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Sanchez J, Martinez ES, Loveless B, Sees JP, Zammuto J, Szurmant H, Fuchs S, Crone P, Hostoffer R. Augmentation of immune response to vaccinations through osteopathic manipulative treatment: a study of procedure. J Osteopath Med 2024; 124:163-170. [PMID: 38011280 DOI: 10.1515/jom-2023-0198] [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: 08/21/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
CONTEXT Anecdotal evidence suggested that osteopathic manipulative treatment (OMT) may have imparted survivability to patients in osteopathic hospitals during the 1918 influenza pandemic. In addition, previous OMT research publications throughout the past century have shown evidence of increased lymphatic movement, resulting in improved immunologic function qualitatively and quantitatively. OBJECTIVES The following is a description of a proposed protocol to evaluate OMT effects on antibody generation in the peripheral circulation in response to a vaccine and its possible use in the augmentation of various vaccines. This protocol will serve as a template for OMT vaccination studies, and by adhering to the gold standard of randomized controlled trials (RCTs), future studies utilizing this outline may contribute to the much-needed advancement of the scientific literature in this field. METHODS This manuscript intends to describe a protocol that will demonstrate increased antibody titers to a vaccine through OMT utilized in previous historical studies. Confirmation data will follow this manuscript validating the protocol. Study participants will be divided into groups with and without OMT with lymphatic pumps. Each group will receive the corresponding vaccine and have antibody titers measured against the specific vaccine pathogen drawn at determined intervals. RESULTS These results will be statistically evaluated. Our demonstration of a rational scientific OMT vaccine antibody augmentation will serve as the standard for such investigation that will be reported in the future. These vaccines could include COVID-19 mRNA, influenza, shingles, rabies, and various others. The antibody response to vaccines is the resulting conclusion of its administration. Osteopathic manipulative medicine (OMM) lymphatic pumps have, in the past through anecdotal reports and smaller pilot studies, shown effectiveness on peripheral immune augmentation to vaccines. CONCLUSIONS This described protocol will be the template for more extensive scientific studies supporting osteopathic medicine's benefit on vaccine response. The initial vaccine studies will include the COVID-19 mRNA, influenza, shingles, and rabies vaccines.
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Affiliation(s)
- Jesus Sanchez
- Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Eric S Martinez
- Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Brian Loveless
- Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Julieanne P Sees
- Fellow Osteopathic Medicine, National Academy of Medicine, Washington, DC, USA
| | - Joseph Zammuto
- Associate Professor of Family Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA, USA
| | - Hendrik Szurmant
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Sebastien Fuchs
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific at Western University of Health Sciences, Pomona, CA, USA
| | - Paula Crone
- Western University of Health Sciences, Pomona, CA, USA
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
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Humpel O, Hostoffer R. Raynaud's phenomenon. J Osteopath Med 2024; 124:43-44. [PMID: 37698069 DOI: 10.1515/jom-2023-0139] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Olivia Humpel
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
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Kalkat A, Humpel O, Hostoffer R. Novel BTK Mutation in Patient with Late Diagnosis of X-Linked Agammaglobulinemia. Case Reports Immunol 2023; 2023:6698913. [PMID: 38046560 PMCID: PMC10693464 DOI: 10.1155/2023/6698913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/12/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
X-linked agammaglobulinemia (XLA) is a genetic disorder with mutation in Bruton's tyrosine kinase (BTK). Defects in B cell development and immunoglobulin production lead to recurrent infections following loss of maternal IgG at 6 months of age. A 55-year-old male with a longstanding common variable immunodeficiency diagnosis on infusion therapy presented to the clinic with cutaneous T-cell lymphoma, which inspired overall repeat evaluation. Immunoglobulin levels and lymphocyte markers, family history, and genetic testing prompted a true diagnosis of XLA and novel mutation in the BTK gene. Disease-associated mutations have been noted in all five domains of BTK, with missense variants most commonly cited among the 100s of reported genetic alterations. The BTK protein is expressed in hematopoietic lineages and plasma cells, with the exception of T lymphocytes. Disruption in the protein function or absence of BTK halts normal B cell development at the pre-B transitional cell stage and induces premature apoptosis. We present the first reported case of a novel hemizygous BTK c.1492C > G mutation in a patient causing XLA.
