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Zimmermann N, Abonia JP, Dreskin SC, Akin C, Bolton S, Happel CS, Geller M, Larenas-Linnemann D, Nanda A, Peterson K, Wasan A, Wechsler J, Zhang S, Bernstein JA. Developing a standardized approach for assessing mast cells and eosinophils on tissue biopsies: A Work Group Report of the AAAAI Allergic Skin Diseases Committee. J Allergy Clin Immunol 2021; 148:964-983. [PMID: 34384610 DOI: 10.1016/j.jaci.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Mast cells and eosinophils are commonly found, expectedly or unexpectedly, in human tissue biopsies. Although the clinical significance of their presence, absence, quantity, and quality continues to be investigated in homeostasis and disease, there are currently gaps in knowledge related to what constitutes quantitatively relevant increases in mast cell and eosinophil number in tissue specimens for several clinical conditions. Diagnostically relevant thresholds of mast cell and eosinophil numbers have been proposed and generally accepted by the medical community for a few conditions, such as systemic mastocytosis and eosinophilic esophagitis. However, for other mast cell- and eosinophil-associated disorders, broad discrepancies remain regarding diagnostic thresholds and how samples are processed, routinely and/or specially stained, and interpreted and/or reported by pathologists. These discrepancies can obfuscate or delay a patient's correct diagnosis. Therefore, a work group was assembled to review the literature and develop a standardized consensus for assessing the presence of mast cells and eosinophils for a spectrum of clinical conditions, including systemic mastocytosis and cutaneous mastocytosis, mast cell activation syndrome, eosinophilic esophagitis, eosinophilic gastritis/enteritis, and hypereosinophilia/hypereosinophilic syndrome. The intent of this work group is to build a consensus among pathology, allergy, dermatology, hematology/oncology, and gastroenterology stakeholders for qualitatively and quantitatively assessing mast cells and eosinophils in skin, gastrointestinal, and bone marrow pathologic specimens for the benefit of clinical practice and patients.
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Affiliation(s)
- Nives Zimmermann
- Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio; Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J Pablo Abonia
- Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Stephen C Dreskin
- Division of Allergy and Immunology, Department of Internal Medicine, University of Colorado, Aurora, Colo
| | - Cem Akin
- Division of Allergy and Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich
| | - Scott Bolton
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Corinne S Happel
- Division of Allergy and Immunology, Department of Internal Medicine, John Hopkins School of Medicine, Baltimore, Md
| | - Mario Geller
- Department of Medicine, the Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Anil Nanda
- Asthma and Allergy Center, Lewisville, Tex; Asthma and Allergy Center, Flower Mound, Tex; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Kathryn Peterson
- Division of Gastroenterology, Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Anita Wasan
- Division of Gastroenterology, Hepatology, and Nutrition, Allergy and Asthma Center, McLean, Va
| | - Joshua Wechsler
- Division of Allergy and Immunology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Simin Zhang
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
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Nanda A, Wasan A. M504 ASPIRIN DESENSITIZATION IN PREGNANCY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nanda A, Wasan A. Actually Calling and Talking with Your Patient. J Allergy Clin Immunol Pract 2019; 5:1473. [PMID: 28888258 DOI: 10.1016/j.jaip.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/03/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Nanda A, Wasan A. ASPIRIN DESENSITIZATION AND MAINTENANCE THERAPY IN A NURSING AERD PATIENT. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Albrecht D, Kim M, Torrado-Carvajal A, Akeju O, Edwards R, Wasan A, Zhang Y, Bergan C, Protsenko E, Hooker J, Napadow V, Loggia M. Glial activation in chronic back pain: replication of the original observation and association with negative affect. The Journal of Pain 2018. [DOI: 10.1016/j.jpain.2017.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wasan A, Nanda A. P476 Allergic contact dermatitis to epoxy resin. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nanda A, Wasan A. P152 Omalizumab and levothyroxine in the treatment of chronic idiopathic urticaria with positive thyroid antibodies. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nanda A, Wasan A, Sussman J. Provider Health and Wellness. J Allergy Clin Immunol Pract 2017; 5:1543-1548. [PMID: 28734859 DOI: 10.1016/j.jaip.2017.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
Provider health and wellness is a significant issue and can impact patient care, including patient satisfaction, quality of care, medical errors, malpractice risk, as well as provider and office staff turnover and early retirement. Health and wellness encompasses various areas including burnout, depression, divorce, and suicide and affects providers of all specialties and at all levels of training. Providers deal with many everyday stresses, including electronic health records, office politics, insurance and billing issues, dissatisfied patients, and their own personal and family issues. Approximately half of all physicians suffer from burnout, and the rate of burnout among physicians of all specialties is increasing. An important first step in dealing with burnout is recognition and then seeking assistance. Strategies to prevent and treat burnout include increasing provider resiliency as well as implementing practical changes in the everyday practice of medicine. There is currently very little data regarding health and wellness specifically in the field of allergy and immunology, and studies are necessary to determine the prevalence of burnout and related issues in this field. Many medical specialties as well as state and national medical associations have health and wellness committees and other resources, which are essential for providers. Health and wellness programs should be introduced early in a provider's training and continued throughout a provider's career.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - James Sussman
- Allergy Partners of New Mexico, Santa Fe, NM; University of New Mexico School of Medicine, Albuquerque, NM
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Hernandez CM, Arisha MJ, Ahmad A, Oates E, Nanda NC, Nanda A, Wasan A, Caleti BE, Bernal CLP, Gallardo SM. Usefulness of three-dimensional echocardiography in the assessment of valvular involvement in Loeffler endocarditis. Echocardiography 2017; 34:1050-1056. [PMID: 28600838 DOI: 10.1111/echo.13575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Loeffler endocarditis is a complication of hypereosinophilic syndrome resulting from eosinophilic infiltration of heart tissue. We report a case of Loeffler endocarditis in which three-dimensional transthoracic and transesophageal echocardiography provided additional information to what was found by two-dimensional transthoracic echocardiography alone. Our case illustrates the usefulness of combined two- and three-dimensional echocardiography in the assessment of Loeffler endocarditis. In addition, a summary of the features of hypereosinophilic syndrome and Loeffler endocarditis is provided in tabular form.
