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Nguyen MHN, Bruening R, Abel T, Lyons S, Denhardt B, Moore J, Sriaroon P, Hajirawala M, Kim AY. A 14-step desensitization protocol for sebelipase alfa hypersensitivity in a patient with Wolman disease and secondary hemophagocytic lymphohistiocytosis. Pediatr Allergy Immunol 2024; 35:e14121. [PMID: 38572778 DOI: 10.1111/pai.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Minh H N Nguyen
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Rachel Bruening
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Trent Abel
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Shannon Lyons
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Brenna Denhardt
- Nutritional Services, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jenna Moore
- Nutritional Services, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Panida Sriaroon
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Monica Hajirawala
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Alexander Y Kim
- Division of Genetics, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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Patel PK, Tanpowpong P, Sriaroon P, Lockey RF. Nonallergic Diseases Associated With Foods. J Allergy Clin Immunol Pract 2024; 12:607-619. [PMID: 37783385 DOI: 10.1016/j.jaip.2023.09.027] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Clinicians are faced with evaluating real and alleged reactions to foods that may be allergic or nonallergic. Pathogenesis, diagnosis, and treatment of various non-IgE-mediated diseases are discussed in this review. These food-related conditions range from mild to severe. Referral for an allergy workup may be pursued despite the lack of IgE-mediated symptoms. Diagnostic testing is available for defined non-IgE-mediated food diseases that are either immunologic or nonimmunologic. These include celiac disease and related disorders, carbohydrate maldigestion, pancreatic insufficiency, and histamine intolerance. In contrast, there is a paucity of definitive studies to prove food intolerance diseases. There are no definitive diagnostic criteria or testing for nonceliac gluten sensitivity. Functional gastrointestinal disorders, such as irritable bowel syndrome, are better stratified diagnostically but still lack reliable testing. Both nonceliac gluten sensitivity and irritable bowel syndrome are linked to dietary triggers including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Therefore, dietary alteration alone may be diagnostic and therapeutic when all other conditions are ruled out. These conditions are important considerations when evaluating a patient with history of a food reaction. There is little evidence that foods are causative in other ailments such as acne, migraines, and nasal congestion and hypersecretion.
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Affiliation(s)
- Priya K Patel
- Department of Pediatric Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla; Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Pornthep Tanpowpong
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panida Sriaroon
- Department of Pediatric Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla; Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
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Patel PK, Chinga ML, Yilmaz M, Joychan S, Ujhazi B, Ellison M, Gordon S, Nieves D, Csomos K, Eslin D, Afify ZA, Meznarich J, Bohnsack J, Walkovich K, Seidel MG, Sharapova S, Boyarchuk O, Latysheva E, Tuzankina I, Shaker AB, Ayala I, Sriaroon P, Westermann-Clark E, Walter JE. Correction to: Clinical and Treatment History of Patients with Partial DiGeorge Syndrome and Autoimmune Cytopenia at Multiple Centers. J Clin Immunol 2024; 44:72. [PMID: 38421526 DOI: 10.1007/s10875-024-01677-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Priya K Patel
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA.
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA.
| | - Michell Lozano Chinga
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
- Division of Immunology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Melis Yilmaz
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Sonia Joychan
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Boglarka Ujhazi
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Maryssa Ellison
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Sumai Gordon
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Daime Nieves
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Krisztian Csomos
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Don Eslin
- BayCare Medical Group, Pediatric Hematology Oncology, St. Joseph's Hospital, St. Petersburg, FL, USA
| | - Zeinab A Afify
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jessica Meznarich
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - John Bohnsack
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - Kelly Walkovich
- BayCare Medical Group, Pediatric Hematology Oncology, St. Joseph's Hospital, St. Petersburg, FL, USA
| | - Markus G Seidel
- Clinical Department of Pediatric Hematology Oncology, Medical University of Graz, Graz, Austria
| | - Svetlana Sharapova
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Oksana Boyarchuk
- Department of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Elena Latysheva
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Irina Tuzankina
- Institute of Immunology and Physiology of the Branch of the Russian Academy of Sciences, Federal State Autonomous Educational Intuition of Higher Professional Education, Ural Federal University of a Name of the First President of Russia B.N. Yeltsin, Yekaterinburg, Russia
| | - Ahmad B Shaker
- BayCare Medical Group, St. Anthony's Hospital, St. Petersburg, FL, USA
| | - Irmel Ayala
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
| | - Panida Sriaroon
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Emma Westermann-Clark
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Jolan E Walter
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
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Patel PK, Chinga ML, Yilmaz M, Joychan S, Ujhazi B, Ellison M, Gordon S, Nieves D, Csomos K, Eslin D, Afify ZA, Meznarich J, Bohnsack J, Walkovich K, Seidel MG, Sharapova S, Boyarchyk O, Latysheva E, Tuzankina I, Shaker AB, Ayala I, Sriaroon P, Westermann-Clark E, Walter JE. Clinical and Treatment History of Patients with Partial DiGeorge Syndrome and Autoimmune Cytopenia at Multiple Centers. J Clin Immunol 2024; 44:42. [PMID: 38231436 DOI: 10.1007/s10875-023-01607-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/05/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Patients with partial DiGeorge syndrome (pDGS) can present with immune dysregulation, the most common being autoimmune cytopenia (AIC). There is a lack of consensus on the approach to type, combination, and timing of therapies for AIC in pDGS. Recognition of immune dysregulation early in pDGS clinical course may help individualize treatment and prevent adverse outcomes from chronic immune dysregulation. OBJECTIVES Objectives of this study were to characterize the natural history, immune phenotype, and biomarkers in pDGS with AIC. METHODS Data on clinical presentation, disease severity, immunological phenotype, treatment selection, and response for patients with pDGS with AIC were collected via retrospective chart review. Flow cytometric analysis was done to assess T and B cell subsets, including biomarkers of immune dysregulation. RESULTS Twenty-nine patients with the diagnosis of pDGS and AIC were identified from 5 international institutions. Nineteen (62%) patients developed Evan's syndrome (ES) during their clinical course and twenty (69%) had antibody deficiency syndrome. These patients demonstrated expansion in T follicular helper cells, CD19hiCD21lo B cells, and double negative cells and reduction in CD4 naïve T cells and regulatory T cells. First-line treatment for 17/29 (59%) included corticosteroids and/or high-dose immunoglobulin replacement therapy. Other overlapping therapies included eltrombopag, rituximab, and T cell immunomodulators. CONCLUSIONS AIC in pDGS is often refractory to conventional AIC treatment paradigms. Biomarkers may have utility for correlation with disease state and potentially even response to therapy. Immunomodulating therapies could be initiated early based on early immune phenotyping and biomarkers before the disease develops or significantly worsens.
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Affiliation(s)
- Priya K Patel
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA.
