The Microbiome and Its Role in Asthma & Allergies (Recording & Recap)

The human body is home to trillions of microorganisms, collectively known as the microbiome. While we often associate microbes with disease, emerging research suggests that a diverse and balanced microbiome may be crucial for preventing allergies and asthma.

Niraj C. Patel, MD, Associate Professor of Pediatrics at Duke University Medical Center, recently shared fascinating insights on this topic in a webinar hosted by Allergy & Asthma Network.

The critical window of opportunity

“Early exposure to diverse microbiomes from birth to one year of age is essential for a protective effect,” Dr. Patel emphasized. This period represents a critical window when the immune system is highly malleable.

Exposure to a wide variety of environmental microbes during this time appears to “train” the immune system, potentially reducing the risk of allergic diseases later in life.

Farm life and the hygiene hypothesis

Intriguingly, studies have shown that children growing up on farms have a lower incidence of allergies and asthma. Dr. Patel explained: “Farm-like exposure is protective against the development of atopic disease — eczema, allergic rhinitis, asthma.”

This observation lends support to the hygiene hypothesis, which suggests that our increasingly sterile environments may be contributing to the rise in allergic conditions.

The gut-lung axis: a two-way street

One of the most exciting areas of research is the emerging understanding of the gut-lung axis. “There is a plethora of data showing that the gut and the lung communicate,” Dr. Patel noted. This bidirectional communication means that the health of our gut microbiome can significantly impact respiratory health and vice versa.

Microbiome interventions: promise and challenges

Can we harness the power of the microbiome to prevent or treat allergies and asthma? Several approaches show promise:

1. Probiotics and prebiotics. These may help establish a diverse, healthy microbiota.
2. Dietary fiber. High-fiber diets promote the production of short-chain fatty acids, which have anti-inflammatory effects.
3. Fecal microbiota transplant (FMT). While still experimental, early studies suggest FMT may help modulate the immune response in some allergic conditions.

Dr. Patel cautioned that many questions remain. “We still don’t know what the optimal timing, dose, or strain combinations are for these interventions.”

The future of allergy and asthma treatment

As our understanding of the microbiome grows, it may revolutionize how we approach allergic diseases. Dr. Patel highlighted an intriguing possibility: “The ultimate question is, can biologics affect the microbiome and interrupt the atopic march?” While more research is needed, the potential to prevent the progression of allergic diseases is tantalizing.

In conclusion, the microbiome represents a promising frontier in allergy and asthma research. By fostering a healthy, diverse microbiome — especially early in life — we may be able to reduce the burden of these chronic conditions.

As Dr. Patel aptly put it, “Location, location, location” matters not just in real estate, but in the microbial world within and around us.

This webinar was recorded on February 25, 2025

Speaker:

Niraj C. Patel, MD, MS Pediatric Allergy and Immunology

Dr. Patel is Associate Professor of Pediatrics at Duke University Medical Center in the Division of Allergy/Immunology. Dr. Patel received his medical degree from the University of Louisville. After completing his residency in pediatrics also at the University of Louisville, he went on to complete fellowship training in both Allergy and Immunology and Infectious Diseases at Texas Children’s Hospital, Baylor College of Medicine in Houston, TX. During this time, Dr. Patel also received a Master’s Degree in Clinical Investigation. Dr. Patel is a member of the Clinical Immunology Society; the American Academy of Allergy, Asthma, & Immunology; the American College of Allergy, Asthma and Immunology; and Infectious Disease Society of America. Dr. Patel has been an author/coauthor of articles published in several peer-reviewed journals, including New England Journal of Medicine, Journal of Allergy and Clinical Immunology, and Journal of Clinical Immunology. Dr. Patel served as Chair of the ACAAI COVID-19 Vaccine Committee and was awarded the ACAAI Distinguished Service Award in 2021. His academic and clinical interests include primary immunodeficiency diseases and infections in immunocompromised hosts. Dr. Patel enjoys spending time with his wife, gardening, karaoke, chauffeuring his 3 children around town, and is a national Gold Medal Champion in Tae Kwon Do.  

This Advances webinar is in partnership with the American College of Allergy, Asthma & Immunology. ACAAI offers CMEs for physicians for this webinar. If you are a member of ACAAI, you can obtain CME through the member portal for Advances webinars.

All attendees will be offered a certificate of attendance. No other continuing education credit is provided.

