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1St LIVE WEBINAR 2Nd LIVE WEBINAR & 1st LIVE WEBINAR Held on Thursday, April 9th 2020 Click here to access first recorded webinar & 2nd LIVE WEBINAR Held on Wednesday, April 15th 2020 Click here to access second recorded webinar #WHITE_COAT_HEROS #STAY_SAFE BIOGRAPHY OF THE SPEAKERS DR. MOHAMAD MIQDADY Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE Dr. Mohamad Miqdady is American Board certified in Pediatric Gastroenterology, Hepatology and Nutrition. He is the Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE. Also an Adjunct Staff at Cleveland Clinic, Ohio USA. Member of the FISPGHAN Council (Federation of International Societies of Pediatric Gastroenterology Hepatology, and Nutrition) Expert member FISPGHAN Malnutrition/ Obesity Expert team. Dr. Miqdady completed his Fellowship in Pediatric Gastroenterology at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX, USA. He held the position of Assistant Professor at Jordan University of Science and Technology in Jordan for six years prior joining SKMC. Main research interests include feeding difficulties, picky eating, obesity, procedural sedation, allergic GI disorders and celiac disease. He has several publications and authored few book chapters including www.uptodate.com. On the Editorial Board of few journals including Gastroenterology & Hepatology. DR. ROSAN MEYER Paediatric Allergy Research Dietitian Kings College, London Honorary Senior Lecturer, Imperial College, London UK Visiting Professo, KU Leuven, Belgium Rosan completed her degree in Dietetics in South Africa and specialised in paediatric nutrition in the UK. In 2004, she finished her MSc in Paediatric Nutrition and in 2008 her PhD at Imperial College London. She was the principal research dietitian at Great Ormond Street Hospital for Children until December 2015, leading a project on the impact of gastrointestinal food allergies on children and their families and after this worked with the allergy team at St. Thomas Hospital as research dietitian until 2018. In addition, she has a busy paediatric dietetic practice specialising in food allergy, feeding difficulties and faltering growth in London. She has published numerous articles and has co-authored a book on paediatric nutrition, food allergy, feeding difficulties and is in particular interested in the association between growth and food allergy. She is currently module leader for the Food Hypersensitivity Module that forms part of the MSc in Allergy at Imperial College London, and is honorary senior lecturer in paediatrics at the same university. She is also visiting Professor at KU Leuven, Belgium, on their MSc on Deglutology (swallow disorders). She is the chair of the European Section of the International Network for Diet and Allergy, secretary of the Allied Health and Primary Care Interest Group of EAACI and member of several EAACI task forces on food allergy. DR. AHMAD ALKHABAZ Consultant Allergist & Clinical Immunologist Head of Pediatric Allergy and Clinical Immunology unit in Mubarak Al-Kabeer University Hospital in Kuwait Head of unit & consultant in Pediatrics & in Allergy, Asthma & Clinical Immunology. KIMS Tutor & Chair of exam committee. Graduate of Newcastle university in the UK. Completed Pediatric residency in McMaster Canada. Then a fellowship in Allergy & Clinical Immunology. He has researched in difficult asthma & the effect of nutrition. Food allergy & immunodeficiency. Dr. Ahmad has been a speaker in multiple local & regional conferences on the topics of food allergy, eczema, rhinitis, drug allergy & asthma. 1st LIVE WEBINAR Held on Thursday, April 9th 2020 | 07:00 - 08:00 PM (UAE Local Time) THE GUT MICROBIOTA AND ITS ROLE IN EARLY LIFE IMMUNITY AND THE DEVELOPMENT OF ALLERGIC DISEASE DR. MOHAMAD MIQDADY CLINICAL EVIDENCE FOR THE ROLE OF SYNBIOTICS IN ALLERGY MANAGEMENT DR. ROSAN MEYER #WHITE_COAT_HEROS #STAY_SAFE THE GUT MICROBIOTA AND ITS ROLE IN EARLY LIFE IMMUNITY AND THE DEVELOPMENT OF ALLERGIC DISEASE DR. MOHAMAD MIQDADY Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE Outline The gut microbiota and its role in early life immunity and the development of allergic disease •Wh allergies infa are st important •Risk factors f allergies M. Miqdady, MD •G microbia dysbiosis allergy American Board of Ped. GI •Immunomodulation: Pre Pro Syn concepts Chief, Ped. GI, SKMC, UAE Adjunct Associate Professor, UAE University Apr-20 © M.Miqdady, M.D. 1 © M.Miqdady, M.D. 2 COVID Allerg allerg disease & asthma ris factors fo SARS‐CoV‐2 infection? A. Yes B. No Apr-20 © M.Miqdady, M.D. 3 Apr-20 © M.Miqdady, M.D. 4 COVID 19 & Allergies “Allergic diseases & asthma are not risk factors for SARS‐CoV‐2 infection” “Elderly age, high # of comorbidities & more prominent lab abnormalities were associated with severe patients”. Apr-20 © M.Miqdady, M.D. 5 Apr-20 © M.Miqdady, M.D. 6 ALLERGIES ARE INCREASING GLOBALLY Allergy –a global health problem– is one of the first detectable immune disorders in early life Food allergies affect up to 8 % of infants & young children in the western world 1, with cow’s milk being their leading cause. 