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA.
| | - Michell Lozano Chinga
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
- Division of Immunology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Melis Yilmaz
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Sonia Joychan
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Boglarka Ujhazi
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Maryssa Ellison
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Sumai Gordon
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Daime Nieves
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Krisztian Csomos
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Don Eslin
- BayCare Medical Group, St. Joseph's Hospital, Pediatric Hematology Oncology, St. Petersburg, FL, USA
| | - Zeinab A Afify
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jessica Meznarich
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - John Bohnsack
- Division of Pediatric Hematology Oncology, University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - Kelly Walkovich
- BayCare Medical Group, St. Joseph's Hospital, Pediatric Hematology Oncology, St. Petersburg, FL, USA
| | - Markus G Seidel
- Clinical Department of Pediatric Hematology Oncology, Medical University of Graz, Graz, Austria
| | - Svetlana Sharapova
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Oksana Boyarchyk
- Immunopathology Department, National Research Center Institute of Immunology FMBA, Moscow, Russia
| | - Elena Latysheva
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Irina Tuzankina
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Ahmad B Shaker
- BayCare Medical Group, St. Anthony's Hospital, St. Petersburg, FL, USA
| | - Irmel Ayala
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
| | - Panida Sriaroon
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Emma Westermann-Clark
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
| | - Jolan E Walter
- Johns Hopkins All Children's Hospital, 601 5Th Street South, Outpatient Care Clinic, 3Rd Floor, St. Petersburg, FL, 33701, USA
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, St Petersburg, FL, USA
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Patel NC, Torgerson T, Thakar MS, Younger MEM, Sriaroon P, Pozos TC, Buckley RH, Morris D, Vilkama D, Heimall J. Safety and Efficacy of Hizentra® Following Pediatric Hematopoietic Cell Transplant for Treatment of Primary Immunodeficiencies. J Clin Immunol 2023; 43:1557-1565. [PMID: 37266769 PMCID: PMC10499723 DOI: 10.1007/s10875-023-01482-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/01/2023] [Indexed: 06/03/2023]
Abstract
Primary immunodeficiency disease (PIDD) comprises a group of disorders of immune function. Some of the most severe PIDD can be treated with hematopoietic cell transplant (HCT). Hizentra® is a 20% liquid IgG product approved for subcutaneous administration in adults and children greater than 2 years of age with PIDD-associated antibody deficiency. Limited information is available on the use of Hizentra® in children following HCT for PIDD. A multicenter retrospective chart review demonstrated 37 infants and children (median age 70.1 [range 12.0 to 176.4] months) with PIDD treated by HCT who received Hizentra® infusions over a median duration of 31 (range 4-96) months post-transplant. The most common indication for HCT was IL2RG SCID (n = 16). Thirty-two patients switched from IVIG to SCIG administration, due to one or more of the following reasons: patient/caregiver (n = 17) or physician (n = 12) preference, discontinuation of central venous catheter (n = 16), desire for home infusion (n = 12), improved IgG serum levels following lower levels on IVIG (n = 10), and loss of venous access (n = 8). Serious bacterial infections occurred at a rate of 0.041 per patient-year while on therapy. Weight percentile increased by a mean of 16% during the observation period, with females demonstrating the largest gains. Mild local reactions were observed in 24%; 76% had no local reactions. One serious adverse event (death from sepsis) was reported. Hizentra® was discontinued in 15 (41%) patients, most commonly due to recovery of B cell function (n = 11). These data demonstrate that Hizentra® is a safe and effective option in children who have received HCT for PIDD.
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Affiliation(s)
- Niraj C Patel
- Department of Pediatrics, Division of Allergy and Immunology, Duke University, Durham, NC, USA.
- Atrium Health, Charlotte, NC, USA.
| | | | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - M Elizabeth M Younger
- Division of Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Panida Sriaroon
- Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA
| | - Tamara C Pozos
- Department of Clinical Immunology, Children's Minnesota, Minneapolis, MN, USA
| | - Rebecca H Buckley
- Department of Pediatrics, Division of Allergy and Immunology, Duke University, Durham, NC, USA
| | | | - Diana Vilkama
- Department of Clinical Immunology, Children's Minnesota, Minneapolis, MN, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bindernagel C, Sotoudeh S, Nguyen M, Wetzstein G, Sriaroon P, Walter J. Case Report: ASCENIV use in three young children with immune abnormalities and acute respiratory failure secondary to RSV infection. Front Immunol 2023; 14:1154448. [PMID: 37781369 PMCID: PMC10539909 DOI: 10.3389/fimmu.2023.1154448] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the most common etiology of bronchiolitis in young children. While most children clinically improve with care at home, RSV is the leading cause of hospitalization among infants aged 12 months or less. Common modalities of treatment for children with immune dysregulation include respiratory support and best supportive care, which may include immunoglobulin therapy. All immunoglobulin therapies adhere to Food and Drug Administration (FDA) - established standards for antibodies against measles, polio, and diphtheria, but there are no required standards for problematic respiratory viral pathogens, including RSV and others. ASCENIV is an approved IVIG that is manufactured from blending normal source plasma with plasma from donors that possess high antibody titers against RSV and other respiratory pathogens of concern. ASCENIV was developed, in part, to the unmet need that exists in immunocompromised patients who lack sufficient antibodies against problematic viral pathogens. ASCENIV is not a currently approved treatment for severe RSV and other viral infections. There is a lack of research regarding its potential benefits in the acute treatment period for RSV and in the pediatric population. Therefore, this case series was developed to describe real-world experiences of ASCENIV use in this less well studied clinical scenario. This case series reviews three pediatric patients ≤ 5 years of age with immune dysregulation and who were severely ill with RSV. Despite receiving best supportive care, and standard immunoglobulin therapy for some, the patients' clinical status continued to decline. All patients received ASCENIV in an intensive care setting. Each patient had ultimately recovered due to the various medical interventions done. This case series demonstrated that ASCENIV (500mg/kg) administration may have contributed to the treatment outcomes of a less well studied age-cohort of patients. In addition, no adverse side effects were observed after ASCENIV administration. Further analysis of the benefits of ASCENIV for the acute and preventative treatment in patients younger than 12 years of age with immune dysregulation should continue to be explored.
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Affiliation(s)
- Constance Bindernagel
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Allergy and Immunology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, United States
| | - Shannon Sotoudeh
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Allergy and Immunology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, United States
| | - Minh Nguyen
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Allergy and Immunology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, United States
| | - Gene Wetzstein
- ADMA Biologics (United States), Ramsey, NJ, United States
| | - Panida Sriaroon
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Allergy and Immunology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, United States
| | - Jolan Walter
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Department of Allergy and Immunology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, United States
- ADMA Biologics (United States), Ramsey, NJ, United States
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Beacker J, Brown JM, Florio J, Baran JV, Lamos L, Oliveros L, Vanderhoof JA, Sriaroon P, Wilsey MJ. Clinician Experience with Using Hypoallergenic Formulas to Treat Infants with Suspected Cow's Milk Protein Allergy: A Secondary Analysis of a Prospective Survey Cohort. Pediatr Gastroenterol Hepatol Nutr 2023; 26:277-283. [PMID: 37736218 PMCID: PMC10509022 DOI: 10.5223/pghn.2023.26.5.277] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose Cow's milk protein allergy (CMPA) is a common condition in infants, but little is known about healthcare providers' clinical experience treating infants with CMPA. To address this gap, we analyzed prospectively collected data from healthcare providers (HCPs) who treated infants under six months old with suspected CMPA using hypoallergenic formulas. The study focused on a commercial extensively hydrolyzed formula containing Lactobacillus rhamnosus GG (ATCC53103) (eHF-LGG) or a commercial amino acid formula (AAF). Methods In this secondary analysis of prospectively collected survey data, 52 HCPs treated 329 infants under six months old with suspected CMPA using hypoallergenic formulas. A series of two de-identified surveys per patient were collected by HCPs to assess short-term symptom relief in the patients and HCP's satisfaction with the management strategies. The initial survey was completed at the initiation of treatment of CMPA, and the second survey was completed at a follow-up visit. Results The majority of HCPs (87%) in the study were general pediatricians, and most saw 2 to 10 CMPA patients weekly. Results showed that clinicians reported satisfaction with treatment in 95% of patients in the EHF cohort and 97% of patients in the AAF cohort and achieved expected clinical results in 93% and 97% of patients using eHF and AAF, respectively. Furthermore, few patients were switched from the hypoallergenic formula once initiated. Conclusion The study provides new insights into HCP perspectives on treating infants with CMPA and supports using hypoallergenic formulas to manage this condition. However, additional prospective controlled studies are needed to confirm these initial findings.