CME is available through ACAAI for this webinar.

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Sponsored by the American College of Allergy, Asthma and Immunology

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Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

De De: Hello, everyone, and thank you for joining us today! I’m De De Gardner, Chief Research Officer of Allergy & Asthma Network, and I’m thrilled to welcome you to this afternoon’s webinar. We have an exciting session, and I’m delighted to introduce today’s presenter, Dr. Niraj Patel. With his extensive knowledge and experience in immunology, we’re in for an engaging and informative session! We have a few housekeeping items before we begin today’s program. First, all participants will remain on mute during the webinar. We will record today’s session and upload it to our website within a few days.  You can find all our recorded webinars at allergyasthmanetwork.org. Please scroll to the bottom of the page to access our recorded webinars and any upcoming events. This webinar will last for one hour, including time for questions. We will address those questions at the end, but you can submit your inquiries in the Q&A section at any time. The Q&A box is located at the bottom of your screen. We have someone monitoring the chat in case you have questions or need assistance. We will answer as many questions as possible before concluding today’s webinar. This Advances webinar is in partnership with the American College of Allergy, Asthma, & Immunology. ACAAI offers CMEs for physicians and attendance credits for all others. You can create a free ACAAI account and obtain CME or attendance credits through the member portal for Advances webinars. All attendees will be offered a certificate of attendance. No other continuing education credit is provided. A few days after the webinar, you will receive an email with supplemental information and a link to download the certificate of attendance. We will also add the link to the certificate in the chat. So, let’s get started! Today’s topic is The Microbiome and Its Role in Asthma & Allergies. The microbiome, particularly the gut microbiome, plays a significant role in the development and progression of asthma and allergies, with research indicating that an imbalance in the microbial composition (dysbiosis) can contribute to increased allergic responses and airway inflammation, potentially through its influence on the immune system development early in life. Today, we will discover how the diverse community of microorganisms in our bodies influences respiratory health and immune responses. It is my pleasure to introduce our speaker, Dr. Niraj Patel.

Dr. Patel is an Associate Professor of Pediatrics at Duke University Medical Center in the Division of Allergy/Immunology. Dr. Patel received his medical degree from the University of Louisville. After completing his residency in pediatrics at the University of Louisville, he completed fellowship training in Allergy and Immunology and Infectious Diseases at Texas Children’s Hospital, Baylor College of Medicine in Houston, TX. During this time, Dr. Patel also received a master’s degree in clinical Investigation. Dr. Patel is a member of the Clinical Immunology Society, the American Academy of Allergy, Asthma, & Immunology, the American College of Allergy, Asthma and Immunology, and the Infectious Disease Society of America. Dr. Patel has been an author/coauthor of articles published in several peer-reviewed journals, including the New England Journal of Medicine, the Journal of Allergy and Clinical Immunology, and the Journal of Clinical Immunology. Dr. Patel served as Chair of the ACAAI COVID-19 Vaccine Committee and was awarded the ACAAI Distinguished Service Award in 2021. His academic and clinical interests include primary immunodeficiency diseases and infections in immunocompromised hosts. Dr. Patel enjoys spending time with his wife, gardening, karaoke, and chauffeuring his 3 children around town. He is a national Gold Medal Champion in Tae Kwon Do.  Thank you for being here, Dr. Patel. I will turn it over to you.

Dr. Patel: I’m excited to talk about updates in the microbiome and how that is applicable for practicing immunology. This is something my relevant to my disclosures but none of the disclosures that are here are relevant for this Here are the learning objectives. Recognize that the environmental microbiome only contributes to the human microbiome. I will show you some data. One of the take-home messages is that this occurs early, including birth to one year. It is a critical period and a way for the body to obtain healthy microbes and immune tolerance. That is to contrast objective two to identify the microbiome that can be a source for genetic still HRAEULGS and lead to disturb the cyst and all genomic asthma and seems to be. Then I hope you to be able to find the result. The microbiome is vast. It refers to a collective genome and microorganisms. A good way to think of the microbiome is two types. T The micro biome within us and on us in terms of skin, gut, and the tract. You’re RAOEFRT a, vaginal tract and more. Microbiomes are the Mike KROBS like viruses, Justin  — fun bacteria and metabolites, structural molecules surrounding the environment. We will talk about will you the micro biome may impact the human microbiome. T The microbiome plays a critical role. I will show you data there can affect the development of asthma and allergy diseases. Before we dive in to talk about the micro pie only, it is important to understand all the definitions.

