Physicians’ Understanding of the Role of the Microbiome in Allergies and Asthma: A Questionnaire-Based Study in Saudi Arabia

Figures & data

Table 1 Demographic and Professional Characteristics and Knowledge About the Microbiome, Dysbiosis, and Probiotics Among Healthcare Workers

Variable	All Participants	Knowledge Score		P value
		High	Low
Age group
Mean ± SD (years)	41.1 ± 10.7	42.4 ± 10.1	39.6 ± 11.2	0.060
< 35 years old	64 (31.5%)	24 (22.6%)	40 (41.2%)	0.015
35–45 years old	69 (34.0%)	39 (36.8%)	30 (30.9%)
> 45 years old	70 (34.5%)	43 (40.6%)	27 (27.8%)
Sex
Male	78 (38.4%)	40 (37.7%)	38 (39.2%)	0.833
Female	125 (61.6%)	66 (62.3%)	59 (60.8%)
Specialty
Pediatrics	108 (53.2%)	54 (50.9%)	54 (55.7%)	0.500
Family Medicine	95 (46.8%)	52 (49.1%)	43 (44.3%)
Level of training
Consultant	109 (53.7%)	66 (62.3%)	43 (44.3%)	0.036
Specialist	44 (21.7%)	18 (17.0%)	26 (26.8%)
Resident and others	50 (24.6%)	22 (20.8%)	28 (28.9%)
Prescription of probiotic food or drinks for most patients
Yes	130 (64.0%)	87 (82.1%)	43 (44.3%)	<0.001
No	73 (36.0%)	19 (17.9%)	54 (55.7%)
Prescription of probiotic food or drinks for most patients with allergies and/or asthma
Yes	36 (17.7%)	27 (25.5%)	9 (9.3%)	0.003
No	167 (82.3%)	79 (74.5%)	88 (90.7%)
Forms of probiotics prescribed for patients
Yogurt	88 (67.7%)	52 (59.8%)	36 (83.7%)	0.048
Naturally fermented products	13 (10.0%)	10 (11.5%)	3 (7.0%)
Pharmacy powder	11 (8.5%)	9 (10.3%)	2 (4.7%)
Pharmacy tablets	18 (13.8%)	16 (18.4%)	2 (4.7%)
Believes that nutritional advice plays an important role in allergies and asthma in children
Strongly agree/agree	157 (77.3%)	97 (91.5%)	60 (61.9%)	<0.001
Strongly disagree/disagree	11 (5.4%)	4 (3.8%)	7 (7.2%)
I do not know	35 (17.2%)	5 (4.7%)	30 (30.9%)
Sources of information about dysbiosis
Internet/social media	32 (32.3%)	22 (29.7%)	10 (40.0%)	0.323
Medical article/clinical trials	45 (45.5%)	34 (45.9%)	11 (44.0%)
Course instructor	9 (9.1%)	9 (12.2%)	0 (0.0%)
Colleagues	8 (8.1%)	5 (6.8%)	3 (12.0%)
Others	5 (5.1%)	4 (5.4%)	1 (4.0%)

Notes: Data are presented as the absolute number (%) of participants who chose a particular survey response and were in specific age, specialty and training groups. Significant P values are shown in bold.

Table 2 Responses of Healthcare Workers to Individual Knowledge Questions About the Microbiome, Dysbiosis, and Probiotics