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Affiliation(s)
- Jesse Beacker
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Jerry M. Brown
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Jared Florio
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Jessica V. Baran
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Luke Lamos
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Lea Oliveros
- Pediatric Gastroenterology, Hepatology, and Nutrition of Florida, St. Petersburg, FL, USA
| | - Jon A. Vanderhoof
- Department of Gastroenterology Hepatology and Nutrition, Boys Town Hospital, Boys Town, NE, USA
| | - Panida Sriaroon
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Michael J. Wilsey
- Pediatric Gastroenterology, Hepatology, and Nutrition of Florida, St. Petersburg, FL, USA
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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8
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Wilsey MJ, Baran JV, Lamos L, Beacker J, Florio J, Oliveros L, Sriaroon P, Brown JM, Vanderhoof JA. Short-term symptom improvement in infants with suspected cow's milk protein allergy using amino acid formula: a prospective cohort analysis. Front Nutr 2023; 10:1208334. [PMID: 37408987 PMCID: PMC10318537 DOI: 10.3389/fnut.2023.1208334] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Background Cow's milk protein allergy (CMPA) occurs commonly in infants. While the long-term efficacy of amino acid formulas for managing CMPA is well-established, there is limited data on the short-term symptom improvement of using amino acid formula (AAF). Objective This study aimed to determine the short-term effects of managing suspected CMPA in infants aged 6 months and under using a commercial AAF. Methods Healthcare providers who treated infants with suspected CMPA aged 6 months or younger (n = 104) provided de-identified survey data in this prospective study. Healthcare providers scored symptoms for severity from 0 to 3 (none, low, moderate, severe) before using a commercial AAF at Visit 1 and at Visit 2 (3-6 weeks later). Results Gastrointestinal (94%), skin (87%), respiratory (86%), and uncategorized symptoms (89%) improved from AAF initiation, and these findings were consistent across different follow-up visit durations. Conclusion This study is the most extensive prospective analysis conducted in the United States examining the short-term change in suspected CMPA symptoms using an AAF. These findings suggest that AAF may decrease the severity of suspected CMPA symptoms in infants 6 months or younger, often by the next follow-up visit. Further randomized controlled trials are required to confirm these initial findings.
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Affiliation(s)
- Michael J. Wilsey
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, United States
- Pediatric Gastroenterology, Hepatology, and Nutrition of Florida, St. Petersburg, FL, United States
| | - Jessica V. Baran
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, United States
| | - Luke Lamos
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, United States
| | - Jesse Beacker
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, United States
| | - Jared Florio
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, United States
| | - Lea Oliveros
- Pediatric Gastroenterology, Hepatology, and Nutrition of Florida, St. Petersburg, FL, United States
| | - Panida Sriaroon
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Jerry M. Brown
- Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, United States
| | - Jon A. Vanderhoof
- Department of Gastroenterology Hepatology and Nutrition, Boys Town Hospital, Boys Town, NE, United States
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9
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Wilsey MJ, Florio J, Beacker J, Lamos L, Baran JV, Oliveros L, Sriaroon P, Brown JM, Vanderhoof JA. Extensively Hydrolyzed Formula Improves Allergic Symptoms in the Short Term in Infants with Suspected Cow’s Milk Protein Allergy. Nutrients 2023; 15:nu15071677. [PMID: 37049517 PMCID: PMC10096968 DOI: 10.3390/nu15071677] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
Although extensively hydrolyzed formula is widely accepted for managing cow’s milk protein allergy (CMPA) long-term, there is a lack of evidence on its short-term efficacy. This study’s objective was to investigate the short-term symptom changes (within 3–6 weeks) of infants diagnosed with CMPA and managed with extensively hydrolyzed formula containing Lactobacillus rhamnosus at their subsequent physician visit. Healthcare providers treating 202 patients diagnosed with CMPA under six months old completed de-identified surveys, which were then analyzed in this prospective study. After their first visit, the patients were started on extensively hydrolyzed formula, and their baseline symptoms were scored on a severity scale of 0–3. Patients were then reevaluated at their next follow-up visit to assess changes in symptom severity. The study found statistically significant improvements in gastrointestinal (93%), skin (83%), respiratory (73%), and uncategorized symptoms (90%). These symptom improvements were consistent across different follow-up visit durations. This study is the largest prospective analysis conducted in the United States evaluating short-term change in CMPA symptoms severity in infants under six months old using extensively hydrolyzed formula. These findings suggest that extensively hydrolyzed formula is associated with clinical symptom relief, which is often noticeable by the next follow-up visit. However, additional randomized control trials are needed to validate these results.
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10
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Lim SJ, Jithpratuck W, Wasylik K, Sriaroon P, Dishaw LJ. Associations of Microbial Diversity with Age and Other Clinical Variables among Pediatric Chronic Rhinosinusitis (CRS) Patients. Microorganisms 2023; 11:microorganisms11020422. [PMID: 36838387 PMCID: PMC9965780 DOI: 10.3390/microorganisms11020422] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a heterogenous disease that causes persistent paranasal sinus inflammation in children. Microorganisms are thought to contribute to the etiology and progression of CRS. Culture-independent microbiome analysis offers deeper insights into sinonasal microbial diversity and microbe-disease associations than culture-based methods. To date, CRS-related microbiome studies have mostly focused on the adult population, and only one study has characterized the pediatric CRS microbiome. In this study, we analyzed the bacterial diversity of adenoid tissue, adenoid swab, maxillary sinus, and sinus wash samples from 45 pediatric CRS patients recruited from the Johns Hopkins All Children's Hospital (JHACH) in St. Petersburg, FL, USA. The alpha diversity in these samples was associated with baseline nasal steroid use, leukotriene receptor antagonist (LTRA) use, and total serum immunoglobulin (Ig) E (IgE) level. Streptococcus, Moraxella, and Haemophilus spp. were most frequently identified from sinus cultures and the sequenced 16S rRNA gene content. Comparative analyses combining our samples with the samples from the previous microbiome study revealed differentially abundant genera between patients with pediatric CRS and healthy controls, including Cutibacterium and Moraxella. Additionally, the abundances of Streptobacillus and Staphylococcus were consistently correlated with age in both adenoid- and sinus-derived samples. Our study uncovers new associations of alpha diversity with clinical parameters, as well as associations of specific genera with disease status and age, that can be further investigated.