The microorganisms that are fungi and the microorganisms that are in our body. The microbiome is the entire habitat. This is an evolving field, but this is the study of the micro biomes of molecules, biological samples. I think this is the only slide I have on the different technologies used to study the microbiome. I don’t want to delve into that because I don’t think it was very helpful outside of just knowing that the way the microbiome is studied today is not based on culture results. Long gone is when you take samples and try to culture it. We really would only be able to sample about half of the microbiome, maybe less. So, since the last can be decades there have been advances in microbiome, and you can see from just biological samples now we can detect the D.NA from bacteria or samples and book do RRP R.NA. Some are genomics and meta-BIOMICS to determine structures, including pathogens. Why is this important? One thing to keep in mind is that were of what — much of what we have on our bodies is obtained from the environment and happens very early. In fact, in utero we get about 70 utero when we are born. Vaginal delivery will lead to much more microbes. Breastfeeding, there is bacteria in breast milk and that is passed along to the baby. The type of diet during pregnancy to a year can impact environmental microbiome and antepartum, there is the suggestion that the buy optics that the mom receives while the back is in utero or in delivery can impact the micro buy only of the infant.

From child to adulthood, we are accumulating changes to our microbiome. I want to let you know in early life this seems to be the most important so later on while our microbiome KHRAEUPBLGS it seems to have less of an impact and in terms of healthy microbiome and we are talking about day care attendance or getting things from the environment, pets. There’s a study about co-housing. Then work. We will talk about the farm and why farming is important and how some of this data came from farm life. One thing you may ask is what is the role of the microbiome in immune training. There’s a dealership between early life and older childhood and adult. The theme here throughout the attack is early is better. In very young infancy and first year or two of life the immune system is very plastic and exposure to microbes particularly good environmental microbes can reverse some of the things we see in atopic disease. TH2 skewing, unfortunately, a lot of the data we have especially the last five or 10 years are preclinical so these are animal model but there are some data I will show you that are coming into play and some huge clinical trials. In older childhood and adult, we become less tolerant. That is where allergic diseases are increased TC4 and less tolerance for the environment. It doesn’t really start or doesn’t have to stop there. Pregnant mothers, it is data with microbiome being administered in pregnant mothers that led to altered CD4 and T regs in a positive sense.

Microbiomes in early life is very important that it starts at birth, influenced by breastfeeding and consolidation in areas like the skin, gut, and the respiratory tract. There is a critical window electric early special its diverse microbes in some studies reduces asthma and allergy Risk This may explain some of the hijack gene hypothesis and where — hygiene hypothesis with excessive cleanliness can hinder the immune system training and lead to a higher exposure to general — antigens and less immune tolerance. When our body sees environmental microbes, we can either see that in two different ways. On the left-hand side is a tolerant immune system. Where you have a host microbiome population, the immune system training. This tends it reduce allergic disease risk. The opposite way it can be viewed is reactive. That typically is later on in life. The microbe as soon or predisposes to antigenic stimulation, response to infection and this model due let’s it refitment certain things in the environment can contribute so who you are is around like family, diet, food, soil, home, we talked about farm and urban environments, and geographic. Urban environment, rural, and pollution. At the bottom is a continuum. This do not stop. In utero is exposure. There’s a critical window from birth to the first year, then childhood, adulthood and later. This is a study and chart that comes from looking at infants and children in the development of E.O.E. What this is trying to show on the X axis is sort of a team line with prenatal, intrapartum and postnatal what increased. Even from the start of prenatal you see maternal fever preterm delivery, KRRPBLT section as you imagine compared to vaginal. Postnatal how it might affect the microbiome. Post preps that we can share. All of those things were studied and looked to increase the risk of E.O.E. Most of our human microbes are inherited from the environment. It was shown even as adults, living together with each other as with house in a group of about 1,000 healthy they were genetically unrelated. People will share same living quarters will a similar gut microbiome. Humans that shared the same homes with pets will similar fecal, or a skin microbiome in the house both with each other and with their pets. This is a figure showing the human microbiome. As artillerist we can think of them as separate into three categories, one is the skin. As you can imagine the skin will be involved in atopic disease.

