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Breastfeeding Is Associated with Infant Gut Microbial Composition
Abstracts AB169
J ALLERGY CLIN IMMUNOL VOLUME 135, NUMBER 2
Breastfeeding Is Associated with Infant Gut Microbial Composition Kyra J. Jones, MEd1, Alexandra R. Sitarik, MS2, Kei Fujimura, PhD3, Christine Cole Johnson, PhD, MPH, FAAAAI2, Suzanne Havstad, MA2, Haejin Kim, MD4, Andrea Cassidy-Bushrow, PhD2, Kevin Bobbitt, PhD2, Nicholas W. Lukacs, PhD5, Kimberley J. Woodcroft, PhD2, Edward M. Zoratti, MD, FAAAAI4, Albert M. Levin, PhD2, Ganesa R. Wegienka, PhD2, Susan V. Lynch, PhD3, Homer A. Boushey, Jr, MD, FAAAAI6, Dennis R. Ownby, MD, FAAAAI7; 1 Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, 2Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, 3University of California San Francisco, San Francisco, CA, 4Division of Allergy and Clinical Immunology, Henry Ford Health System, Detroit, MI, 5University of Michigan, Ann Arbor, MI, 6University of California, San Francisco, San Francisco, CA, 7Department of Pediatrics, Georgia Regents University, Augusta, GA. RATIONALE: Breastfeeding has been shown to influence the development of allergic disorders, with results varying by maternal history of disease and feeding exclusivity and duration. Breastfeeding may affect allergic outcomes through its effects on the infant’s gut microbiome. Therefore, we examined the stool microbiomes of breastfed versus nonbreastfed babies in a population-based birth cohort. METHODS: Microbiomes of infant stools (N5298) collected at 1 month (range 1- <6) and at 6 months (range 6-11) after birth from the Detroit WHEALS birth cohort were characterized by MiSeq sequencing of the 16S rRNA gene. Indices of stool microbial community composition richness, evenness and diversity were calculated by breast feeding exposure. Compositional differences in the microbiome were evaluated using permutational multivariate analysis of variance. Tests of differential operational taxonomic unit (OTU) abundance were performed using zero-inflated negative binomial regression with false discovery rate adjustment (q-value<0.05 considered significant). RESULTS: Current breastfeeding at 1 month was associated with lower stool richness, evenness and diversity, and distinct microbial compositions at both 1 and 6 months (all p<0.002). Similar associations were found for current breastfeeding at 6 months and the concurrent stool samples. In both the 1 and 6 month stools, non-breastfed babies were primarily significantly enriched with Lachnospiraceae, while breastfed babies were significantly enriched with a multitude of phylogenetically diverse bacteria. CONCLUSIONS: Our results show that breastfeeding at age 1 and 6 months is associated with distinct microbiomes in infants, suggesting that feeding patterns could contribute to stool microbiome characteristics and subsequently to immune development and the evolution of allergic diseases.
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Comparative Effectiveness of Stepping Down Asthma Medications in a Nationally Representative Sample Matthew A. Rank, MD, FAAAAI1, Juliette Liesinger2, Megan Branda2, Michael Gionfriddo2, Michael Schatz, MD, MS, FAAAAI3, Robert S. Zeiger, MD, PhD, FAAAAI3, Nilay Shah2; 1Mayo Clinic, Scottsdale, AZ, 2Mayo Clinic Midwest, 3Kaiser Permanente Southern California, San Diego, CA. RATIONALE: Limited data exist for outcomes after stepping-down asthma medications. METHODS: Individuals were identified from the Medical Expenditure Panel Survey from between 2000-2010 by applying the Healthcare Effectiveness Data and Information Set criteria for persistent asthma; each individual was in the study for 2 years which were divided into 5 periods which were about 4-5 months each. Eligibility for stepping-down asthma medications was defined as having no hospitalizations for asthma and no emergency department (ED) visits for asthma in periods 1-3, and no systemic corticosteroid for asthma and <3 rescue inhalers dispensed in periods 2-3. Step-down was defined by a decrease of >1 steps when comparing period 4 to 3. The primary outcome of complete asthma control
in period 5 was defined as no asthma hospitalizations, ED visits, systemic corticosteroid dispensing, and <2 rescue inhalers dispensed. RESULTS: Controlling for age, sex, ethnicity, poverty, self-reported health, Charlson score, smoking status, geographic region, period length, metropolitan statistical area, specialty care, baseline step level, depression, COPD, GERD, and rhinitis/sinusitis, the percentage of individuals who were eligible to step-down, did step-down, and had complete asthma control was 89.4% (95% CI 86.4- 92.4%), which compares favorably with those similarly eligible for step-down who maintained their current step level, 83.5% (95% CI 79.9-87.0%). CONCLUSIONS: In a nationally representative sample adjusted for available variables, stepping-down asthma medication in those who were eligible led to clinically similar outcomes compared to those who maintained their step level.