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Affiliation(s)
- Shen Jean Lim
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Warit Jithpratuck
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Kathleen Wasylik
- Pediatric Ear, Nose & Throat Specialists, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA
| | - Panida Sriaroon
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
- USF Pediatric Allergy/Immunology Clinic, Food Allergy Clinic, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA
| | - Larry J. Dishaw
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
- Correspondence: ; Tel.: +1-727-553-3601
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11
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Patel P, Ujhazi B, Yilmaz M, Potts D, Ellison M, Meehan C, Gordon S, Cruz R, Ayala I, Eslin D, Cockrell E, Rico F, Mayer J, Sing-Ong M, Meyer A, Hauk C, Dasso J, Westermann-Clark E, Sriaroon P, Csomos K, Walter J. Evaluation of a Panel of Cellular Biomarkers for Immune Dysregulation in Inborn Errors of Immunity. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.656] [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: 02/05/2023]
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12
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Sriaroon P, Ledford DK, Lockey RF. Allergic and Non-Allergic Systemic Reactions including Anaphylaxis. Immunol Allergy Clin North Am 2022. [DOI: 10.1016/s0889-8561(21)00095-3] [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: 11/05/2022]
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13
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Ponda P, Russell AF, Yu JE, Land MH, Crain MG, Patel K, Shroba JA, Sriaroon P. Access barriers to epinephrine autoinjectors for the treatment of anaphylaxis: A survey of practitioners. J Allergy Clin Immunol Pract 2021; 9:3814-3815.e4. [PMID: 34126272 DOI: 10.1016/j.jaip.2021.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Punita Ponda
- Division of Allergy and Immunology, Department of Pediatrics, Cohen Children's Medical Center of New York, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
| | - Anne F Russell
- School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich
| | - Joyce E Yu
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Michael H Land
- Allergy Department, Southern California Permanente Medical Group, San Diego, Calif
| | | | - Kiran Patel
- Division of Pulmonology, Allergy, Cystic Fibrosis, and Sleep Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jodi A Shroba
- Division of Allergy and Immunology. Children's Mercy Hospital, Kansas City, Mo
| | - Panida Sriaroon
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Fla
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14
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Abstract
PURPOSE OF REVIEW Despite the COVID-19 pandemic, progress continued in the field of peanut oral immunotherapy over the past 12 to 18 months. Of importance, the first oral immunotherapy product for the treatment of peanut allergy was approved by the US Food and Drug Administration in January 2020. RECENT FINDINGS Suggested modifications to the practice of oral immunotherapy, some of which may have lasting impacts, were circulated as a result of the pandemic. New advances in pathophysiology, sustained unresponsiveness, quality of life, safety, and cost effectiveness were also published. SUMMARY During 2020, COVID-19 influenced the daily practice of allergy and immunology, with peanut oral immunotherapy being no exception. However, clinicians now have a FDA-approved treatment option for peanut allergy in children, a welcome development for a difficult disease. Future research is needed to clarify several knowledge deficits surrounding the best use of peanut OIT.
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Affiliation(s)
- Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine
| | - Panida Sriaroon
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal Medicine
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15
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Westermann-Clark E, Meehan CA, Meyer AK, Dasso JF, Amre D, Ellison M, Patel B, Betensky M, Hauk CI, Mayer J, Metts J, Leiding JW, Sriaroon P, Kumar A, Ayala I, Walter JE. Primary Immunodeficiency in Children With Autoimmune Cytopenias: Retrospective 154-Patient Cohort. Front Immunol 2021; 12:649182. [PMID: 33968040 PMCID: PMC8100326 DOI: 10.3389/fimmu.2021.649182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Primary immunodeficiency is common among patients with autoimmune cytopenia. Objective The purpose of this study is to retrospectively identify key clinical features and biomarkers of primary immunodeficiency (PID) in pediatric patients with autoimmune cytopenias (AIC) so as to facilitate early diagnosis and targeted therapy. Methods Electronic medical records at a pediatric tertiary care center were reviewed. We selected 154 patients with both AIC and PID (n=17), or AIC alone (n=137) for inclusion in two cohorts. Immunoglobulin levels, vaccine titers, lymphocyte subsets (T, B and NK cells), autoantibodies, clinical characteristics, and response to treatment were recorded. Results Clinical features associated with AIC-PID included splenomegaly, short stature, and recurrent or chronic infections. PID patients were more likely to have autoimmune hemolytic anemia (AIHA) or Evans syndrome than AIC-only patients. The AIC-PID group was also distinguished by low T cells (CD3 and CD8), low immunoglobulins (IgG and IgA), and higher prevalence of autoantibodies to red blood cells, platelets or neutrophils. AIC diagnosis preceded PID diagnosis by 3 years on average, except among those with partial DiGeorge syndrome. AIC-PID patients were more likely to fail first-line treatment. Conclusions AIC patients, especially those with Evans syndrome or AIHA, should be evaluated for PID. Lymphocyte subsets and immune globulins serve as a rapid screen for underlying PID. Early detection of patients with comorbid PID and AIC may improve treatment outcomes. Prospective studies are needed to confirm the diagnostic clues identified and to guide targeted therapy.