Within the respiratory tract. You can imagine that is associated with asthma. Then the gut which is really associated with both atopic and asthma but has an impact on food allergist. What it shows is that there’s lots of organisms that colonize different areas of the human microbiome. When the different microbiota has an adverse impact increase risk for Atopic allergic and asthma disease is shown with a red up arrow. If you look at the skin, staph and influenza and others and the arrow was green downside, or down pointing arrows are her risk. Some of the most common ones studied are look to be bad sill his and BIFADO bacteria. Segregating these parts can help with understanding diseased that we deal with every day. There are plenty of f actors that affect the microbiota. If you look in four separate areas there’s diet, medicine and health amount lifestyle and other factors. What this figure shows or is trying to show is that there’s multiple things in our environment that can affect our microbiota. Some of them can increase the risk for arm genomic decease appear asthma and some can reduce the risk. With diet there are differences between fiber and traditional cooking homemade food which can reduce and improve gut microbiota versus junk food. There are things we talked about mode of delivery with the idea is not to go over every idea but to let you know that there’s a lot of environmental influences and I think that these are all areas that we can look at in terms of places to home in on and study. I mentioned farm life exposure is protective. It is because we have some of the Post prevalent data has come with farm life exposure you think of rural areas that are away From environmental pollutants and things that we think about in terms of urban environments you will see that in many of these studies that have been replicated growing up on a farm has a protective environment against the development of atopic disease, eczema rye night it’s. Studying the indoor dust mite of we will go through some of these have been found in gut microbiomes of children but more importantly tease were children that had a protective effect from allergic diseased. Then you can see in terms of lung inflammation, air whiner responsiveness in mice these bacteria in cow sheds where they go and underneath protective areas in terms of inclement weather or feeding having these bacteria have a protective effect. So, some studies looked at trying to create a farm lake environment in an urban setting. Studies looked the at wearing shoes at home and some correlated a farm lake Microbe biome with a true farm in terms of soil underneath the shoes, bringing soil-derived microbial exposure. Pet owner and animal exposure may provide protection, but it is impossible to try to tell our patients to go live on a farm or convert their house to a farm, so we need to have a better idea.

I would like to know change gears and talk to you about actual allergic diseases. We will talk about asthma, talk about eczema, dermatitis and food allergist and how does the human and microbiome impact these diseases. Going with the farm and farm lake theme, in terms of asthma, being around a farm lake environment had a protective effect for asthma. In farms in touch with house dust mite samples in the first year of life correlated with a degree of protection and not only living in a farm or farm lake environment but some is timing of exposure. We know that in the first year of life is where a lot of the human microbiome is established with the environment and there seems to be a higher degree of protection when the exposure occurs early on in life. If you look at the same bacteria we talked about the previous slide and look at dust they colonize nasal and gut they could be associated with reduced asthma risks. Farm lake indoor environments have more things that are affiliated with Hoover hoofed animals and fewer human associated microbes were less likely to infect humidity would be — humans would be farm lake indoor environments. Some are like microbes we see on Hoovered animals like compared to once in museum who are staff and strep. They are less likely to infect humans because colonization like certain bacteria human coccus and others plus viral illnesses can increase the risk for allergic diseases including asthma. What about urban. There’s a change in microbiome that occurs in the gut, in the respiratory tree but the bottom line is the gut microbiome compared to farm like has reduced types of bacteria. VELLONIA and increased others and if you guess the good bacteria reduced the ones that are more likely to induce allergic disease. Same for house dust in urban environments, nasal microbiome. Overall, the increase seems to be higher for asthma in Anirban environment. What you also see is that the risk is dependent on age of exposure. If you look at high allergen exposure in-house dust at one year of age that is associated with her risk of asthma so not only is the critical age up to a year but exposure to a wide variety of bacteria and allergens seems to — all allergens seem to be protective. Talking a little about the gut one of the things that is important the gut has been probably the most well studied in terms of microbiome portion so we are learning more about the skin, respiratory but not only is the gut microbiome the most well studied but I will show you data that this Connecticut verse — converses or communicates with the skin or lung so there is this lung access and if that gut-lung access is destroyed or interrupted it has impact for long disease including asthma, skin and atopic dermatitis Some data shows the gut appear lung communicate in particular when you digest fiber it has been good helps establish a good gut microbiome. Fiber helps break down the gut in short contain fatty acids.