Question	Correct	Incorrect	Do Not Know
Microbiome
1. What is the microbiome?	155 (76.4%)	16 (7.9%)	32 (15.8%)
2. All microorganisms cause diseases in humans*	179 (88.2%)	12 (5.9%)	12 (5.9%)
3. There are microorganisms living naturally in the intestinal tract	200 (98.5%)	0 (0.0%)	3 (1.5%)
4. There are microorganisms living naturally in the respiratory tract	162 (79.8%)	18 (8.9%)	23 (11.3%)
5. There are microorganisms living naturally on the skin	197 (97.0%)	4 (2.0%)	2 (1.0%)
6. Microorganisms naturally living in body compartments play a major role in human health and disease pathogenesis	182 (89.7%)	11 (5.4%)	10 (4.9%)
7. There are microorganisms present in breast milk	119 (58.6%)	26 (12.8%)	58 (28.6%)
8. There are microorganism naturally present in some food we eat	183 (90.1%)	9 (4.4%)	11 (5.4%)
9. Mothers can transfer microorganisms to infants during pregnancy	147 (72.4%)	23 (11.3%)	33 (16.3%)
10. Mothers can vertically transmit microorganisms to their newborn during natural birth	180 (88.7%)	5 (2.5%)	18 (8.9%)
11. Mothers can transmit microorganisms to their infant during breast feeding	153 (75.4%)	13 (6.4%)	37 (18.2%)
12. Interactions occur between microorganisms living in different body compartments, such as between the intestinal and lung microbiomes	73 (36.0%)	32 (15.8%)	98 (48.3%)
13. The diversity among the microbial species of the microbiome varies between individuals and between various body compartments within the same individual	154 (75.9%)	1 (0.5%)	48 (23.6%)
14. Cleaning hands with antimicrobial soap is important to prevent all infections*	64 (31.5%)	126 (62.1%)	13 (6.4%)
Dysbiosis
15. What is dysbiosis?	92 (45.3%)	30 (14.8%)	81 (39.9%)
16. A strong link exists between microbes living in our body (microbiome) and the development of allergic diseases	134 (66.0%)	4 (2.0%)	65 (32.0%)
17. Changes (microbial dysbiosis) in the respiratory microbiome are associated with the development of bronchial asthma and allergic rhinitis	102 (50.2%)	5 (2.5%)	96 (47.3%)
18. Changes (microbial dysbiosis) in the gastrointestinal microbiome are associated with allergic conditions such as eczema and food allergy	114 (56.2%)	3 (1.5%)	86 (42.4%)
19. Early exposure to environmental flora and fauna can lower the risk of developing allergies	135 (66.5%)	8 (3.9%)	60 (29.6%)
20. Reduced antibiotic use during early infancy or during the perinatal period can lower the risk of dysbiosis development and future allergies and asthma in children	149 (73.4%)	5 (2.5%)	49 (24.1%)
21. Maternal cesarean section causes dysbiosis in the child and increases the risk for the development of allergic disorders during early life	59 (29.1%)	27 (13.3%)	117 (57.6%)
22. Microbial manipulation can reduce the risk of allergic immune responses	69 (34.0%)	19 (9.4%)	115 (56.7%)
Probiotics
23. What is the definition of a probiotic?	145 (71.4%)	39 (19.2%)	19 (9.4%)
24. It is advisable to avoid consuming any supplement labeled as “bacterial strains” or “probiotics” because they may be harmful*	144 (70.9%)	25 (12.3%)	34 (16.7%)
25. Do you know reasons for prescribing pro-/prebiotics?	115 (56.7%)	12 (5.9%)	76 (37.4%)
26. Which products are good sources of probiotics?	125 (61.6%)	8 (3.9%)	70 (34.5%)
27. Cultured dairy products, such as yogurt, buttermilk, and kefir, are sources of good bacteria	176 (86.7%)	2 (1.0%)	25 (12.3%)

Notes: Data are presented as the absolute number (%) of participants with correct, incorrect, or “do not know” answers to each question. *Negatively stated questions.

Table 3 Multivariate Logistic Regression Model for the Predictors of Higher Overall Microbiome Knowledge Among Healthcare Workers

Variable	Reference	Odds Ratio	95% Confidence Interval		P value
			Lower	Upper
Age group
35–45 years old	< 35 years	1.72	0.75	3.91	0.200
> 45 years old	< 35 years	2.60	1.13	5.99	0.025
Prescription of probiotic food or drinks for most patients	No prescription	15.96	3.07	82.88	0.001
Belief that nutritional advice plays an important role in allergies and asthma in children
Strongly agree/agree	I do not know	8.52	2.81	25.86	<0.001
Strongly disagree/disagree	I do not know	3.32	0.60	18.53	0.171

Notes: Factors that could predict higher knowledge about the topics of the microbiome, dysbiosis, and probiotics were analyzed in a multivariate logistic regression model. The analysis was adjusted for age, training level, prescription of probiotics, forms of probiotics, and belief in nutritional advice. The model R-squared = 0.361. Significant P values are shown in bold.

Figure 1 Trends of disease-specific pro-/prebiotic prescriptions and areas of concern with regard to this topic among healthcare workers. (A) Reasons for prescribing pro-/prebiotics and (B) areas of concern regarding the recommendation of probiotics among healthcare workers.