World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics

Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. Methods: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. Results: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. Conclusions: WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D

Background: The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20–30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic diseases. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations addressing the use of vitamin D in primary prevention of allergic diseases. Methods: Our WAO guideline panel identified the most relevant clinical questions and performed a systematic review of randomized controlled trials and non-randomized studies (NRS), specifically cohort and case-control studies, of vitamin D supplementation for the prevention of allergic diseases. We also reviewed the evidence about values and preferences, and resource requirements (up to January 2015, with an update on January 30, 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. Results: Having reviewed the currently available evidence, the WAO guideline panel found no support for the hypothesis that vitamin D supplementation reduces the risk of developing allergic diseases in children. The WAO guideline panel suggest not using vitamin D in pregnant women, breastfeeding mothers, or healthy term infants as a means of preventing the development of allergic diseases. This recommendation does not apply to those mothers and infants who have other indications for prophylactic or therapeutic use of vitamin D. The panel’s recommendations are conditional and supported by very low certainty evidence. Conclusions: WAO recommendations about vitamin D supplementation for the prevention of allergic diseases support parents, clinicians and other health care professionals in their decisions whether or not to use vitamin D in preventing allergic diseases in healthy, term infants

63-OR: Focused Educational Screening Improves Knowledge of Diabetes as a Leading Risk Factor for Chronic Kidney Disease

Background: Diabetes is the leading cause of chronic kidney disease (CKD) and a major risk factor in the progression of kidney failure or end-stage kidney disease. An estimated 34.2 million Americans have diabetes, and 1 in 3 adults with diabetes may have CKD, many of whom do not know they have it. Interventions to increase CKD awareness and its complications may help promote early testing and identification among adults with diabetes. The American Kidney Fund (AKF) developed a 5-minute CKD education session and focused this intervention in the District of Columbia-Maryland-Virginia (DMV) metropolitan area. Methods­: In 2020, AKF administered a 5-item questionnaire at two AKF kidney disease screening events to assess CKD knowledge before and after 5-minute CKD education sessions. Individuals demonstrating CKD risk factors, including self-reported history of diabetes or elevated blood sugar level results, attended the education sessions. We compared responses from 129 participants and performed a paired samples t-test to determine the education sessions’ effectiveness in improving CKD knowledge. Results: The average pre-post scores increased from 57% to 89% (t(128)=10.65, p&amp;lt;0.001), with the largest gains in understanding the definition of CKD (11% to 86%, t(128)=17.62, p&amp;lt;0.001). There was a significant difference in pre-post scores for identifying diabetes and high blood pressure as the top risk factors for CKD (49% to 86%, t(128)=6.62, p&amp;lt;0.001). For the best ways to prevent CKD, keeping a healthy blood sugar level and healthy blood pressure level was also significant (65% to 89%, t(128)=4.91, p&amp;lt;0.001). Conclusion: Our study demonstrated low awareness of CKD risk factors. Educational sessions are effective for improving CKD knowledge and increasing awareness about diabetes as a major risk factor. Our study supports the expansion of CKD-related educational programs for populations at high risk for CKD. Disclosure L. Vo: None. M. Paris: None. M. Alawode: None. M. Spigler: None. </jats:sec

622-P: Comorbid ESRD and Diabetes Is Associated with Greater Odds for Depression

People with comorbid end-stage renal disease (ESRD) and diabetes are more prone to poor clinical outcomes including increased mortality and hospitalization, poor treatment compliance and quality of life. Self-management of these coexisting conditions is challenging as the treatment regime is complex, burdensome, and nutrition guidelines may conflict. While it is known that each morbidity is known to be associated with an increased risk for depression, limited research has explored the potential compounding effect of comorbidity. To explore this, determinants of depression were compared between a cohort of ESRD patients with and without diabetes. Data from the American Kidney Fund Health Insurance Premium Program of 63,254 low-income adults with ESRD were analyzed. All demographic and health condition data were collected through self-report. A logistic regression was performed to ascertain the effect of diabetes on the likelihood of depression in individuals with ESRD. Unadjusted and adjusted odds of having depression were calculated in those with and those without diabetes. Age, sex, race/ethnicity, income, marital status, employment status, and health conditions known to be associated with depression including anxiety, cardiovascular disease, insomnia, and sexual problems were included as covariates. After adjusting for demographic and clinical variables, diabetes remained independently associated with higher odds of depression (1.9; 95% confidence interval: 1.8-2.1) . Odds of depression significantly increased among adults with ESRD in the presence of diabetes. Screening for depression among people with ESRD is of particular importance to mitigate adverse outcomes and disease progression. Future studies should further examine the mechanisms of depression in both ESRD and diabetes, and test modifiable targets for interventions to prevent and treat depression in these populations. Disclosure R. Woolley: None. R. Pierce: None. M. Spigler: None. </jats:sec