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Affiliation(s)
- Amanpreet Kalkat
- University Hospitals of Cleveland, 5915 Landerbrook Dr, Mayfield Heights, OH 44124, USA
| | - Olivia Humpel
- Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Boulevard, Bradenton, FL 34211, USA
| | - Robert Hostoffer
- University Hospitals of Cleveland, 5915 Landerbrook Dr, Mayfield Heights, OH 44124, USA
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Humpel O, Fill L, Hostoffer R. Emerging treatment of prurigo nodularis with dupilumab. J Osteopath Med 2023; 123:555-556. [PMID: 37540840 DOI: 10.1515/jom-2023-0125] [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] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Olivia Humpel
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
| | - Lauren Fill
- Allergy/Immunology Associates Inc., Mayfield Heights, OH, USA
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Ali I, Kalkat A, Hostoffer R. Rapid desensitization to elexacaftor/tezacaftor/ivacaftor in a cystic fibrosis patient using fatty snack for improved absorption. Pediatr Pulmonol 2023; 58:2954-2955. [PMID: 37503879 DOI: 10.1002/ppul.26609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Irfan Ali
- Cleveland Medical Center, University Hospitals, Cleveland, Ohio, USA
| | - Amanpreet Kalkat
- Cleveland Medical Center, University Hospitals, Cleveland, Ohio, USA
| | - Robert Hostoffer
- Cleveland Medical Center, University Hospitals, Cleveland, Ohio, USA
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6
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Cho M, Hostoffer R. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. J Osteopath Med 2023; 123:459-460. [PMID: 37382386 DOI: 10.1515/jom-2023-0037] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Mandy Cho
- Department of Internal Medicine, Summa Health Internal Medicine Residency, Akron, OH, USA
| | - Robert Hostoffer
- Allergy/Immunology Associates, Inc., Mayfield Heights, Cleveland Heights, OH, USA
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Saab R, Hostoffer R. Rosacea with pustules and papules. J Osteopath Med 2023; 123:325-326. [PMID: 36998111 DOI: 10.1515/jom-2023-0052] [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: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Remie Saab
- Department of Internal Medicine, University Hospitals Geauga Medical Center, Chardon, OH, USA
| | - Robert Hostoffer
- Allergy/Immunology Associates, Inc., Mayfield Heights, OH; and University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
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Sarkaria S, Hostoffer Z, Callahan M, Venglarick J, Hostoffer R. IgG3 Antibody Response to COVID-19 Vaccination in a Patient With a Large Heavy Chain Deletion. Therapeutic Advances in Allergy and Rhinology 2023; 14:27534030231156206. [PMID: 36968252 PMCID: PMC10035523 DOI: 10.1177/27534030231156206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Vaccinations for pathogenic organisms have been utilized for decades in both the protection and diagnosis of immunodeficiency patients. Some of these immunodeficient patients may not create an adequate response to vaccination, although some who have significant aberrancies in their immune system may surprisingly create antibodies to immunizations. We present a patient with a large Ig heavy chain deletion (severe deficiency of serum IgG1, IgG2, IgG4, and IgA1) that showed a considerable response (presumably through IgG3) after the Pfizer BioNTech COVID-19 vaccination. This finding in this unique immunodeficient patient warrants further research into alternate antibody response pathways against COVID-19.