They are important for a healthy microbiome. It is produced by gut bacteria and shown to reduce inflammatory making. In patients or persons with reduced short chain fatty acids who have a disruption in gut microbiome taking antibiotics and so on can impact the short chain fatty acids were the short chain fatty acids in the gut if reduced can impact what is going on in the lungs because of the gut long access. It is linked to asthma and overgrowth of bacteria can exacerbate allergies. Remember the figure I shed you there is bacteria in the gut, some become tear himself her the risk and some increase. Here is the gut lung access. This plays a key role in the development of asthma. If you a look straight at the gray figure in the middle you see her end the gut and red arrow from the left, green arrow from the right. What happens is that there could be two different signals. If things are going well at the gut and there is home, you home your stasis it has a good relationship with the lung. You see that with the green arrow pointing to lung. That is typically reduced airway inflammation. I want to get you there. Then you can see that red arrow poisoning from the gut to on the left-hand side to the red lung is increased airway information. Take a look to the right of that. There’s a picture of a gut then a PWURPLG of different — a bunch of metabolites and chemicals. This is a healthy gut lung access when you have the breakdown products of fiber histamine has an important role in communicating between the gut and the lung in terms of allergic disease. There are other components shown that plenty in normal amounts they could help a healthy gut microbiome and target the lung for healthy lung microbiota and reduced airway inflammation. Contrast to left, you don’t see SFTH. You see breakdown like 1, 2, 1, 3, which is a pro-inflammatory chemical. What you see is breakdown of the gut bear your offer where you see increased permeability. When you have that you get tab lights that then go into, that cross the gut barrier. That disrupts the gut microbiome and when it does that that sends signals through the gut lung access and can increase airway inflammation. What I will show you is some data that shows you exactly that. When you look at patients with asthma and what is going on in their lungs it recaps plates what is going on in their gut. There is a slide on top that shows you asthmatic versus healthy children of lung microbiota. You see on the right-hand side you see in blue are the micro biota that have Been associated with reduced asthma its children. If you look on the left-hand side in red those bacteria have an increased risk when present in high amounts for increased risk for asthma or more dangerous disease weren’t — disease. [The — had the bacteria associated with inflammation thread more evidence of inflammation and evidence of IO4 and IO5. It doesn’t matter what we breathe, where we are located, we do know after a year of life and this is children, adults, that environmental exposure, particularly high environmental exposure beyond early life is associated with increased asthma symptoms, increased severity. We know in the urban environments and school environments studies have shown high levels of bacteria, fungi but the environment you might age. Age of school buildings, high humidity level with figment air conditioning can all shape the environmental microbiome and that is important because whatever is going on in the environment, we colonize in the human environment, which is natural. Fungi more than bacteria may play a stronger relevance in asthma. We don’t know as much about the financing guy. Most of the study have look at bacteria. But this is also the southerner with EBPA and immune deficiencies, an invasive disease.

But in allergic airway response seems to have a predisposition to inducing a strong airway response and can correlate with severe asthma a fungal sensitization. There is certain fine know types of as pa that may be predisposed to worsening response of disease based on what is in the environment. I think this is well known for all of us. But there may be a few things to take away from here. We know about asthma risk from infection. Some call this the environmental viral. We know viral represent the largest driver of asthma exacerbation and RHINO is demonstrate and exposure early in life can impact asthma risk 10-fold by the time you are six years of age and early on infection. Infection in that critical area after the critical area no level of infection is beneficial for the human microbiome. Infections less than three months of age is associate with high risk of asthma and more severe respiratory infection has more consequence than a mild infection and may be related to destruction of good bacteria. We know that strain variation plays a role not just RHINO virus, but the type can impact the risk of asthma and early consolidation, these are the top three bacteria that colonize humans in the upper respiratory tree and the same three that are the three most common of O tight its sign knew site it’s and pneumonia. So, consolidation — colonization can have an increased risk for not only setting yourself up for disease but increasing the risk for asthma. Other bacteria like a common skin Flora but seems to be in the environment certain times of obstacle coccus. Such it the airways is OK but, on the skin, doesn’t seem to be. This is not necessarily S STAPHORIUS. We will move to the skin microbiome. This one to me makes the most sense because we see this in clinical practice. These are an imbalance in skin microbiota. Most of these have staphylococcus aureus and we know the colonization rates are high and increased allergic sensitization. Healthy microbiotas maintain skin into integrity. Remember that picture I shed you of the gut and when you have a breakdown of the barrier of the gut you can have things that invade. Same for skin barrier destruction. So, maintaining skin barrier function is very important what. is known by atopic DERM and microbiome. STAPH content it is associated with atopic determine tight I it’s. It lives on unanimated objectives. 20% of the population have it living in their nose is you can see how this would be easy it passes on from person its person. Interestingly farm exposure is associated with a decreased risk for atopic dermatitis. Environmental diversity is associated with increased likelihood of atopic dermatitis. We though TH2 skewing leads to severe viral inspections with atopic dermatitis. We have heard of these. We may just not have put appear so, with how these can affect at atopic DERM we know about eczema being associated with HSV but staff and STREP not only boils and abscesses but things like COCAKI virus and they can lead at the steer infections in patients with atopic dermatitis an TH2 skewing can increase risk for atopic dermatitis so the micro biome in each especially the skin can play a huge role. What about allergic rye night it’s it is probably least known and studied in terms of disease in the micro biome. I’m going to son like I’m beating a dead horse but early diverse environmental microbiome PRERPBTS allergic rye night it’s. It does seem it protect against allergic rye night it’s and that is still being worked out going to farm exposure because we have most of the data in farm it is protective fence allergic rhinitis. We will change gears, and I think this is something that burgeoning with potential studies, data and the reason is it makes sense for the gut microbiota might have an impact on food, sensitization, timing an even food allergy treatment. They differ between children with food allergy versus non. Children with egg allergy will less diversely gut microbiome. Infants with milk allergy will narrow row gut nor are. So can we do anything about this and intervene early enough and change the natural history of food allergy sensitization. I want to let you know that all is not lost. There are trials in gut microbiome at attachment one of the things about the microbiome different than other diseases is most of the data and studies that are done are this is sort of preclinical. So, a lot of these are epidemiological studies looking at correlations, some are mouse models, so we are just starting to get into real clinical trials, and I think this is going to be fasci fascinating.

We will go over a few of those shortly. The gut microbiota is associate with food allergen infants with milk allergy and particularly gut becomes tear that is helpful by age it three it six months later resolved milk allergy by eight years of age compared to those who didn’t have it, bacteria. A Japanese study showed those are reduced stool microbiome that developed other allergy compared to nonfood allergic so what was present in the G.I. and stool made a difference. A Canadian study shows for each 25% increase in gut microbial diversity at three months of age so really early was associated with a 55% reduced risk of food sensitization by skin protesting by one years of age. Food allergy a gut microbomb we talked about C section; vaginal delivery seems to be better, but its C section doesn’t seem to confer risk for food allergy. Breastfeeding is beneficial. Older siblings and pets are protected so what is around you farm lake effect the yielded mixed results in this particular disease statement we any in certain communities’ traditional lifestyle was associated with reduced food allergy so maybe less processed foods. This shows you a pathway that may explain why the gut microbiome is so important from an immune standpoint, healthy compared to those with food allergies. On the left-hand side at the top you can see where there’s a group of bacteria that says healthy microbiota seen by the enema yum. Then you see ACFA that is protective. You see a T cell response. T regs are being educated. What I want to point out is that on the healthy side on let it is regulating or downplaying what is going on with food allergist so directly done regulating at the bottom of the healthy it produces IG antibody that can be protective in blocking the that doesn’t happen with a fad allergy. There is an allergic microbiota. It stimulates mass cells IO4. I won’t go into a whole bunch, but you get down regulation, T reg and more I.G.E. so there seems to be a stark difference between immune system in a food allergy patient and a healthy patient. What we are interested in is are their interactions it present and treat diseases. We know about breastfeeding and in certain mice changing supplemental fiber to ACFA can help induce immune response. That is seen in sort of fawn allergic or no asthmatic. You might think if you are destroying bacteria, you might get increased inflame station, but it looks like the overall result tends to be less inflammatory, but it hasn’t been well studied in the microbiome effect on allergic diseases so thing more to come. When you are just looking at the analysis and what can we do to intervene. We are still not there but on the left-hand side there is objectionable which some of the data I showed you is observational. In the middle there’s a functional analysis. I mentioned some studies on mice and there are some in vitro but with we want to know are their interventions that work in humans. That is on the right-hand side, the clinical trials meet there is diet. We will tack a little about that but most of these trials are still in infancy but data is coming out monthly. So, what — most of the studies are looking at the gut microbiome. It is harder to do the skin or lung.

