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Introduction
Upper and lower respiratory tract diseases represent the leading cause of morbidity and mortality in pediatrics, especially in age groups under 5 years old, being the main cause of presentation and hospitalization in pediatric emergency services(1-4).
Upper respiratory tract infections are the most common respiratory disease, but also the main reason for the administration of often unjustified antibacterial therapy, taking into account the fact that their etiology is predominantly viral(5,6). Also, upper respiratory tract diseases are responsible for a significant percentage of the progression of pathogenic microorganisms to the lower respiratory tract, in the presence of low immunity and less prompt and effective therapeutic management(7-9).
Prevention of upper respiratory tract pathologies by supporting a balanced immune system can be a real ally, reducing the impact on the lower respiratory tract, but also contributing to the global fight against antibiotic resistance(10-12).
Pediatric respiratory diseases can lead to an overload of the medical system for a long period of the year (fall, winter and spring). Certain age groups are more frequently affected (infants, toddlers and preschoolers), the reasons being multiple(13):
- immaturity of the immune system in the first part of life;
- often overcrowded communities, such as nurseries and kindergartens;
- age-specific psychomotor development, which makes little ones put objects around them in their mouths;
- inability to maintain adequate hand hygiene or to respect the rule of sneezing and coughing(4,14).
In these educational institutions (nurseries and kindergartens), maintaining effective hygiene is difficult, as children are often brought by their parents in the prodromal or onset phase of respiratory diseases. The transmission of these infections is mainly through Flügge droplets, which can persist on surfaces, objects and even food(4,5).
The long-term effects of repeated respiratory infections are not negligible:
- prolonged absence of the child from school, with negative repercussions on the educational preparation process;
- repeated hospitalizations that produce costs in the medical system;
- parents are forced to take sick leave to be able to care for the child, an action that affects the family budget;
- the possibility of losing their job due to repeated absences;
- chronic complications specific to each respiratory condition(3,10,14).
All these reasons make the study of the immune system – especially in the context of respiratory diseases – of interest nowadays, especially when environmental factors leave their mark on health and everyone, especially on parents, who want natural but effective alternatives for prevention(15-17).
Nutraceuticals (defined since 1989) are those natural products isolated from foods that are marketed in medicinal forms, with beneficial pharmacological effects. When a nutraceutical product demonstrates its immunomodulatory capacity, it becomes an immunoceutical. (e.g., mushroom polysaccharides, omega-3 fatty acids, zinc, selenium, vitamin D3)(15,16).
Beta-glucans, known as regulators of biological response, represent an extensive class of complex polysaccharides that can be found in an abundance of sources (e.g., plants, mushrooms, yeasts, etc.)(18). Depending on their origin, they are classified as cereal-derived and non-cereal-derived.
Structurally, they are glucose polymers linked by different types of beta glycosidic bonds. The beta-glucans from Pleurotus ostreatus have a beta-1,3-glucan configuration with beta-1,6 side chains, a structure recognized by receptors on the surface of immune cells(25).
Among the naturally occurring compounds, fungal beta-glucans are among the most studied, with demonstrated pleiotropic biological activities. There are 20,000 published studies confirming their beneficial effects in numerous conditions(18,19).
On a large scale, fungal beta-glucans have begun to be increasingly used as immunomodulators, especially in countries with significant socioeconomic development, including the USA (since 2007), European countries (2009), Canada, China or Japan(20-22).
Beta-glucans extracted from the Pleurotus ostreatus mushroom have been used in traditional Chinese medicine for centuries, and are mentioned in manuscripts dating back approximately 500 years in India(19). In Egypt, the first record of the name of mushrooms is linked to the god Osiris, and their anticancer properties were demonstrated more than 80 years ago by Lucas(23,24).
In recent years, the specialized literature has increasingly highlighted the anti-inflammatory, immunomodulatory, hypoglycemic, antibacterial and antiviral properties of beta-glucans (Figure 1)(25-30). Also, studies conducted on animal models have demonstrated that the administration of beta-glucans does not involve the risk of overdose(31), aspect that confirms their safety profile and supports the potential for their long-term use.
The purpose of this article is to highlight the importance of prevention in infectious respiratory pathologies in children, through the use of immunoceuticals, especially beta glucans extracted from mushrooms.
Materials and method
A comprehensive literature search was conducted using PubMed, MEDLINE and Google Scholar for articles published between 2010 and 2025 on the benefits of beta-glucans extracted from Pleurotus ostreatus in preventing and reducing the frequency and number of episodes of respiratory infections in pediatric patients. The search terms were: “beta-glucan”, “Pleurotus ostreatus”, “prevention”, “respiratory system”, “pediatrics”, “children”, “pleuran”.