341-OR: Expanding Diabetes Self-Management Education to Include Chronic Kidney Disease Education

Background: Diabetes is the leading cause of kidney failure. Thirty million Americans have diabetes and 1 in 3 adults with diabetes has chronic kidney disease (CKD). While the Diabetes Self-Management Education and Support (DSMES) curriculum cites CKD risk within one of its eight core content areas, increasing rates of kidney failure among diabetics warrants more robust content devoted to diabetes’ association with CKD. Methods: From October 2017-April 2019, TMF Health Quality Institute recruited clinical and peer educators in Arkansas, Missouri, Oklahoma, Puerto Rico, and Texas to complete the American Kidney Fund (AKF) Kidney Health Coach (KHC) online training as a means of equipping them with content and strategies to incorporate into DSMES or stand-alone CKD education sessions for Medicare beneficiaries at risk for CKD. Upon completing KHC, three CKD education delivery methods were piloted: 1) in-person educator-led 2) recorded video shown in class 3) video on-demand. The effectiveness of each method was determined by assessing participant knowledge and comprehension using the AKF Kidney Health Education Session pre/post-test. Results: 615 educators became KHCs and delivered CKD education to a total of 2,250 individuals. Pre/post test scores indicated collective effectiveness among the three delivery methods in increasing understanding of the relationship between CKD and diabetes (relative improvement rate (RIR)= 36.5%). In-person CKD education showed most effective in increasing knowledge gain (RIR=38.8%), compared to the recorded video shown in class (RIR=25.3%) and on-demand video (RIR=18.7%) methods. Conclusion: This study supports the expansion of KHC integration into DSMES, as educating people with diabetes on CKD prevention is critical to reducing the burden of CKD and improving health outcomes, and that an educator-led presentation modality was most effective in improving understanding of CKD. Disclosure P. Prithivathi: None. M. Spigler: None. M. Paris: None. M. Alawode: None. M. Bello: None. U. Fatima: None. Funding Centers for Medicare &amp; Medicare Services (HHSM-500-2014-QIN0051) </jats:sec

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics

Background: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. Methods: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. Results: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. Conclusions: WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.COL005956

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D

Abstract Background The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20–30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic diseases. Objective The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations addressing the use of vitamin D in primary prevention of allergic diseases. Methods Our WAO guideline panel identified the most relevant clinical questions and performed a systematic review of randomized controlled trials and non-randomized studies (NRS), specifically cohort and case-control studies, of vitamin D supplementation for the prevention of allergic diseases. We also reviewed the evidence about values and preferences, and resource requirements (up to January 2015, with an update on January 30, 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. Results Having reviewed the currently available evidence, the WAO guideline panel found no support for the hypothesis that vitamin D supplementation reduces the risk of developing allergic diseases in children. The WAO guideline panel suggest not using vitamin D in pregnant women, breastfeeding mothers, or healthy term infants as a means of preventing the development of allergic diseases. This recommendation does not apply to those mothers and infants who have other indications for prophylactic or therapeutic use of vitamin D. The panel’s recommendations are conditional and supported by very low certainty evidence. Conclusions WAO recommendations about vitamin D supplementation for the prevention of allergic diseases support parents, clinicians and other health care professionals in their decisions whether or not to use vitamin D in preventing allergic diseases in healthy, term infants

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics

Background: The prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10 % and reaches 20-30 % in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Prebiotics - non-digestible oligosaccharides that stimulate growth of probiotic bacteria - have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of prebiotics in the prevention of allergy. Methods: The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy. We performed a systematic review of randomized controlled trials of prebiotics, and reviewed the evidence about patient values and preferences, and resource requirements (up to January 2015, with an update on July 29, 2015). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. Results: Based on GRADE evidence to decision frameworks, the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants. Both recommendations are conditional and based on very low certainty of the evidence. We found no experimental or observational study of prebiotic supplementation in pregnant women or in breastfeeding mothers. Thus, the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding, at this time. Conclusions: WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy, term infants.DanoneDicofarmBambino Gesù Ospedale PediatricoHeinzCOL005956

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics

Abstract Background Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. Methods We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. Results Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants