Asthma, Allergy, and Immunology Clinical Updates – May 2020

Food allergy
We are establishing an extensive network for the diagnosis and management of food allergies including protocols for advanced diagnostic testing and challenges. Patients are also invited as appropriate to participate in many of the novel therapeutic desensitization clinical research protocols currently being developed.

Drug Allergy
We have established a Drug Allergy Clinic as part of antimicrobial stewardship. In this clinic, we evaluate not only beta-lactam (penicillin) allergy, but also evaluate for other drug allergies as well as contrast allergy. Approximately 10% of people report an allergy to penicillin, but on further investigation, up to 90% of those people are able to tolerate penicillin. The time elapsed since the clinical reaction is useful information because penicillin allergy can wane over time. Patients with recent reactions are more likely to be allergic than patients with distant reactions.

Approximately 50% of patients with penicillin allergy lose their sensitivity 5 years after reacting, and this percentage increases to about 80% in 10 years. Listed penicillin allergy results in increased use of broad-spectrum antibiotics, increased healthcare-associated infections, increased length of hospital stay, increased risk of readmission, as well as the increased monetary cost to the patient from the alternative agents chosen instead of penicillin. We test for these drug allergies and if appropriate will try to de-label the patient of the allergy.

Severe Asthma
Through our close collaboration with Drs Jonathan Hemler and Samantha Minnicozzi (Department of Pediatrics), we are establishing an extensive network for the diagnosis and management of food allergies including protocols for advanced diagnostic testing and challenges. We are additionally preparing for the roll-out of the first FDA-approved treatment of peanut allergy, Palforzia, which will be available for clinical use in the near future.

Dermatologic Manifestations of Allergic Disease and Immunodeficiency
The combined allergy, immunology and dermatology clinic provides care for adult and pediatric patients with a variety of skin conditions, including severe atopic dermatitis, chronic urticaria, and skin conditions associated with immunodeficiencies (Dr Monica Lawrence and Dr Barrett Zlotoff – Dermatology)

Eosinophilic Esophagitis (EoE)
In order to provide integrated care to patients with EoE, we have established a multidisciplinary EoE clinic, which combines the expertise of allergy (Emily McGowan, MD), gastroenterology (Bryan Sauer, MD [adult] and Barrett Barnes, MD [pediatric]), and nutrition (Tegan Medico and Alexa West). Patients with EoE receive comprehensive care in the diagnosis, treatment, and management of this condition, which includes the opportunities to pursue either medical or dietary therapy and participate in ongoing clinical trials.

Chronic Sinusitis
Our sinusitis clinics involve combined appointments with members of the allergy division (Drs Larry Borish and Anna Smith) who work in close collaborations with two colleagues in the Department of Otolaryngology (Drs. Spencer Payne and José Mattos). Patients are thereby offered a comprehensive evaluation of anatomical, allergic, and immunologic mechanisms driving their disease, thorough assessments with nasal endoscopy, and radiographic analysis followed by team developed medical and surgical individualized protocols. As with all of our other specialty clinics we have a strong research interest including studies regarding pathogenic mechanisms of eosinophilic chronic sinusitis, mechanisms of aspirin-exacerbated respiratory disease, and evaluation of causes of anosmia in these diseases. In addition, as appropriate, patients are offered opportunities to participate in clinical trials of the numerous biologic therapies being developed for these disorders.

Primary Immunodeficiencies
Honored in April 2019 with the designation as a Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, our Primary Immunodeficiency Clinic provides cutting edge care for patients with complex primary immunodeficiency and immunodysregulatory disorders, as well as conducts research in the pursuit of answers for primary immunodeficiency patients. Our center has several unique features that contribute to the quality of patient care, including dedicated adult and pediatric clinics with the ability to seamlessly transition patients from the pediatric to the adult clinic, giving patients continuity of care over their lifetime; an established network of specialists with expertise in particular disorders associated with primary immunodeficiency; and a care team including doctors, fellows, and a dedicated and experienced nurse care coordinator, Darla Low, RN.

Filed Under: Basic Research, Clinical Research

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