There is diet and high fiber, single symbiosis. Pro Probiotics so if you talk about therapeutic intervention just getting started you can encourage patients it incases fiber, terminated foods, reduce processed foods. What we don’t know is the impact on asthma exacerbation, the severity of asthma, impact on food or subsequent sensitization. But this is met easy to do and relatively simple dietary fiber how that might help with reducing that. Children were given yogurt  the first year as it increased good metabolites in their stool and reduced environmental food allergens by the time they were 3 to 6 years of age, so some have gone with intervention looking at the development long-term. What about probiotics. This is project — they are the most commonly studied and they establish diverse healthy microbiome there’s quite a variety of probiotics. They don’t all work the same, but they can be — there have been studies shown to promote antigen nick sensitization Ent we still don’t know how it uses them or optimal dose. There was a study in 2015 by the World Health Organization giving probiotics in the last trimester of pregnancy and in breastfeeding and eczema was significantly decreased. Interestingly, there was no change in the appear food allergy. A test of 422 children with double Brooklyn trial and probiotics seemed to reduce the exacerbation by a third so that was promising in terms of probiotics for allergens. These are from terminated gut there have been a few trials with some mixed results. There’s a meta-analysis showing a potential reduction in the risk of section ma development but in the as movement symbiosis is the combination of pro and prebiotic supplements a good example is the breast milk. There have been studies looking at amino acid formulas appear to be beneficial appear looking at there’s been a shift in gut biome to a healthier profile. A multiple-centered trial looked at 90 infants with atopic dermatitis. They had reduced asthma when given formulas with this. It is one of most transplants. We do there for C DIF. The questions are lots. Who do you get it from, how you transfer it. There has been within study done at b children looking at gut microbiome after FMT was given and showed a positive effect in terms of changing the gut microbiome a reduced risk for food allergy. There was one study that came out of that showing children peanut allergic they give them up to half a peanut, gave patients the Facebook al micro b biota transfer it was a frozen pill at the took orally and followed those patients, did challenges on those patients and they were subsequently able to tolerate up to two peanuts so quite a change just from changing the gut microbiome. We will talk about what is the new he was kid on the block almost Jack Nicklaus — bio almost genomics. This is a topic DERM. There’s been a couple studies as know it is approved for atopic dermatitis down it six months of age and there have been positive results. It was given to 10 adults, 12 weeks increased the skin diversity, increased hydration so maintained the barrier severity index. 71 parents with moderate to severe atopic dermatitis reduced just after three days. More importantly, a 10-fold increase. So, we have biologics coming up all the time.

Can they affect the microbiome, and it is yet to be seen. On the right-hand side, it the middle you can see the micro biome STAPH appear causing IO5, IO13 and you see the biogenetics that may have impact to potentially interrupt the atopic march. Anything is possible but we just have to wait to see. Challenges include personalization, who will benefit from these interventions. How do you personalize it. What is really going on in these accesses, gut, lung, long-term studies in terms of pre and post biotics and fecal transplant and we feed better ways it improves microbial sequencing it better tailor appear even the playing field. In summary, number one the microbiome I hope I have shown you is crucial for protect against or contributing to the development of asthma an allergic diseased technically early exposure. Early exposure it a diverse range of microbiomes from birth to one years of age is essentially for protective effect. As when age environmental antigen backs our foe, and exposure can disrupt microbe accurately balance which is associate with asthma an article gist. There are potential therapeutic approaches targeting the microbiome including prebiotics, probiotics, and some data look promising. Ongoing research is necessary. Transmittal treatment aimed to mo. model. So, keep tuned to things that are coming up the pipeline. With that, here are some college resources. With that, I really appreciate your attention. I will turn it back over to De De the Q&A.

De De: We want two ask you to go back it slide 22, might be 23, with the, we were looking at the slide with the different colors where you had the different microbiome on being allergic — this one because we believe that the internet might have dropped a little bit so right in the middle we lost you for a few seconds. With your mind reaping so we have it on — repeating.

Dr. Patel: Is that the only time it dropped? Perfect. >> This is trying to see that with you see in the lung, the microbe ideal in the lung is associated with an increased risk of asthma in asthmatics to no asthmatics. In the blue bacteria are associated with a healthy microbiome. In those patients, they didn’t have asthma, you can see that the bottom these are from B. A.L.’s very little inflammation in fact, no inflammation, known IO4 or IO5 compared to the left-hand side We any bacteria associated with reduced healthy microbiota are associated with increased asthma, increased inflammation, including IO4 and IO5. Thanks for that piece.

