three treatment groups . Patients in groups A and B received two capsules per day of live or heat-killed LAB ( 5 x 10(9 ) colony-forming units/capsule ) , respectively , over a period of 30 days while those in Group C received placebo capsules . A modified question naire on pediatric rhinoconjunctivitis-related quality of life was administered to all subjects or their parents during each clinical visit . The overall quality of life score decreased for groups A and B , as compared with the placebo group , in terms of both frequency ( 9.47 + /- 2.89 , 6.30 + /- 2.19 , vs. -3.47 + /- 1.53 , respectively ; p < 0.0001 ) and level of bother ( 5.91 + /- 3.21 , 6.04 + /- 2.44 , vs. -2.80 + /- 1.64 , respectively ; p = 0.004 ) after the 30-day treatment . The efficacy of the heat-killed LP33 was not inferior to the live variant . No obvious side effects were reported for either active treatment group during the study period . Our results suggest that heat-killed LP33 can effectively improve the overall quality of life for patients with allergic rhinitis , and that it may be efficacious as an alternative treatment Japanese cedar pollinosis is an important contributor to allergic rhinitis in Japan . Lactobacillus may be useful as an immunomodulator and is used widely as a foodstuff . The purpose of the study was to examine the effects of daily intake of the Lactobacillus paracasei strain KW3110 in patients with cedar pollinosis . The effects of daily intake of KW3110 in patients with cedar pollinosis were investigated in 126 patients who received KW3110 or a placebo  in a double-blind study . The study began 1 month before the start of the pollen season and lasted for 3 months . A significant reduction of nasal symptoms and the serum level of eosinophil cationic protein and improvement of quality of life scores occurred in the patients who received KW3110 when pollen scattering was low . However , the effects were limited during the peak period of pollen scattering . Intake of KW3110 may reduce allergic inflammation , but the effect is limited tion of both CP and cisplatin . Hypersensitivity to mannitol was reported as a cause of apparent hypersensitivity to cisplatin . 6 In case 2 the result of a skin test with mannitol was negative , whereas the result of a skin test with the commercial formulation containing CP and mannitol was positive , suggesting that CP was solely responsible for the hypersensitivity reaction . In addition to the clinical tolerance induced by the desensitization protocol , skin responses to intradermal CP  diminished . As shown in Table I , the ratio between wheal sizes of CP and histamine decreased more than 3.5 times after the desensitization . The observation of wheal- and -flare responses becoming negative has already been described in penicillin desensitization . 7 This phenomenon supports an antigen-specific desensitization . The rate at which the drug concentration increases in the extracellular fluid seems to be the most important factor in a successful outcome of desensitization . As suggested by our two patients , this rate can differ in each individual case . We conclude that the 4-hour desensitization protocol may not be suitable for all patients allergic to CP  , whereas a modified prolonged protocol seems to be more tolerable . Until further data have been accumulated , the short protocol may be at tempted initially but should be replaced by the prolonged protocol if adverse effects appear . The prolonged protocol seems to be both safe and efficacious with regard to anti tumor activity To examine whether long-term consumption of fermented milk containing a specific Lactobacillus casei may improve the health status of preschool children suffering from allergic asthma and /or rhinitis a r and omized , prospect i ve , double blind , controlled trial was conducted in 187 children 2–5 y of age . The children received for 12 mo either fermented milk ( 100 mL ) containing Lactobacillus casei ( 108 cfu/mL ) or placebo . The time free from and the number of episodes of asthma/rhinitis after starting intervention were the outcome measures . The number of fever or diarrhea episodes and the change in serum immunoglobulin were further assessed . No statistical difference between intervention and control group occurred in asthmatic children . In children with rhinitis , the annual number of rhinitis episodes was lower in the intervention group , mean difference ( 95 % CI ) , −1.6 ( −3.15 to −0.05 ) ; the mean duration of an episode of diarrhea was lower in the intervention group , mean difference −0.81 ( −1.52 to −0.10 ) days . While long-term consumption of fermented milk containing Lactobacillus casei may improve the health status of children with allergic rhinitis no effect was found in asthmatic children Objective To study , we examined the effect of Lactobacillus salivarius on the clinical symptoms and medication use among children with established allergic rhinitis ( AR ) . Design Double blind , r and omized , controlled trial . Setting Hualien Tzu-Chi General Hospital . Methods Atopic children with current allergic rhinitis received 4 × 109 colony forming units/g of Lactobacillus salivarius ( n=99 ) or placebo ( n=100 ) daily as a powder mixed with food or water for 12 weeks . The SCORing Allergic rhinitis index ( specific symptoms scores [ SSS ] and symptom medication scores [ SMS ] ) , which measures the extent and severity of AR , was assessed in each subject at each of the visits — 2 weeks prior to treatment initiation ( visit 0 ) , at the beginning of the treatment ( visit 1 ) , then at 4 ( visit 2 ) , 8 ( visit 3 ) and 12 weeks ( visit 4 ) after starting treatment . The WBC , RBC , platelet and , eosinophil counts as well as the IgE antibody levels of the individuals were evaluated before and after 3 months of treatment . Results The major outcome , indicating the efficacy of Lactobacillus salivarius treatment , 
    Output:
    
Probiotics may be beneficial in improving symptoms and quality of life in patients with allergic rhinitis ; however , current evidence remains limited due to study heterogeneity and variable outcome measures .