2-4 1. EAACI. Advocacy manifesto, tackling the allergy crisis in europe-concerted policy action needed, 2015 2. Rona, R. J. et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 120, 638-646,(2007). 3. Prescott, S. L. et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J 6, 21, 2013. 4. Schoemaker, A. A. et al. Incidence and natural history of challenge-proven cow’s milk allergy in European children--EuroPrevall birth cohort. Allergy 70, 2015. The pattern of cow’s milk allergy (CMA) is becoming increasingly Q 2 aggressive 128% p<0.05 250 Prevalence is 2-5% +44.2% worldwide p<0.05 • The prevalence of Food induced anaphylaxis ? 200 admissions A. Increasing 150 of hospital 100 B. Decreasing Number Increasing trend of the number of hospital admissions for FIA among Italian C. Same children from 2006 to 2014 50 <4 years 5-14 years FIA: food-induced anaphylaxis 0 Fiocchi et al. Pediatr Allergy Immunol. 2010;21(S21):1-125 2006 2007 2008 2009 2010 2011 Prescott et al. World Allergy Organ. 2013;6(21) Skripak et al. J Allergy Clin Immunol. 2007;120:1172-77 Year Apr-20 © M.Miqdady, M.D. 9 Nocerino et al. J Allergy Clin Immunol. 2015;135:833-835 e833 The burden of allergy goes beyond symptoms Strong rationale for developing effective strategies for infants at risk and with allergy Outline Physical Financial • Increased medical, • Increased risk of health and indirect future NCDs •Wh allergies infa are st important costs •Risk factors f allergies Psychological Social •G microbia dysbiosis allergy • Distress for child • Isolation and parents • Fear of future •Immunomodulation: Pre Pro Syn concepts • Impact on QoL health problems NCDs, non-communicable diseases; QoL, quality of life Pawankar et al. WAO, White Book on Allergy. Update 2013:5-55; Prescott, SL. J Allergy Clin Immunol. 2013;131(1):23-30; West et al. J Allergy Clin Immunol. 2015;135(1):3-13; Silverberg JI. J Allergy Clin Immunol. 2015 Mar;135(3):721-8; Gupta et al. JAMA Pediatr. 2013;167(11):1026-31; Patel et al. J Allergy Clin Immunol. 2011;128(1):110-115e1; © M.Miqdady, M.D. 12 Dalgard et al. J of Inv Dermatol. 2015;135:984-91 Risk factors for the development of allergies Early life disruption in microbiota is associated with allergy development Hereditary Gut Microbiota Environmental Factors challenge challenge http://www.dailymail.co.uk/home/index.html Pollution Family History of C-Section Antibiotics Use Allergy & early sign of eczema Rodult et al. Thorax 2009;64(2):107-13 Marra et al. Chest 2006;129(3):610-8 Risk to develop allergy: Global Prevalence: Use in infancy & Increased risk of 1 2 15%-70% EU: 15%-35% childhood allergy: http://www.healio.com/dermatology/dermatitis/news/ Asia Urban: >50%2 Up to 10 - 20 courses3,4 Up to 20%5,6 1Bergmann et al., 1998, 2OECD data 2011, 3Sharland 2007, 4Blaser 2011, 5Patel et al., 2011, 6Ryan etal., 2013, Cesarean Delivery Associated Childhood Diseases1 2Odds ratio (OR) with 95% CI versus vaginal delivery 3Increase not appreciated for male fetuses 4requiring hospitalization 1. Neu & Rushing, 2011 WHO, 2011 Q 3 Outline • During this time; which of the following you believe is true A. Social distancing may increase the risk of allergy •Wh allergies infa are st important B. Lockdown may increase risk of allergy •Risk factors f allergies C. Routine use of PPE may decrease risk of latex •G microbia dysbiosis allergy allergy among health care workers •Immunomodulation: Pre Pro Syn concepts D. Use of disinfectants does not disturb human microbiota Apr-20 © M.Miqdady, M.D. 17 © M.Miqdady, M.D. 18 “You are not human, you are a walking bacterial colony” The “1st colonizers”: Jeroen Raes, Flanders Institute of Biology, TED talks 2012, http:www\\tedxbrussels.eu Establishing the symbiosis between the gut microbiota & immune system Surface of approximately 300m2 100 trillion bacteria “Gut Microbiota” 70-80% of immune 100 million neurons cells Mitsuoka, 1992 & 2014 Wopereis et al., 2014 Early microbiome development in immune challenged population Gut microbiota alterations associate with food allergies Healthy, breastfed babies CMA babies with lower levels of healthy Bifiobacteria dominated by healthy an higher levels of potentially harmfl Bifidobacteria Clostriia and Eubacteria trong rationale for the nee of gt microbiota moification in the ietary prevention an management of allergy. Gestational Environmental Clostridium and Eubacterium ssp. Bifidobacterium Other genera (not analyzed) Breastfeeding/ Complementary age exposure Mixed feeding feeding Roger et al. Microbiology 2010;156(11):3329-41; Scholtens et al. J Nutr. 2008;138:1141-7; Mitsuoka, T. Biosci Microbiota Food Health 2014;33:99-116; Thompson-Chagoyan et al. Pediatr Allergy Immonol. 2010;21(2):394-400; Candy et al.
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