Today I saw a baby with diarrhea. While investigating the cause, the parents mentioned taking probiotics. They had loose stools with mucus after taking them, but they stopped taking them. This time, they started taking them again, and the diarrhea returned . The last time, the diarrhea was short-lived, and the probiotics stopped, but this time, it hasn’t healed.
Although probiotics as a cause of child diarrhea are not mentioned in the diarrhea chapter of textbooks, and we usually know that probiotics can be used to treat diarrhea (such as antibiotic-associated diarrhea , etc., to relieve the course of the disease for half a day to one day), for this baby, based on the medical history and excluding other problems, the diarrhea is caused by probiotics.
The parents also provided the explanation from the probiotic manufacturer, suggesting it might be a Herxheimer reaction
When I saw this, I was stunned. How could probiotics be used to treat the reaction during syphilis treatment? Is this explanation correct?
What causes Child diarrhea?
Does it mean as the picture above says that babies with allergies need to use probiotics continuously for more than 3-6 months?
Let’s talk about it today.
Simple and rough version
The Herxheimer reaction is an acute inflammatory reaction that occurs within 24 hours of antibiotic treatment of infection, when pathogens decompose toxins and release cytokines, and cytokines and lipoproteins enter the patient’s blood.
After taking probiotics, adverse reactions such as diarrhea may occur, which may be caused by abnormal metabolism caused by probiotics and has little to do with the Herxheimer reaction.
Therefore, there is no need to stop taking probiotics for a long time just because of this reaction. There is no clear evidence that long-term probiotic use can relieve or treat allergies.
1. What is the Herxheimer reaction?
The Jarisch–Herxheimer reaction, formerly known as the Jarisch and Herxheimer reaction or the Jarisch and Herxheimer reaction, is so called because the reaction was discovered by Jarisch and Herxheimer.
When these two physicians used mercury to treat syphilis, some patients developed sudden high fever and worsening rash. This reaction also occurred when they used arsenic to treat syphilis.
This symptom was later observed in syphilis treated with penicillin , with symptoms including fever, chills, rigors, nausea and vomiting, headache, tachycardia, hypotension, hyperventilation, flushing, myalgia, and worsening of skin lesions within 24 hours of treatment.
At the same time, this symptom can occur not only in syphilis, but also when antibiotics are used to treat leptospirosis , Lyme disease , and relapsing fever .
The pathogenesis is currently unclear, but it is believed to be related to the decomposition of spirochetes after the use of antibiotics, leading to the release of toxins and cytokines.
Cytokines and lipoproteins enter the patient’s blood, leading to an acute inflammatory response (dilation of small blood vessels and capillaries, dermal edema, and perivascular and interstitial infiltration of polymorphonuclear round cells and leukocytes). Symptoms usually begin 2 hours after the start of antibiotics and resolve within 24 hours.
2. Child Diarrhea after taking probiotics, should Herxheimer reaction be considered?
When searching for probiotics and Herxheimer reaction in the medical database, only one article was found. It was about an adverse reaction of using probiotics to treat autism in China. In the study, two patients (2/37) developed diarrhea after taking probiotics for one week. The adverse reaction disappeared after the third week of continuous use. It was considered that it might be due to the Jarisch-Herxheimer reaction.
The child diarrhea here appears after 1 week and improves after 3 weeks. At the same time, some promotional texts for probiotics also state that symptoms will appear within a few weeks after using probiotics and will subside with continued use. These are inconsistent with the Herxheimer reaction, which usually appears and subsides within 24 hours.
Why does this symptom occur? The probiotic manufacturer explains that probiotics have to fight against the bad bacteria in the intestines. After the bad bacteria die, the toxins or inflammatory mediators released cause symptoms. Then, these bad bacteria gradually die, the symptoms disappear, and then the probiotics become effective. Therefore, it takes 3-6 months to take effect on probiotics.
The above statement of classifying the adverse reactions of probiotics as Herxheimer’s reaction is incorrect. It is based on imagination and analogy. It seems reasonable and can allow people to use probiotics for a longer period of time, but there is no evidence to support it and no scientific support.
At the same time, it is difficult for parents to disprove this statement. If there are problems with the use of the probiotics, they will not consider it to be a problem with the probiotics, but a normal phenomenon. If there is no improvement after continuing to use the probiotics, it means that the probiotics have not been used for a long enough time, and they will not blame the probiotics. It is a very universal statement.
Oh, by the way, there is currently no evidence that using probiotics is effective for allergies, and there is no evidence that they need to be taken for 3-6 months. Please remember this.
3. Why does probiotics cause child diarrhea?
Adverse reactions caused by probiotics are rare, but they still exist. Currently, there are four main types: infection, abnormal metabolism, excessive immune stimulation, and gene transfer.
Diarrhea is caused by abnormal metabolism . After using probiotics, they will separate and dehydroxylate bile salts during the colonization process in the small intestine. The unconjugated bile acids formed will stimulate intestinal peristalsis and secrete more water into the intestine, leading to diarrhea and intestinal damage.
In addition, some studies have reported abdominal cramps, nausea, loose stools, and flatulence after using probiotics
Finally, adverse reactions after using probiotics are not necessarily caused entirely by the probiotics. They may also be related to other substances contained in the probiotic products. This is difficult to explain clearly. In short, just stop using them .
Finally, let me say again that there are very few adverse reactions after taking probiotics. Probiotics are still a good thing. After they are thoroughly studied in the future, they will definitely be of great help to humans. It’s just that we don’t know how to use them correctly now, and we don’t know in which situations which probiotics are effective.
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