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Affiliation(s)
- Sandeep Sarkaria
- University Hospitals Cleveland Medical Centre, Cleveland, OH, USA
| | | | | | - John Venglarick
- University Hospitals Cleveland Medical Centre, Cleveland, OH, USA
| | - Robert Hostoffer
- University Hospitals Cleveland Medical Centre, Cleveland, OH, USA
- Allergy/Immunology Associates, Inc., Mayfield Heights, OH, USA
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9
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Sarkaria S, Callahan M, Hostoffer Z, Venglarcik J, Hostoffer R. IgM Deficiency Associated With Connexin Mutation in an 18-Year-old Male. Therapeutic Advances in Allergy and Rhinology 2023; 14:27534030231156116. [PMID: 36968253 PMCID: PMC10035527 DOI: 10.1177/27534030231156116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
IgM deficiency is characterized by remarkably low serum levels of IgM with normal IgG and IgA levels. These patients clinically present with recurrent infections, autoimmune disorders, and malignancies. While unknown, the proposed mechanisms explain the pathophysiology as an issue due to impaired IgG antibody response. The connexin genes encode for gap junctional proteins where mutations can cause hearing deficits and immune dysregulation. We present a unique case of an 18-year-old patient with recurrent sinusitis, diagnosed connexin-26 mutation and an IgM deficiency. An 18-year-old male with chronic sinusitis, Marfanoid joint hypermobility syndrome, and sensorineural hearing loss due to connexin-26 deficiency with bilateral cochlear implants. This patient's mutation is a GJB2 deletion located on chromosome 13 which encodes for the connexin-26 protein. The patient experienced recurrent infections, and serum immunoglobulins showed a normal IgA (84 mg/dL; normal: 70-400 mg/dL), IgG (922 mg/dL; normal: 700–1600 mg/dL) and reduced IgM (26 mg/dL; normal: 40–230 mg/dL) levels. The patient was responsive to Mumps, Measles, Rubella, and Diphtheria vaccinations among others, consistent with SIGMD diagnoses. Antibody responses to polysaccharide antigens were absent. The leukocyte counts were within normal limits. His parents are connexin-26 deficient carriers, and his older brother was diagnosed with SIGMD. Connexin-26 has been identified with multiple immunological mechanisms. Although mutations of this gene have no direct tie to antibody formation in relation to IgM, the presence of these 2 pathologies in 1 patient is intriguing and may suggest a pathophysiologic connection. We describe the first case of connexin mutation with an IgM deficiency in an 18-year-old male.
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Affiliation(s)
- Sandeep Sarkaria
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | | | | | | | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
- Allergy/Immunology Associates Inc., Mayfield Heights, OH, USA
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10
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Sarkaria S, Callahan M, Hostoffer Z, Venglarcik J, Hostoffer R. SERUM IGM DEFICIENCY ASSOCIATED WITH CONNEXIN MUTATION IN AN 18-YEAR-OLD MALE. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.854] [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: 11/11/2022]
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11
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Blunk H, Birch K, Callahan M, Hostoffer R. A CASE OF PULMONARY EMBOLISM POST COVID-19 INFECTION IN A PATIENT WITH STAT3 MUTATION. Ann Allergy Asthma Immunol 2022. [PMCID: PMC9646434 DOI: 10.1016/j.anai.2022.08.851] [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: 11/11/2022]
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12
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Sarkaria S, Kalkat A, Hostoffer R. A coronavirus disease 2019-vaccinated patient with phosphoinositide 3-kinase disease with mild illness after severe acute respiratory syndrome coronavirus 2 infection. Ann Allergy Asthma Immunol 2022; 128:459-460. [PMID: 35167905 PMCID: PMC8840824 DOI: 10.1016/j.anai.2022.02.004] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Robert Hostoffer
- University Hospitals Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio
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13
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Scott O, Dadi H, Vong L, Pasternak Y, Garkaby J, Willett Pachul J, Mandola AB, Brager R, Hostoffer R, Nahum A, Roifman CM. DNA-Binding domain mutations confer severe outcome at an early age among STAT1 gain-of-function patients. Pediatr Allergy Immunol 2022; 33:e13694. [PMID: 34738677 DOI: 10.1111/pai.13694] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND STAT1 gain-of-function (GOF) is an immune dysregulatory disorder with poorly studied genotype-phenotype correlation, impeding prognostication and early intervention. Given previous mechanistic studies, as well as anecdotal clinical reports, we sought to systematically determine whether DNA-binding domain (DBD) mutations in STAT1 result in a different phenotype than mutations in other gene domains. METHODS Negative prognostic features previously identified by the International STAT1 GOF Study Group (invasive infections, intracranial aneurysms, and malignancy), as well as other clinical features and mortality, were compared within a cohort of 30 patients with STAT1 GOF diagnosed at our center, consisting of 9 patients with DBD mutations and 21 patients with non-DBD mutations. We subsequently re-analyzed mortality data from a large, previously-published 274-patient cohort by the International STAT1 GOF Study Group. RESULTS While no differences were noted with respect to malignancy or symptomatic aneurysms, invasive /opportunistic infections were substantially more common among DBD patients, as were sinopulmonary infections, bronchiectasis, enteropathy, endocrinopathies, lymphoproliferative manifestations, and recurrent fevers/HLH. DBD patients also had a lower probability of survival and younger age of mortality compared with non-DBD patients. Our re-evaluation of the published data from the International STAT1 GOF Study Group revealed a similar finding of earlier mortality among patients harboring DBD mutations. CONCLUSION We report that STAT1 GOF patients with DBD mutations may be regarded as a unique subgroup, impacted more by early-onset profound combined immunodeficiency and with earlier mortality. These findings may impact clinical decision making with respect to early intervention, and in particular hematopoietic stem cell transplant considerations, in such patients.
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Affiliation(s)
- Ori Scott
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Harjit Dadi
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,The Canadian Centre for Primary Immunodeficiency and The Jeffrey Modell Research Laboratory for the diagnosis of Primary Immunodeficiency, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda Vong
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,The Canadian Centre for Primary Immunodeficiency and The Jeffrey Modell Research Laboratory for the diagnosis of Primary Immunodeficiency, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yehonatan Pasternak
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Jenny Garkaby
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Jessica Willett Pachul
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Amarilla B Mandola
- Pediatrics Department A, Soroka University Medical Center, Beer-Sheva, Israel
| | - Rae Brager
- Division of Rheumatology, Immunology, and Allergy, Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Robert Hostoffer
- Division of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amit Nahum
- Pediatrics Department A, Soroka University Medical Center, Beer-Sheva, Israel.,The Primary Immunodeficiency Research Laboratory, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chaim M Roifman
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,The Canadian Centre for Primary Immunodeficiency and The Jeffrey Modell Research Laboratory for the diagnosis of Primary Immunodeficiency, The Hospital for Sick Children, Toronto, Ontario, Canada
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Nagireddi L, Raimondo R, Hostoffer R. Recurrent Bilateral Lime Disease in a Young Female- Case Report. Allergy�Rhinol (Providence) 2022; 13:21526567221074944. [PMID: 35096464 PMCID: PMC8796115 DOI: 10.1177/21526567221074944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Lime phytodermatitis, also known as margarita dermatitis, is a condition that results in a skin rash after sunlight exposure when handling certain plants. Misdiagnosis is common due to its resemblance to skin burns or allergic contact dermatitis. Detailed history and disease recognition is important to provide accurate treatment recommendations. Case Report A 32-year-old woman presented with a recurrent rash on her hands that would only occur in the summer months. She was previously misdiagnosed as allergic contact dermatitis. History revealed yearly vacations involving margaritas and squeezing lime into her drinks followed by exposure to sunlight. A presumptive diagnosis of lime phytodermatitis was made and she was advised to avoid contact with limes followed by exposure to direct sunlight. Discussion Lime phytodermatitis occurs after direct contact with lime and sunlight exposure. A phototoxic compound found in limes, Furocoumarin, has been implicated as a cause for lime disease. Detailed history is important in establishing a diagnosis of lime disease. Treatment is symptomatic with topical corticosteroids, avoidance of furocoumarin-containing objects, cold compresses, and subsequent UV exposure. Conclusion We present the first case of recurrent, bilateral phytodermatitis in a 32-year-old woman following contact with limes and subsequent sunlight exposure in the summer months.
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Affiliation(s)
| | - Rachel Raimondo
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
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15
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Jalil M, Pietras J, Ahmed SN, Daniels P, Hostoffer R. COVID-19 Infection in Patients with Humoral Immunodeficiency: A Case Series and Literature Review. Allergy�Rhinol (Providence) 2022; 13:21526575221096044. [PMID: 35496893 PMCID: PMC9047039 DOI: 10.1177/21526575221096044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The coronavirus 2019 disease (COVID-19) has infected many individuals worldwide and continues to pose a significant threat to those with weakened immune systems. The data evaluating the clinical outcomes of patients with humoral immunodeficiencies that contract COVID-19 is limited and conflicting. Objective To describe the clinical outcomes of COVID-19 infections in patients with primary humoral immunodeficiency and compare results to current literature. Methods We conducted a retrospective cohort review on 15 patients with a humoral immunodeficiency defined as Common Variable Immunodeficiency, Specific Antibody Deficiency, or unspecified hypogammaglobulinemia, who contracted COVID-19. Severity scores were determined to evaluate the clinical outcomes of these patients. Results Of our 15-patient cohort, 33% of individuals with a humoral immunodeficiency infected with COVID-19 had moderate to severe disease, requiring hospitalization or resulting in death. COVID-19 mortality rate was found to be 7%. All 5 of our patients with severe COVID-19 infection had at least 1 comorbidity or risk factor. Conclusion Within our cohort of humoral immunodeficient patients infected with COVID-19, we found a higher rate of moderate to severe COVID-19 infection and worse clinical outcomes, particularly in patients with comorbidities or risk factors.