We included in this search only studies published in English that evaluated the effect of administering a beta-glucan preparation extracted from Pleurotus ostreatus for three months, with careful and subsequent monitoring of the effects in children.
Results
After eliminating duplicates and carefully analyzing the study designs, we analyzed a total of four studies that totaled 1614 children, from over seven countries, of which one study was double-blind control (Table 1). All children who received a pleuran-based preparation for three months associated a significant reduction in episodes of respiratory infections compared to the previous year, but also to the period before the administration of beta-glucan from Pleurotus ostreatus (Figure 2).
A study conducted on 215 children from the Czech and Slovak Republics demonstrated an approximately 50% reduction in the prevalence of respiratory infections, thus the rate of infectious episodes decreased significantly from 8.9 per year to 3.6 episodes per year (p<0.0001) after regular administration for three months of a preparation containing pleuran(12).
Similar rates of reduction in the frequency of respiratory tract infectious episodes, especially among preschoolers, were also identified in a study conducted in Spain, in which pleuran was administered for a period of three months(32).
In another clinical study in Poland, which included 194 children, a significant reduction in all types of respiratory infections was found after regular administration of pleuran compared to the year before administration(33).
Another double-blind study on a group of 175 children demonstrated a statistically significant reduction in respiratory episodes among the study group versus the control group (p<0.05). Also, the analysis of immune parameters revealed the modulation of humoral and cellular immunity (statistically significant)(34).
Discussion
According to specialized studies, viral etiology is the most frequently incriminated when talking about respiratory tract damage among pediatric patients(35,36).
The high number of hospitalizations due to respiratory diseases is a constant reality and overloads the pediatric medical system.
In a study(35) conducted in Italy, 36.8% of hospitalizations were due to respiratory diseases, and the average age was 2.7±3.21 years old. These results are consistent with other research that has shown that the under-5 years old group is more susceptible to respiratory diseases (83.6% of the total study group was represented by this age group)(35).
An important risk factor for infectious pediatric respiratory pathology is represented by crowded environments (nurseries and kindergartens), where children spend a lot of time and human contact is very close. This was demonstrated during the pandemic, when the incidence of respiratory diseases was significantly lower compared to periods before and after the COVID-19 pandemic(37,38).
In the DBPCRT study, beta-glucans isolated from Pleurotus ostreatus demonstrated multiple preventive effects on respiratory tract diseases(12).
Auinger et al. studied beta-glucans from yeast, and they observed a 25% reduction in respiratory conditions in the study group where patients received beta-glucans versus the control group(39).
Sadoughi et al. present, in addition to the anti-inflammatory effect of beta-glucans, their ability to induce apoptosis, with utility in malignant pathologies, supported by many specialized studies(40).
In recent years, numerous studies have been published which have investigated the effects of mushroom beta-glucans on lung inflammation in SARS-CoV-2 infection, reducing the cytokine storm. In an in vitro study, a reduction in inflammation was observed in a lung epithelial model, dependent on the dose of beta-glucan used(25).
The connection between the gut microbiome and the immune system – a hot topic that many studies are focusing on – can also be modulated with the help of beta-glucans from mushrooms(41,42). Thus, the increase of Bifidobacterium bifidum and Lactobacillus acidophilus was observed in patients who received beta-glucan supplementation(43-45).
Increases in interleukin-10 were observed in asthma patients who received mushroom-derived beta-glucans, as well as decreases in immunoglobulin E levels among allergy patients, proving their beneficial effects in allergic pathologies(46,47).
Conclusions
Respiratory pathologies represent an important factor of morbidity and mortality for the pediatric population, affecting mainly young ages and representing one of the main causes of presentation in the emergency department and/or hospitalization in health units.
The use of immunoceuticals – and especially beta-glucans – represents a natural way, with proven efficiency in numerous clinical studies, to prevent infectious respiratory diseases, especially in pediatric patients. The favorable safety profile of beta-glucans and the multiple beneficial effects on health, demonstrated in clinical studies, recommend these compounds as promising immunomodulators.
Of course, more extensive studies are needed on large samples of pediatric patients to highlight the mechanisms of action and the beneficial effects of beta-glucans as multisystemic immunomodulators, but also at the respiratory level (dose-dependent effects and duration of administration).
Autor corespondent: Heidrun Adumitrăchioaiei E-mail: ad.heidi91@gmail.com
CONFLICT OF INTEREST: none declared.
FINANCIAL SUPPORT: none declared.
This work is permanently accessible online free of charge and published under the CC-BY.
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