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Affiliation(s)
- Carlos M Hernandez
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Mohammed J Arisha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amier Ahmad
- Division of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ethan Oates
- Division of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, TX, USA.,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Beda E Caleti
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Cinthia L P Bernal
- National Medical Center (Siglo XXI), Cardiology Hospital, IMSS, Mexico City, Mexico
| | - Sergio M Gallardo
- National Medical Center (Siglo XXI), Specialties Hospital (Dr. Bernardo Sepulveda), IMSS, Mexico City, Mexico
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Wasan A, Nanda A. Systemic reaction to timothy grass pollen sublingual immunotherapy. Ann Allergy Asthma Immunol 2017; 118:732-733. [PMID: 28457642 DOI: 10.1016/j.anai.2017.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Nanda A, Wasan A. P308 Mast cell activation syndrome presenting as pruritic dermatitis. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nanda A, Wasan A. Allergic contact dermatitis to parthenolide. J Allergy Clin Immunol Pract 2016; 4:993-4. [PMID: 27161148 DOI: 10.1016/j.jaip.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/18/2016] [Accepted: 04/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Mala P, Ghada M, Wasan A, Noor A, Alhamadani A, Gmach S, Muntasir E, Mansour Z, Rady A, Iliana M, Elganainy A, Musani A, Malik M. Establishment of EWARN system for the Syrian crisis: Experiences and challenges. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mensing G, Martel M, Wasan A, Edwards R. Sex differences in the temporal stability of conditioned pain modulation (CPM) among patients with chronic back pain. The Journal of Pain 2013. [DOI: 10.1016/j.jpain.2013.01.526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scrivani S, Moulton E, Wasan A, Bajwa Z, Becerra L, Bosrook D. Functional Brain Imaging for Pain: A Clinical Drug Trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2012. [DOI: 10.1016/j.oooo.2012.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Guéna J, Chauvat D, Jacquier P, Jahier E, Lintz M, Sanguinetti S, Wasan A, Bouchiat MA, Papoyan AV, Sarkisyan D. New manifestation of atomic parity violation in cesium: a chiral optical gain induced by linearly polarized 6S-7S excitation. Phys Rev Lett 2003; 90:143001. [PMID: 12731912 DOI: 10.1103/physrevlett.90.143001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2002] [Indexed: 05/24/2023]
Abstract
We have detected, by using stimulated emission, an atomic parity violation (APV) in the form of a chiral optical gain of a cesium vapor on the 7S-6P(3/2) transition, consecutive to linearly polarized 6S-7S excitation. We demonstrate the validity of this detection method of APV, by presenting a 9% accurate measurement of expected sign and magnitude. We stress several advantages of this new approach which fully exploits the cylindrical symmetry of the setup. Future measurements at the percent level will provide an important cross-check of an existing more precise result obtained by a different method.
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Affiliation(s)
- J Guéna
- Laboratoire Kastler Brossel, 24 Rue Lhomond, F-75231 Paris Cedex 05, France
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Abstract
Using a computer database, we conducted a retrospective review of all ankle fractures treated at our institution from March 1985 to October 1996. Twenty-one patients with diabetes mellitus and isolated ankle fractures that were treated operatively met all inclusion criteria. Seven had insulin-dependent diabetes, and 14 had non-insulin-dependent diabetes. A randomly selected control group of 46 patients without diabetes who also underwent operative treatment of ankle fractures during this same time period were matched for age, sex, and fracture severity. The complication rate was 43% with 13 complications in nine patients with diabetes. There were seven (15.5%) complications in the control group. Complications in the diabetic group included seven infections (five deep, two superficial) and three losses of fixation. The complications were more severe in our diabetic population, requiring seven additional procedures including two below-knee amputations; a third patient refused an amputation. No additional procedures were required in our control group. All complications in our control group resolved with treatment. The relative risk for postoperative complications in patients with diabetes who sustained ankle fractures that were treated operatively was 2.76 times greater than the control group's (95% confidence interval, 1.57-3.97).
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Affiliation(s)
- R H Blotter
- Department of Orthopaedic Surgery, U.S. Naval Hospital, Yokosuka, Japan
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