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Affiliation(s)
- Maaz Jalil
- Cleveland Medical Center, University Hospitals, Cleveland, Ohio, USA
| | - Julianne Pietras
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Syed N. Ahmed
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Phuong Daniels
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Robert Hostoffer
- Cleveland Medical Center, University Hospitals, Cleveland, Ohio, USA
- Allergy/Immunology Associates Inc., Mayfield Heights, Ohio, USA
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16
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Jalil M, Abraham JM, Hostoffer R. The Successful Vaccination of an IVIgG Naive CVID Patient with an mRNA COVID-19 Vaccine. Allergy Rhinol (Providence) 2021; 12:21526567211049744. [PMID: 34659871 PMCID: PMC8514739 DOI: 10.1177/21526567211049744] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction Different subtypes of vaccines have been developed to help protect populations from COVID-19. Currently, three vaccines have been authorized by the United States Food and Drug Administration for emergency use to combat the COVID-19 pandemic. With COVID-19 vaccination rates increasing, it is important to know whether immunodeficient patients have the capacity to mount an immune response with the available vaccines. Case Report A 78-year-old female with Common Variable Immunodeficiency and anti-IgA antibodies who is naïve to IVIgG treatment responded positively to a COVID-19 mRNA vaccine. Successful seroconversion was proved by having positive COVID-19 spike protein IgG antibodies weeks after the vaccination. Her recent IgG, IgA, and IgM levels were all significantly reduced. Previously, she had no response to the polysaccharide pneumococcal vaccine, but did maintain titers afterTdap vaccination. Discussion Immunodeficient patients are a susceptible population during a pandemic. Unfortunately, there is a paucity of research on the infectivity, vaccination, and outcome of these patients during the COVID-19 outbreak. Our patient with CVID was able to respond to protein/toxoid vaccines, but did not respond to polysaccharide pneumococcal vaccine. After inoculation with an mRNA COVID-19 vaccine she was able to create COVID-19 spike protein IgG antibodies. Conclusion We present a case of successful vaccination to COVID-19 by an mRNA vaccine in an IVIgG naïve CVID patient.
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Affiliation(s)
- Maaz Jalil
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
| | - John M Abraham
- University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis
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Alflen C, Birch K, Shilian R, Wu SS, Hostoffer R. Two Cases of Well Controlled Chronic Spontaneous Urticaria Triggered by the Moderna COVID-19 Vaccine. Allergy Rhinol (Providence) 2021; 12:21526567211026271. [PMID: 34249404 PMCID: PMC8236777 DOI: 10.1177/21526567211026271] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
Chronic spontaneous urticaria (CSU, chronic idiopathic urticaria) is a clinical diagnosis characterized by recurrent urticaria of unknown origin, with or without angioedema, that occurs for six weeks or longer. Management of CSU includes a second-generation H1 antihistamine and/or elimination of exacerbating factors. If initial treatment is unsuccessful, trials of first generation H1 antihistamine, H2 blocking antihistamine, leukotriene-receptor antagonist, anti-inflammatory or immunosuppressive agents may be administered. Exacerbating factors include stress, environmental conditions, medications, physical stimuli, and infections. We report the first two cases of a COVID-19 vaccine triggered relapse of CSU that was previously well controlled on therapy.
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Affiliation(s)
- Cylie Alflen
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Katheryn Birch
- Allergy/Immunology Associates Inc., Mayfield Heights, Ohio
| | - Ryan Shilian
- Allergy/Immunology Associates Inc., Mayfield Heights, Ohio
| | - Shan Shan Wu
- Allergy/Immunology Associates Inc., Mayfield Heights, Ohio.,Cleveland Medical Center, University Hospitals, Cleveland, Ohio
| | - Robert Hostoffer
- Allergy/Immunology Associates Inc., Mayfield Heights, Ohio.,Cleveland Medical Center, University Hospitals, Cleveland, Ohio
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Jalil M, Hostoffer R, Wu SS. Jackfruit Anaphylaxis in a Latex Allergic Non-Healthcare Worker. Allergy Rhinol (Providence) 2021; 12:21526567211009195. [PMID: 34104534 PMCID: PMC8165822 DOI: 10.1177/21526567211009195] [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] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/03/2022]
Abstract
Introduction Anaphylaxis to jackfruit (Artocarpus heterophyllus) is rare. Two previously reported
cases have been published in two healthcare workers from jackfruit endemic regions.
Latex allergy and birch pollen cross reactivity have both been associated with jackfruit
anaphylaxis, providing two separate mechanisms of sensitization. We present a case of
jackfruit anaphylaxis in a young latex allergic non-healthcare worker in a non-endemic
region. Case Report A 21-year-old male had an anaphylactic reaction immediately after ingesting dried
jackfruit. He had a history of allergic rhinitis and latex allergy. He was born
premature and required neonatal intensive care and multiple surgeries in infancy, which
could possibly be the source of his latex sensitization. Skin prick testing was positive
for jackfruit and latex. Discussion Jackfruit anaphylaxis has only been described in conjunction with a latex allergy or a
birch pollen allergy. As jackfruit becomes more available across the world, it is
important for physicians and patients with these sensitivities to be aware of these
possible cross reactions. Fruit sensitivities in latex allergic patients have been well
established as Latex-fruit syndrome. Our case highlights the association of latex
sensitization and jackfruit anaphylaxis. Conclusion We present a case of Jackfruit anaphylaxis associated with latex allergy in a
non-healthcare worker from Midwestern United States. As jackfruit becomes more popular
in non-endemic regions, its possible cross reactivity with latex, as well as birch
pollen should be recognized.
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Affiliation(s)
- Maaz Jalil
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Shan Shan Wu
- Allergy/Immunology Associates Inc, Mayfield Heights, Ohio
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19
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Daniels P, Valencia R, Hostoffer R. Efficacy of epinephrine rinse in allergen immunotherapy with aeroallergen and venom. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.476] [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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20
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Valencia R, Daniels P, Birch K, Abraham T, Murray J, Hostoffer R. The Study of a Novel Triple Spray Combination of Corticosteroid, Antihistamine and Decongestant Delivered in a Single Spray. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.481] [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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21
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Jalil M, Rowane M, Rajan J, Hostoffer R. Successful Anti-SARS-CoV-2 Spike Protein Antibody Response to Vaccination in MAGT1 Deficiency. Allergy�Rhinol (Providence) 2021; 12:21526567211056239. [PMID: 34868726 PMCID: PMC8640323 DOI: 10.1177/21526567211056239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Novel messenger RNA vaccines against severe acute respiratory syndrome coronavirus (SARS-CoV-2) have been vital in resolving the coronavirus disease-2019 (COVID-19) pandemic. Detection of neutralizing antibodies (NAbs) against the SARS-CoV-2 spike protein (S) confirms immunogenicity with high sensitivity and specificity. Few recent studies with primary and secondary immunodeficient cohorts present adequate or reduced antibody response. We describe the first reported successful response to anti-SARS-CoV-2 S antibody post-vaccination in magnesium transporter 1 (MAGT1) gene deficiency, more commonly recognized as x-linked immunodeficiency with magnesium defect, Epstein-Barr Virus infection, and neoplasia (XMEN). Case Presentation We present a 30-year-old male with selective anti-polysaccharide antibody deficiency, peripheral blood CD5 + /CD19 + B-cell predominance (97%), MAGT1 mutation, and reduced CD16 + CD56 + natural killer- and/or CD8 + T-cell receptor, Group 2, Member D expression. His initial immunological evaluation revealed all seronegative post-vaccination antibody titers but clinically adequate response to protein antigens tetanus and diphtheria anti-toxoids. COVID-19 vaccination and associated serology antibody testing was recommended at this office visit. Anti-SARS-CoV-2 immunoglobulin (Ig)M and IgG antibodies before and after the first BNT162b2 mRNA COVID-19 vaccine doses, as well as nucleocapsid antibody, were negative. S protein total antibody was reactive after the second dose. Discussion Robust immunological sequelae post-COVID-19 vaccination in the general population are well-documented in the recent literature. Few studies have evaluated COVID-19 vaccination antibody response in immunodeficient patients. The majority positive anti-S antibody detection in most primary immunodeficient (PID) patients among the few studies in the literature, such as the present case, support the safety and efficacy of mRNA COVID-19 vaccination in immunodeficient patients, although larger scale studies are needed.