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Affiliation(s)
- Emma Westermann-Clark
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Division of Allergy and Immunology, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Cristina Adelia Meehan
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Anna K Meyer
- Division of Allergy and Immunology, Department of Pediatrics, National Jewish Health, Denver, CO, United States.,Graduate Medical Education, University of Colorado, Denver, CO, United States
| | - Joseph F Dasso
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Department of Biology, University of Tampa, Tampa, FL, United States
| | - Devendra Amre
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Maryssa Ellison
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Bhumika Patel
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Marisol Betensky
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States.,Division of Hematology, Department of Pediatrics Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Charles Isaac Hauk
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States
| | - Jennifer Mayer
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States
| | - Jonathan Metts
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Division of Allergy/Immunology, Department of Pediatrics Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Panida Sriaroon
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Division of Allergy/Immunology, Department of Pediatrics Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Ambuj Kumar
- Research Methodology and Biostatistics Core, Morssani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Irmel Ayala
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States.,Division of Hematology, Department of Pediatrics Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Jolan E Walter
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Division of Allergy/Immunology, Department of Pediatrics Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, United States
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16
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Patel P, Westermann-Clark E, Joychan S, Shaker A, Ujhazi B, Meehan C, Ellison M, Csomos K, Gordon S, Nieves D, Mateus J, Ayala I, Walter J, Sriaroon P. Clinical and Treatment History of Patients with Partial DiGeorge Syndrome and Autoimmune Cytopenia. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.271] [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: 10/22/2022]
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17
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Dawson I, Chitty-Lopez M, Sriaroon P. Characteristics of Fish and Shellfish Allergy – Single Center Experience. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.366] [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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18
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Miranda MA, Dasso J, Ellison M, Trotter J, Timothy P, Chitty-Lopez M, Duff C, Nieves D, Westermann-Clark E, Tang N, Sher M, Ballow M, Leiding J, Sriaroon P, Walter J. Clinical Characteristics of SARS-CoV2 Infected and Exposed Patients at a Tertiary Care Allergy/Immunology Program in Florida. J Allergy Clin Immunol 2021. [PMCID: PMC7849430 DOI: 10.1016/j.jaci.2020.12.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Anderson JT, Bonagura VR, Cowan J, Hsu C, Mustafa SS, Patel NC, Routes JM, Sriaroon P, Vinh DC, Hofmann JH, Praus M, Rojavin MA. Safety and Tolerability of Subcutaneous IgPro20 at High Infusion Parameters in Patients with Primary Immunodeficiency: Findings from the Pump-Assisted Administration Cohorts of the HILO Study. J Clin Immunol 2021; 41:458-469. [PMID: 33409867 PMCID: PMC7858210 DOI: 10.1007/s10875-020-00912-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/04/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the safety and tolerability of subcutaneous IgPro20 (Hizentra®, CSL Behring, King of Prussia, PA, USA) administered at high infusion parameters (> 25 mL and > 25 mL/h per injection site) in patients with primary immunodeficiency. METHODS The Hizentra® Label Optimization (HILO) study was an open-label, parallel-arm, non-randomized study (NCT03033745) of IgPro20 using a forced upward titration design for infusion parameters. Patients experienced with pump-assisted IgPro20 infusions received weekly IgPro20 infusions at a stable dose in the Pump-Assisted Volume Cohort (N = 15; 25-50 mL per injection site) and in the Pump-Assisted Flow Rate Cohort (N = 18; 25-100 mL/h per injection site). Responder rates (percentage of patients who successfully completed ≥ 75% of planned infusions), safety outcomes, and serum immunoglobulin G (IgG) trough levels were evaluated. RESULTS Responder rates were 86.7% (13/15, 25 mL) and 73.3% (11/15, 40 and 50 mL) in the Volume Cohort, and 77.8% (14/18, 25 and 50 mL/h), 66.7% (12/18, 75 mL/h), and 61.1% (11/18, 100 mL/h) in the Flow Rate Cohort. Infusion compliance was ≥ 90% in all patients in the Volume Cohort and in 83.3% of patients in the Flow Rate Cohort. The number of injection sites (Volume Cohort) and the infusion duration (Flow Rate Cohort) decreased with increasing infusion parameters. The rate of treatment-emergent adverse events per infusion was low (0.138 [Volume Cohort] and 0.216 [Flow Rate Cohort]). Serum IgG levels remained stable during the study. CONCLUSION Pump-assisted IgPro20 infusions are feasible at 50 mL and 100 mL/h per injection site in treatment-experienced patients, which may result in fewer injection sites and shorter infusion times. TRIAL REGISTRATION NCT03033745 ; registered January 27, 2017.
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Affiliation(s)
- John T Anderson
- Clinical Research Center of Alabama, 504 Brookwood Blvd Suite 250, Birmingham, AL, 35209, USA.
| | - Vincent R Bonagura
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA.,Hofstra-NS-LIJ School of Medicine, Feinstein Institute for Medical Research, Rm. 1236, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Juthaporn Cowan
- University of Ottawa, 501 Smyth Road, Box 223, Ottawa, ON, K1H8L6, Canada
| | - Connie Hsu
- Allergy & Immunology Specialists, PLLC, 13575 W. Indian School Road, Suite 200, Litchfield Park, AZ, 85340, USA
| | - S Shahzad Mustafa
- Rochester Regional Health, 222 Alexander Street, Suite 3000, Rochester, NY, 14607, USA.,University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Niraj C Patel
- Department of Pediatrics, Levine Children's Hospital, Atrium Health, 1000 Blythe Blvd, PO Box 32861, Charlotte, NC, 28232, USA
| | - John M Routes
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Medical College of Wisconsin, Milwaukee, 9000 W. Wisconsin Ave., Milwaukee, WI, 53226, USA
| | - Panida Sriaroon
- University of South Florida, 140 7th Ave. South, CRI 4008, St. Petersburg, FL, 33701, USA
| | - Donald C Vinh
- McGill University Health Centre - Research Institute, 1001 Decarie Blvd, Block E, Rm EM3-3230 (Mail Drop: EM3-3211), Montreal, QC, H4A 3J1, Canada
| | | | - Michaela Praus
- CSL Behring GmbH, Emil-von-Behring-Straße 76, 35041, Marburg, Germany
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20
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Miranda M, Sriaroon P, Leiding J, Walter J. M280 DIAGNOSTIC SAGA FOR A FAMILY WITH HIES. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.308] [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: 11/15/2022]
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21
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Cruz RJ, Dasso JF, Duff C, Krasnopero D, Long Z, Ellison M, Nieves D, Sriaroon P, Asante-Korang A, Walter JE. Hyaluronidase-Facilitated High-Dose Subcutaneous IgG Effectively Controls Parvovirus B19 Infection in a Pediatric Cardiac Transplant Patient With Severe T-Cell Lymphopenia. Open Forum Infect Dis 2020; 7:ofaa076. [PMID: 32391400 PMCID: PMC7200086 DOI: 10.1093/ofid/ofaa076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/10/2020] [Indexed: 11/14/2022] Open
Abstract
We treated three pediatric cardiac transplant patients with chronic parvovirus viremia with high-dose intravenous immunoglobulin (HD-IVIG). One patient with severe T-cell lymphopenia suffered recurrent viremia and aseptic meningitis, which resolved remarkably when he was switched to high-dose hyaluronidase-facilitated subcutaneous immunoglobulin (HD-SCIG-Hy). We discuss the advantages of HD-SCIG-Hy vs HD-IVIG treatment for similar cases.
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Affiliation(s)
- Rachel J Cruz
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Joseph F Dasso
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Biology, University of Tampa, Tampa, Florida, USA
| | - Carla Duff
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Diane Krasnopero
- Division of Cardiology, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
| | - Zsofia Long
- Division of Cardiology, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
| | - Maryssa Ellison
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Daime Nieves
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Panida Sriaroon
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Alfred Asante-Korang
- Division of Cardiology, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
| | - Jolan E Walter
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Division of Allergy and Immunology, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
- Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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22
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Anderson J, Bonagura V, Cowan J, Hu C, Mustafa S, Patel N, Routes J, Sriaroon P, VINH D, Hofmann J, Rojavin M. The HILO Study: High Volumes and Flow Rates of Subcutaneous IgPro20 Pump-assisted Infusions in Patients with Primary Immunodeficiency. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.253] [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: 10/24/2022]
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23
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Rojavin M, Hu C, Anderson J, Bonagura V, Cowan J, Lugar P, Maglione P, Mustafa S, Patel N, Routes J, Sriaroon P, VINH D, Hofmann J. Safety Profile of High IgPro20 Infusion Parameters in Patients with Primary Immunodeficiency (PID): Results from The Forced Upward Titration HILO Study. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.826] [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: 11/27/2022]
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24
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Jithpratuck W, Kays D, Sriaroon P. A mysterious rash around surgical wounds. Ann Allergy Asthma Immunol 2019; 124:106-107. [PMID: 31520773 DOI: 10.1016/j.anai.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Warit Jithpratuck
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St Petersburg, Florida
| | - David Kays
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Panida Sriaroon
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St Petersburg, Florida.