550
Breath Connection: A School-Based Telemedicine Program for Rural Children with Asthma Tamara T. Perry, MD1,2, Jill S. Halterman, MD, MPH3, Rita H. Brown, BA1,2, Cassandra R. Hunter, MPH1, Shemeka M. Randle, MS1, J. Mick Tilford, PhD1, Mallikarjuna Rettiganti, PhD1,2; 1University of Arkansas for Medical Sciences, Little Rock, AR, 2Arkansas Children’s Hospital, Little Rock, AR, 3University of Rochester Medical Center, Rochester, NY. RATIONALE: To improve translation of guidelines-based asthma recommendations to high-risk children living in rural regions. METHODS: We are conducting a cluster randomized trial with rural children, ages 7-14 years, to compare a school-based telemedicine intervention to usual care. The intervention provides comprehensive asthma education via telemedicine to rural children with asthma, their caregivers and school nurses; prospectively monitors asthma symptoms and lung function; and provides primary care providers with evidencebased treatment prompts. RESULTS: To date, 364/414 parent-child dyads have been enrolled from 17 school districts in the rural Mississippi Delta region of Arkansas. Median age of children enrolled is 9.6 years, with 54.6% being male, 81.8% African-American, 80% with state-issued insurance and 45.6% from a family with total household income <$15,000. At baseline, 72.2% children were classified as moderate-severe persistent asthmatics and 72.1% were uncontrolled according to national guidelines. At 3 months, days wheezing (P50.03) and peak flow meter use (P<.0001) significantly improved in the intervention group compared to usual care. At 6 months, peak flow meter use among intervention participants remained statistically significant (P50.007) and intervention participants had 2.62 vs 1.83 days improvement in the number of symptom free days (SFD) in the previous 2 weeks compared to usual care participants. CONCLUSIONS: The Breath Connection program aims to improve asthma outcomes for a high-risk, rural cohort through school-based telemedicine education and monitoring. We present results from a planned interim analysis of data. Results are encouraging and suggest positive benefits of the intervention.
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J ALLERGY CLIN IMMUNOL VOLUME 135, NUMBER 2
Breastfeeding Is Associated with Infant Gut Microbial Composition Kyra J. Jones, MEd1, Alexandra R. Sitarik, MS2, Kei Fujimura, PhD3, Christine Cole Johnson, PhD, MPH, FAAAAI2, Suzanne Havstad, MA2, Haejin Kim, MD4, Andrea Cassidy-Bushrow, PhD2, Kevin Bobbitt, PhD2, Nicholas W. Lukacs, PhD5, Kimberley J. Woodcroft, PhD2, Edward M. Zoratti, MD, FAAAAI4, Albert M. Levin, PhD2, Ganesa R. Wegienka, PhD2, Susan V. Lynch, PhD3, Homer A. Boushey, Jr, MD, FAAAAI6, Dennis R. Ownby, MD, FAAAAI7; 1 Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, 2Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, 3University of California San Francisco, San Francisco, CA, 4Division of Allergy and Clinical Immunology, Henry Ford Health System, Detroit, MI, 5University of Michigan, Ann Arbor, MI, 6University of California, San Francisco, San Francisco, CA, 7Department of Pediatrics, Georgia Regents University, Augusta, GA. RATIONALE: Breastfeeding has been shown to influence the development of allergic disorders, with results varying by maternal history of disease and feeding exclusivity and duration. Breastfeeding may affect allergic outcomes through its effects on the infant’s gut microbiome. Therefore, we examined the stool microbiomes of breastfed versus nonbreastfed babies in a population-based birth cohort. METHODS: Microbiomes of infant stools (N5298) collected at 1 month (range 1- <6) and at 6 months (range 6-11) after birth from the Detroit WHEALS birth cohort were characterized by MiSeq sequencing of the 16S rRNA gene. Indices of stool microbial community composition richness, evenness and diversity were calculated by breast feeding exposure. Compositional differences in the microbiome were evaluated using permutational multivariate analysis of variance. Tests of differential operational taxonomic unit (OTU) abundance were performed using zero-inflated negative binomial regression with false discovery rate adjustment (q-value<0.05 considered significant). RESULTS: Current breastfeeding at 1 month was associated with lower stool richness, evenness and diversity, and distinct microbial compositions at both 1 and 6 months (all p<0.002). Similar associations were found for current breastfeeding at 6 months and the concurrent stool samples. In both the 1 and 6 month stools, non-breastfed babies were primarily significantly enriched with Lachnospiraceae, while breastfed babies were significantly enriched with a multitude of phylogenetically diverse bacteria. CONCLUSIONS: Our results show that breastfeeding at age 1 and 6 months is associated with distinct microbiomes in infants, suggesting that feeding patterns could contribute to stool microbiome characteristics and subsequently to immune development and the evolution of allergic diseases.
