A Practitioner's Guide to Probiotics: Immune Conditions and Skin Health

Probiotic supplements contain beneficial microorganisms, similar to those found in the human gastrointestinal tract (254). When ingested, these live microorganisms confer a number of health benefits to the host (50). In recent years, extensive research has been conducted on the role of probiotics in modulating the body’s innate and adaptive immune responses as a means to prevent or treat a wide variety of health conditions (10).

Maintaining immune function through modulation of the gut microbiome can help to prevent or treat a wide variety of conditions, including gastrointestinal, respiratory and urogenital infections, inflammatory conditions (e.g., inflammatory bowel disease and rheumatoid arthritis), and other immune conditions such as cancers and allergies (37, 55, 70, 71, 185).

Probiotic supplements may support a healthy composition of bacteria in the gastrointestinal tract and improve immune function by a number of mechanisms, including:

  • Modulation of innate immunity through non-specific responses to pathogens with neutrophils, monocytes, macrophages, and natural killer (NK) cells
  • Modulation of adaptive immunity using lymphocytes such as B and T cells, which act via long-term mechanisms to recognize and destroy recurrent pathogens of the body
  • Regulation of the GI/mucosal immune system to produce innate or adaptive immune activity in protection of the oral-pharyngeal cavity, respiratory tract, gastrointestinal tract, urogenital tract, and exocrine glands
  • Regulation of anti-inflammatory or pro-inflammatory cytokines, such as interleukins, tumor necrosis factors, interferons, transforming growth factor, and chemokines (e.g., lymphocytes, granulocytes, macrophages, mast cells, epithelial cells, and dendritic cells) (10)

While probiotics are now commonly prescribed therapeutically and clinical research examining the relationship between the gut microbiome and immune disorders is becoming increasingly available (103), clear guidelines for clinical application have yet to be established. This is particularly important as the effectiveness of probiotic supplementation may be dependent on the condition, strain, dosing, and duration of therapy (234). 

This guide provides an overview of the available research for the clinical application of probiotics in developing and maintaining immune function in healthy individuals, and in immunodeficiency-related disorders. It includes dosing and administration for single-strain and multi-strain probiotics. 

Note: It is important to note that immune processes relating to the GI tract and of the neurological system have been reviewed in previous articles: Gastrointestinal Conditions and Neurological Conditions. Upcoming publications will review immunity in cardiometabolic conditions, and in conditions specific to urogenital, and oral health.

Download the full guide to probiotics in immune conditions and skin health.

Safety Considerations & Contraindications

While probiotics are considered safe, rare short term side effects, such as gas and bloating, may occur (26). Isolated cases of bacteremia or fungemia have been associated with probiotics, though population data also indicates that there is no widespread risk of these complications (218). 

There is some limited evidence that probiotics should not be administered in critically ill patients, as demonstrated by an increased risk of mesenteric ischemia and mortality in a trial of patients with predicted severe acute pancreatitis (16).

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