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25
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Sriaroon P, Casale TB. The challenge of choosing the correct biologic for the correct asthma patient. Ann Allergy Asthma Immunol 2019; 121:385-386. [PMID: 30290891 DOI: 10.1016/j.anai.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Panida Sriaroon
- USF/All Children's Hospital Allergy/Immunology clinic, Tampa, Florida
| | - Thomas B Casale
- University of South Florida, Morsani College of Medicine, Dept of Medicine, Tampa, Florida.
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26
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Sriaroon P, Chang Y, Ujhazi B, Csomos K, Joshi HR, Zhou Q, Close DW, Walter JE, Kumánovics A. Familial Immune Thrombocytopenia Associated With a Novel Variant in IKZF1. Front Pediatr 2019; 7:139. [PMID: 31069201 PMCID: PMC6491668 DOI: 10.3389/fped.2019.00139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/25/2019] [Indexed: 01/19/2023] Open
Abstract
We report a novel variant in IKZF1 associated with IKAROS haploinsufficiency in a patient with familial immune thrombocytopenia (ITP). IKAROS, encoded by the IKZF1 gene, is a hematopoietic zinc-finger transcription factor that can directly bind to DNA. We show that the identified IKZF1 variant (p.His195Arg) alters a completely conserved histidine residue required for the folding of the third zinc-finger of IKAROS protein, leading to a loss of characteristic immunofluorescence nuclear staining pattern. In our case, genetic testing was essential for the diagnosis of IKAROS haploinsufficiency, of which known presentations include infections, aberrant hematopoiesis, leukemia, and age-related decrease in humoral immunity. Our family study underscores that, after infections, ITP is the second most common clinical manifestation of IKAROS haploinsufficiency.
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Affiliation(s)
- Panida Sriaroon
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida Morsani College of Medicine, St. Petersburg, FL, United States
| | - Yenhui Chang
- Pathology and Laboratory Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Boglarka Ujhazi
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida Morsani College of Medicine, St. Petersburg, FL, United States
| | - Krisztian Csomos
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida Morsani College of Medicine, St. Petersburg, FL, United States
| | - Hemant R Joshi
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Qin Zhou
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Devin W Close
- ARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States
| | - Jolan E Walter
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida Morsani College of Medicine, St. Petersburg, FL, United States
- Division of Allergy/Immunology, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Attila Kumánovics
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
- ARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Purswani P, Walter JE, Sriaroon P. Treatment Challenges of Refractory Thrombocytopenia in DiGeorge Syndrome. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.342] [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: 11/26/2022]
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Purswani P, Meehan CA, Kuehn HS, Chang Y, Dasso JF, Meyer AK, Ujhazi B, Csomos K, Lindsay D, Alberdi T, Joychan S, Trotter J, Duff C, Ellison M, Bleesing J, Kumanovics A, Comeau AM, Hale JE, Notarangelo LD, Torgersen TR, Ochs HD, Sriaroon P, Oshrine B, Petrovic A, Rosenzweig SD, Leiding JW, Walter JE. Two Unique Cases of X-linked SCID: A Diagnostic Challenge in the Era of Newborn Screening. Front Pediatr 2019; 7:55. [PMID: 31024866 PMCID: PMC6460992 DOI: 10.3389/fped.2019.00055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/11/2019] [Indexed: 12/17/2022] Open
Abstract
In the era of newborn screening (NBS) for severe combined immunodeficiency (SCID) and the possibility of gene therapy (GT), it is important to link SCID phenotype to the underlying genetic disease. In western countries, X-linked interleukin 2 receptor gamma chain (IL2RG) and adenosine deaminase (ADA) deficiency SCID are two of the most common types of SCID and can be treated by GT. As a challenge, both IL2RG and ADA genes are highly polymorphic and a gene-based diagnosis may be difficult if the variant is of unknown significance or if it is located in non-coding areas of the genes that are not routinely evaluated with exon-based genetic testing (e.g., introns, promoters, and the 5'and 3' untranslated regions). Therefore, it is important to extend evaluation to non-coding areas of a SCID gene if the exon-based sequencing is inconclusive and there is strong suspicion that a variant in that gene is the cause for disease. Functional studies are often required in these cases to confirm a pathogenic variant. We present here two unique examples of X-linked SCID with variable immune phenotypes, where IL2R gamma chain expression was detected and no pathogenic variant was identified on initial genetic testing. Pathogenic IL2RG variants were subsequently confirmed by functional assay of gamma chain signaling and maternal X-inactivation studies. We propose that such tests can facilitate confirmation of suspected cases of X-linked SCID in newborns when initial genetic testing is inconclusive. Early identification of pathogenic IL2RG variants is especially important to ensure eligibility for gene therapy.
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Affiliation(s)
- Pooja Purswani
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Cristina Adelia Meehan
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Hye Sun Kuehn
- Immunology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Yenhui Chang
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Joseph F Dasso
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Department of Biology, University of Tampa, Tampa, FL, United States
| | - Anna K Meyer
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Boglarka Ujhazi
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Krisztian Csomos
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - David Lindsay
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States
| | - Taylor Alberdi
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Sonia Joychan
- Dearborn Allergy & Asthma Clinic, PC, Dearborn, MI, United States
| | - Jessica Trotter
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Carla Duff
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Maryssa Ellison
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Jack Bleesing
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Attila Kumanovics
- Department of Pathology, University of Utah, Salt Lake City, UT, United States.,ARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States
| | - Anne M Comeau
- New England Newborn Screening Program and Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jaime E Hale
- New England Newborn Screening Program, University of Massachusetts Medical School, Worcester, MA, United States
| | - Luigi D Notarangelo
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States
| | - Troy R Torgersen
- Department of Pediatrics, University of Washington & Seattle Children's Research Institute, Seattle, WA, United States
| | - Hans D Ochs
- Department of Pediatrics, University of Washington & Seattle Children's Research Institute, Seattle, WA, United States
| | - Panida Sriaroon
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Benjamin Oshrine
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Aleksandra Petrovic
- Department of Pediatrics, University of Washington & Seattle Children's Research Institute, Seattle, WA, United States
| | - Sergio D Rosenzweig
- Immunology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Jennifer W Leiding
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Jolan E Walter
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, United States
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Casale TB, Haselkorn T, Ciaccio CE, Sriaroon P, Chipps BE. Harmonization of Terminology for Tolerated and Reactive Dose in Food Allergy Immunotherapy. J Allergy Clin Immunol Pract 2018; 7:389-392. [PMID: 30557719 DOI: 10.1016/j.jaip.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022]
Abstract
Currently, there is no Food and Drug Administration-approved therapy for food allergy. Several new potential treatments are under investigation, including food allergen immunotherapy via various routes of administration, such as oral immunotherapy, epicutaneous immunotherapy, subcutaneous immunotherapy, and sublingual immunotherapy. The double-blind, placebo-controlled food challenge (DBPCFC) has traditionally been used for diagnostic purposes, but extrapolation of the specific terminology used in food allergy diagnosis to interpretation of efficacy in clinical trials is incongruent and difficult to apply. There is a need for standardization of the terminology used in food allergy clinical trials, because inconsistencies can lead to potential misinterpretation of end points. The reactive dose, previously referred to as the eliciting dose, is defined as the dose given that induces the onset of unequivocal allergic symptoms, or the dose that stops the challenge based on physician discretion. Conversely, the single highest tolerated dose is defined as the highest dose given during a food challenge that elicits either no symptoms or symptoms that do not meet stopping criteria per the study protocol. The evolving field of food allergy provides a novel opportunity to define those end points that are most meaningful for patients, which is fundamental for successful implementation, education, and safety.
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Affiliation(s)
- Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla.
| | | | | | - Panida Sriaroon
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla
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Jithpratuck W, Kays D, Sriaroon P. A MYSTERIOUS RASH AROUND SURGICAL WOUNDS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.440] [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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31
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Purswani P, Sriaroon P. A TODDLER WITH ALTERNATIVE PATHWAY COMPLEMENT DEFICIENCY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.369] [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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32
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Rolfes MC, Sriaroon P, Dávila Saldaña BJ, Dvorak CC, Chapdelaine H, Ferdman RM, Chen K, Jolles S, Patel NC, Kim YJ, Tarrant TK, Martelius T, Seppanen M, Joshi AY. Chronic norovirus infection in primary immune deficiency disorders: an international case series. Diagn Microbiol Infect Dis 2018; 93:69-73. [PMID: 30174143 DOI: 10.1016/j.diagmicrobio.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Predictive factors associated with clinical outcomes of chronic norovirus infection (CNI) in primary immunodeficiency diseases (PIDD) are lacking. METHOD We sought to characterize CNI using a multi-institutional cohort of patients with PIDD and CNI using the Clinical Immunology Society's CIS-PIDD Listserv e-mail group. RESULTS Thirty-four subjects (21 males and 13 females) were reported from centers across North America, Europe, and Asia. All subjects were receiving high doses (median IgG dose: 1200 mg/kg/month) of supplemental immunoglobulin therapy. Fifty-three percent had a complete absence of B cells (median B-cell count 0; range 0-139 cells/μL). Common Variable Immune Deficiency (CVID) subjects manifested a unique phenotype with B-cell lymphopenia, non O+ blood type, and villous atrophy (logistic regression model, P = 0.01). Five subjects died, all of whom had no evidence of villous atrophy. CONCLUSION While Norovirus (NoV) is thought to replicate in B cells, in this PIDD cohort of CNI, B-cell lymphopenia was common, indicating that the presence of B lymphocytes is not essential for CNI.
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Affiliation(s)
- M C Rolfes
- Mayo Clinic School of Medicine, Rochester, MN
| | - P Sriaroon
- USF/All Children's Hospital Allergy/Immunology, St. Petersburg, FL
| | - B J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - C C Dvorak
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplantation, University of California, San Francisco, CA
| | - H Chapdelaine
- Department of Allergy and Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - R M Ferdman
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - K Chen
- Department of Pediatrics, Division of Allergy and Immunology, University of Utah School of Medicine, Salt Lake City, UT
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - N C Patel
- Division of Pediatric Infectious Disease and Immunology, Levine Children's Hospital, Carolinas Medical Center, Charlotte, NC
| | - Y J Kim
- Division of Infectious Diseases and Immunodeficiency, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - T K Tarrant
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC
| | - T Martelius
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Seppanen
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Rare Disease Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Y Joshi
- Mayo Clinic School of Medicine, Rochester, MN; Division of Pediatric Allergy and Immunology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN.
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Alberdi T, Castro-Wagner JB, Patel B, Joychan S, Lindsey D, Laham FR, Csomos K, Ujhazi B, Duff CM, Trotter J, Bleesing JJ, Kumanovics A, Chang Y, Hale JH, Sriaroon P, Hale G, Oshrine BR, Notarangelo L, Abraham RS, Comeau AM, Petrovic A, Leiding JW, Walter JE. An Atypical Severe Combined Immunodeficiency (SCID) Case Diagnosis Complicated by Alternative Care in the Era of Newborn Screening (NBS) for SCID. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.015] [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: 10/20/2022]
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Ballow M, Conaway MR, Sriaroon P, Rachid RA, Seeborg FO, Duff CM, Bonilla FA, Younger MEM, Shapiro R, Burns TM. Construction and validation of a novel disease-specific quality-of-life instrument for patients with primary antibody deficiency disease (PADQOL-16). J Allergy Clin Immunol 2017; 139:2007-2010.e8. [PMID: 28065678 DOI: 10.1016/j.jaci.2016.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/16/2016] [Accepted: 11/08/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Mark Ballow
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida, Johns Hopkins All Children's Hospital, St Petersburg, Fla.
| | - Mark R Conaway
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Va
| | - Panida Sriaroon
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Rima A Rachid
- Department of Pediatrics, Division of Immunology, Allergy and Rheumatology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Filiz O Seeborg
- Division of Allergy and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
| | - Carla M Duff
- Department of Pediatrics, Division of Allergy and Immunology, University of South Florida, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Francisco A Bonilla
- Department of Pediatrics, Division of Immunology, Allergy and Rheumatology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - M Elizabeth M Younger
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Johns Hopkins University, School of Medicine, Baltimore, Md
| | | | - Ted M Burns
- Department of Neurology, University of Virginia Health System, Charlottesville, Va
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Abstract
Eosinophils can regulate local and systemic inflammation, and their presence in higher numbers appears to play an important role in the pathology of various atopic and inflammatory diseases. Eosinophil maturation, recruitment, and survival depend on several cytokine regulators, including interleukin (IL)-5, IL-4, and IL-13 as well as growth factors such as GM-CSF. Over the last decade, the approach to treating eosinophilic diseases has changed greatly. A number of biologic modulators have been developed to target eosinophilic inflammatory pathways, and their usage has resulted in variable clinical improvement in the treatment of eosinophilic-associated conditions. Novel targeted therapies that are safe and effective for treating these disorders are being investigated. This review summarizes the clinical use of biologic agents that have been studied in clinical trials or approved for treating eosinophilic diseases.
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Affiliation(s)
- Panida Sriaroon
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, 140 7th ave S, CRI 4008, St. Petersburg, FL, 33701, USA.
| | - Mark Ballow
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, 140 7th ave S, CRI 4008, St. Petersburg, FL, 33701, USA
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Gemayel KT, Litman GW, Sriaroon P. Autosomal recessive agammaglobulinemia associated with an IGLL1 gene missense mutation. Ann Allergy Asthma Immunol 2016; 117:439-441. [PMID: 27576013 DOI: 10.1016/j.anai.2016.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/25/2016] [Accepted: 07/30/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Kristina T Gemayel
- Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, Florida
| | - Gary W Litman
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of South Florida Morsani College of Medicine, Saint Petersburg, Florida
| | - Panida Sriaroon
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of South Florida Morsani College of Medicine, Saint Petersburg, Florida.