De De: Thank you so much for doing that. We do have several questions and so what I wanted to do is field these a little bit. One of the first questions is as an allergist, how do you balance beneficial focus without causing tell a severe reaction?

Dr. Patel: For most of these likes in terms of intervention as I’m seeing what you are talking about patient’s sense advertise — sensitized. Or what is currently known in terms of gut, alteration of gut microbiome, it would be fiber, probiotics, prebiotics, very young, breastfeeding, I think there is very little downside in terms of risks of adverse events from those particular interventions. That is probably all that we know. Some things are being looked at in terms of more invasive interventions. The jury is out on how that will impact. But as long as my opinion is that if they are a.m. innocuous and with that said if never had an allergic reaction it probiotics or they are not severely immune compromised meaning they don’t have a where you are worried about proceed biotics causing disease the vast majority of patients should be able to tolerate and I would be honest with the patient saying learn some data may suggest an improvement and the risks a pretty minimized an if you are willing to do X, Y, Z it would be a room option and shared decision making you would have with your patient.

De De: Another person is asking about antihistamine use and its influence on the gut. Is this an option?

Dr. Patel: That is a great question. It is funny, you probably saw that there’s a histamine that is a normal chemical that is outside the gut lining that is beneficial for the healthy gut microbiome. That being said, it is not clear whether antihistamines are going to have an effect one way or the other. You may say they might reduce or block the histamine effect. That might have a downstream effect in terms of reducing the healthy gut microbiome. But there’s no convincing data to suggest that we should be holding off antihistamines, that means so with I would say is there’s no convincing data. I would use the dose that you feel is clinically appropriate, but at the same time, I think there’s not enough information that we know directly at that. My gut feeling no pun intended the histamine may have very little impact if any, but we don’t have the data it tells you one way or the other.

De De: I think that we have room for one question left. We have a couple of these that are focused on vaccinations or on COVID. Do you have a choice which one you would like?

Dr. Patel: Either one is fine.

De De: Let’s go with the one at the end, it says it seems like the first year of life is so critical, has anyone looked at the potential role of vaccines administered in the first year or ingredients in traditional formulas, used in the first year of life.

Dr. Patel: That is a great question because there are usually killed bacteria in the first year of life, almost all killed viruses except RODO and measles, mumps, that is what you would get at 12 months of age. I think that raises a biological fundamental question about logic and the answer is that there is no answer for that. The the studies that have been done looking at the development of atop KWRBG disease — atopic disease, food allergy– have been in patients who were usually in one of two groups. Had the disease or were placebos. I’m not aware of studies that looked specifically at patients and vaccine status. What might be something to look at would be patients who were not vaccinated versus patients that were vaccinated and trying to see what the difference in their microbiome is. — microbiome S. We are still trying it combat the ways we can intervene, and dosing expected effect and side effect profile. We just don’t have the data but hopefully somebody will be doing that soon. These are trials that could be available.

De De: In the last few seconds, Thank you again, Dr. Niraj Patel! This has been such an informative presentation!  Zoom will email you in a few days with a link to the recording, an evaluation, and supplemental resources.

We have two exciting webinars coming up in March that you won’t want to miss!

Join us on March 13th at 4 PM ET for another thought-provoking Advances webinar: Managing Allergic Rhinitis: Effective Strategies, presented by Dr. Andrew White. During this webinar, Dr. White will explore the latest advancements in understanding allergic rhinitis and provide practical strategies for managing this condition.

Then, on March 27th at 4 PM ET, we invite you to join us for another session in our Unidos Hablemos webinar series. We are excited to welcome Berenice Aburto, who will share her personal experience living with eczema. In this heartfelt presentation, Berenice will discuss the physical and emotional challenges of living with eczema and emphasize the importance of raising awareness and understanding of this often-misunderstood condition. Through her story, attendees will gain valuable insights into the daily realities of managing eczema and hear from Dr. Esteban Fernandez-Faith about the significance of support, both from healthcare providers and the community.

Thank you once again from all of us at Allergy and Asthma Network, where we strive daily to be your trusted resource for people with allergies, asthma, and related conditions.