549
Comparative Effectiveness of Stepping Down Asthma Medications in a Nationally Representative Sample Matthew A. Rank, MD, FAAAAI1, Juliette Liesinger2, Megan Branda2, Michael Gionfriddo2, Michael Schatz, MD, MS, FAAAAI3, Robert S. Zeiger, MD, PhD, FAAAAI3, Nilay Shah2; 1Mayo Clinic, Scottsdale, AZ, 2Mayo Clinic Midwest, 3Kaiser Permanente Southern California, San Diego, CA. RATIONALE: Limited data exist for outcomes after stepping-down asthma medications. METHODS: Individuals were identified from the Medical Expenditure Panel Survey from between 2000-2010 by applying the Healthcare Effectiveness Data and Information Set criteria for persistent asthma; each individual was in the study for 2 years which were divided into 5 periods which were about 4-5 months each. Eligibility for stepping-down asthma medications was defined as having no hospitalizations for asthma and no emergency department (ED) visits for asthma in periods 1-3, and no systemic corticosteroid for asthma and <3 rescue inhalers dispensed in periods 2-3. Step-down was defined by a decrease of >1 steps when comparing period 4 to 3. The primary outcome of complete asthma control
in period 5 was defined as no asthma hospitalizations, ED visits, systemic corticosteroid dispensing, and <2 rescue inhalers dispensed. RESULTS: Controlling for age, sex, ethnicity, poverty, self-reported health, Charlson score, smoking status, geographic region, period length, metropolitan statistical area, specialty care, baseline step level, depression, COPD, GERD, and rhinitis/sinusitis, the percentage of individuals who were eligible to step-down, did step-down, and had complete asthma control was 89.4% (95% CI 86.4- 92.4%), which compares favorably with those similarly eligible for step-down who maintained their current step level, 83.5% (95% CI 79.9-87.0%). CONCLUSIONS: In a nationally representative sample adjusted for available variables, stepping-down asthma medication in those who were eligible led to clinically similar outcomes compared to those who maintained their step level.
550
Breath Connection: A School-Based Telemedicine Program for Rural Children with Asthma Tamara T. Perry, MD1,2, Jill S. Halterman, MD, MPH3, Rita H. Brown, BA1,2, Cassandra R. Hunter, MPH1, Shemeka M. Randle, MS1, J. Mick Tilford, PhD1, Mallikarjuna Rettiganti, PhD1,2; 1University of Arkansas for Medical Sciences, Little Rock, AR, 2Arkansas Children’s Hospital, Little Rock, AR, 3University of Rochester Medical Center, Rochester, NY. RATIONALE: To improve translation of guidelines-based asthma recommendations to high-risk children living in rural regions. METHODS: We are conducting a cluster randomized trial with rural children, ages 7-14 years, to compare a school-based telemedicine intervention to usual care. The intervention provides comprehensive asthma education via telemedicine to rural children with asthma, their caregivers and school nurses; prospectively monitors asthma symptoms and lung function; and provides primary care providers with evidencebased treatment prompts. RESULTS: To date, 364/414 parent-child dyads have been enrolled from 17 school districts in the rural Mississippi Delta region of Arkansas. Median age of children enrolled is 9.6 years, with 54.6% being male, 81.8% African-American, 80% with state-issued insurance and 45.6% from a family with total household income <$15,000. At baseline, 72.2% children were classified as moderate-severe persistent asthmatics and 72.1% were uncontrolled according to national guidelines. At 3 months, days wheezing (P50.03) and peak flow meter use (P<.0001) significantly improved in the intervention group compared to usual care. At 6 months, peak flow meter use among intervention participants remained statistically significant (P50.007) and intervention participants had 2.62 vs 1.83 days improvement in the number of symptom free days (SFD) in the previous 2 weeks compared to usual care participants. CONCLUSIONS: The Breath Connection program aims to improve asthma outcomes for a high-risk, rural cohort through school-based telemedicine education and monitoring. We present results from a planned interim analysis of data. Results are encouraging and suggest positive benefits of the intervention.
SUNDAY
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