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Yoon JY, Sriaroon P, Leiding JW, Ballow M. Idiopathic CD4 Lymphocytopenia: Immunologic Characteristics, Clinical Manifestations, and Disease Course. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.848] [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: 10/22/2022]
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Leiding JW, Sriaroon P, Ly JMB, Petrovic A, Howard DL, Shamblott M, Kuehn HS, Fleisher TA. Hypomorphic interleukin-7 receptor α-chain mutations and T-cell deficiency: a delay in diagnosis. Ann Allergy Asthma Immunol 2015; 115:1-3. [PMID: 26123418 DOI: 10.1016/j.anai.2015.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer W Leiding
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, St Petersburg, Florida.
| | - Panida Sriaroon
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, St Petersburg, Florida
| | - Jean M B Ly
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, St Petersburg, Florida
| | - Aleksandra Petrovic
- Blood and Bone Marrow Transplant Program, All Children's Hospital, St Petersburg, Florida
| | - Deborah L Howard
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of South Florida, St Petersburg, Florida
| | - Michael Shamblott
- Children's Research Institute, University of South Florida, St Petersburg, Florida
| | - Hye-Sun Kuehn
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Thomas A Fleisher
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Yin L, Hou W, Liu L, Cai Y, Wallet MA, Gardner BP, Chang K, Lowe AC, Rodriguez CA, Sriaroon P, Farmerie WG, Sleasman JW, Goodenow MM. IgM Repertoire Biodiversity is Reduced in HIV-1 Infection and Systemic Lupus Erythematosus. Front Immunol 2013; 4:373. [PMID: 24298273 PMCID: PMC3828670 DOI: 10.3389/fimmu.2013.00373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/30/2013] [Indexed: 12/25/2022] Open
Abstract
Background: HIV-1 infection or systemic lupus erythematosus (SLE) disrupt B cell homeostasis, reduce memory B cells, and impair function of IgG and IgM antibodies. Objective: To determine how disturbances in B cell populations producing polyclonal antibodies relate to the IgM repertoire, the IgM transcriptome in health and disease was explored at the complementarity determining region 3 (CDRH3) sequence level. Methods: 454-deep pyrosequencing in combination with a novel analysis pipeline was applied to define populations of IGHM CDRH3 sequences based on absence or presence of somatic hypermutations (SHM) in peripheral blood B cells. Results: HIV or SLE subjects have reduced biodiversity within their IGHM transcriptome compared to healthy subjects, mainly due to a significant decrease in the number of unique combinations of alleles, although recombination machinery was intact. While major differences between sequences without or with SHM occurred among all groups, IGHD and IGHJ allele use, CDRH3 length distribution, or generation of SHM were similar among study cohorts. Antiretroviral therapy failed to normalize IGHM biodiversity in HIV-infected individuals. All subjects had a low frequency of allelic combinations within the IGHM repertoire similar to known broadly neutralizing HIV-1 antibodies. Conclusion: Polyclonal expansion would decrease overall IgM biodiversity independent of other mechanisms for development of the B cell repertoire. Applying deep sequencing as a strategy to follow development of the IgM repertoire in health and disease provides a novel molecular assessment of multiple points along the B cell differentiation pathway that is highly sensitive for detecting perturbations within the repertoire at the population level.
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Affiliation(s)
- Li Yin
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida , Gainesville, FL , USA ; Florida Center for AIDS Research, University of Florida , Gainesville, FL , USA
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Tillipman Ladinsky H, Gillispie M, Sriaroon P, Leiding JW. Thoracic Duct Injury Resulting in Abnormal Newborn Screen. The Journal of Allergy and Clinical Immunology: In Practice 2013; 1:583-8. [DOI: 10.1016/j.jaip.2013.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022]
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Brown J, Sleasman J, Dorsey MJ, Sriaroon P. Novel Interleukin-7Rα (IL-7Rα) Mutations Causing Delayed Onset Isolated T Cell Immunodeficiency Disease. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.1229] [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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42
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Damrongwatanasuk R, Sriaroon P, Sleasman J. Atopic Dermatitis in Patients with Agammaglobulinemia Is Associated with Cutaneous Staphylococcal Infections. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.926] [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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Abstract
A one-day intensive educational course on allergy and immunology theory and diagnostic procedure significantly increased the competency of allergy and immunology fellows-in-training.
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Affiliation(s)
- A. Elizalde
- University of South Florida; Morsani College of Medicine; St. Petersburg; FL
| | - E. E. Perez
- University of South Florida; Morsani College of Medicine; St. Petersburg; FL
| | - P. Sriaroon
- University of South Florida; Morsani College of Medicine; St. Petersburg; FL
| | - D. Nguyen
- University of South Florida; Morsani College of Medicine; St. Petersburg; FL
| | - R. F. Lockey
- University of South Florida; Morsani College of Medicine; Tampa; FL; USA
| | - M. J. Dorsey
- University of South Florida; Morsani College of Medicine; St. Petersburg; FL
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Dorsey M, Elizalde A, Perez E, Sriaroon P, Nguyen D, Lockey R, Sleasman J. Effectiveness of an Educational Intensive Course on Allergy and Immunology Clinical and Diagnostic Procedures. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.260] [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: 10/14/2022]
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Nguyen D, Kellner E, Hudey S, Dorsey M, Sriaroon P, Sleasman J, Perez E. Elevation of Soluble CD14 levels Supports Chronic Innate Immune Activation in Subjects with CVID, XLA, and SLE Compared to Healthy Subjects. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.055] [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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Sriaroon P, Tangsinmankong N, Skoda-Smith S, Elder M, Sleasman J. Eosinophilic Fasciitis Associated with X-Linked Agammaglobulinemia: Report of Two Cases. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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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Sriaroon C, Sriaroon P, Daviratanasilpa S, Khawplod P, Wilde H. Retrospective: Animal attacks and rabies exposures in Thai children. Travel Med Infect Dis 2006; 4:270-4. [PMID: 16905457 DOI: 10.1016/j.tmaid.2005.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 06/07/2005] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
Abstract
Over 50% of animal bites and potential rabies exposures in Thailand are in children and they also have the more severe injuries due to inexperience, smaller size and less ability to fend off attacks. Potential rabies exposures and animal bites are common in Thailand. Majority of these are in children where the extent of the injuries is also much more severe. The bitten areas correlate to the age of the children and level of the bitten animal head. These are areas noted for a higher risk of infection with rabies virus and shorter incubation periods. The vast majority of bites are due to dogs (86%) of which 74.6% are stray or community-owned animals. The prevalence of dog bites shows no seasonal variation in adults but there are two peaks during school vacation period for children. Extensive educational efforts directed at the Thai public are responsible for the rapid presentation of victims for post-exposure treatment. The dramatic reduction of human rabies deaths in Thailand during the last decades was achieved largely by the provision of expensive WHO standard post-exposure treatment, utilizing modern tissue culture vaccines and immunoglobulins. Canine and feline rabies is nevertheless still endemic and not likely to be controlled or eliminated till sustainable humane methods of dog population control and comprehensive countrywide canine rabies vaccination become possible through government policy.
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Affiliation(s)
- Chakrapol Sriaroon
- Queen Saovabha Memorial Institute, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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