Conclusion We demonstrate successful vaccination in the PID MAGT1 deficiency in this first reported case of reactive anti-S antibody post-COVID-19 vaccination.
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Affiliation(s)
- Maaz Jalil
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marija Rowane
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Jayanth Rajan
- Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, Pennsylvania
| | - Robert Hostoffer
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Allergy/Immunology Associates, Inc., Mayfield Heights, Ohio
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22
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Daniels P, Jalil M, Michaud C, Hostoffer R. Negative penicillin skin testing induced anaphylaxis with concurrent beta blocker and angiotensin-converting enzyme inhibitor use. Ann Allergy Asthma Immunol 2020; 126:435-437. [PMID: 33387614 DOI: 10.1016/j.anai.2020.12.013] [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: 08/23/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Phuong Daniels
- Department of Pediatrics, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio.
| | - Maaz Jalil
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Robert Hostoffer
- Department of Pediatrics, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine University Hospitals Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio
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23
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Schend J, Daniels P, Sanan N, Tcheurekdjian H, Hostoffer R. Clinical Observation of COVID-19 in a Patient With an Acquired Humoral Deficiency Secondary to Chemotherapeutic Agents. Allergy Rhinol (Providence) 2020; 11:2152656720978764. [PMID: 33354381 PMCID: PMC7734533 DOI: 10.1177/2152656720978764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes worldwide devastation. We describe the course of a patient with COVID-19 in the setting of an acquired humoral deficiency as a result of chemotherapeutic treatment for rheumatologic conditions. Case Report A 49-year-old Caucasian male presented with non-relieving fever, hypoxemia, and persistent diarrhea after seven days following a positive SARS-CoV-2 polymerase chain reaction (PCR) assay. The patient’s past medical history was significant for mixed connective tissue disease, rheumatoid arthritis, and systemic lupus erythematosus treated with methotrexate and rituximab since 2008. He was diagnosed with acquired humoral deficiency in 2017 managed by intravenous immunoglobulin (IVIG) infusion every three weeks. The patient’s course of hospitalization was complicated by acute respiratory distress which necessitated intensive unit care and required up to 20 L/min oxygen supplementation via a humidified high flow generator. He was treated with hydroxychloroquine and azithromycin and received an IVIG transfusion. The patient was discharged to home after forty-two days of hospitalization with oxygen supplementation only during ambulation and a complete resolution of diarrhea. Discussion According to current limited data, patients with immunodeficiency have longer length of hospitalization compared to immunocompetent individuals. Our patient demonstrated a form of immunodeficiency as the result of a chemotherapeutic agent, and his clinical course appeared to be more severe. Conclusion More studies are necessary to shed light on the immunological response to SARS-CoV-2 and its impact on immunocompromised and immunocompetent and individuals. We describe the course of a patient with COVID-19 in the setting of an acquired humoral deficiency.
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Affiliation(s)
- Jason Schend
- Department of Pulmonary/Critical Care, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Phuong Daniels
- Department of Pediatrics, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Neha Sanan
- Department of Pulmonary/Critical Care, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Haig Tcheurekdjian
- Department of Pediatrics, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.,Allergy/Immunology Associates Inc., Mayfield Heights, Ohio
| | - Robert Hostoffer
- Department of Pulmonary/Critical Care, University Hospitals, Cleveland Medical Center, Cleveland, Ohio.,Department of Pediatrics, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.,Allergy/Immunology Associates Inc., Mayfield Heights, Ohio
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24
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Huq M, Sanan N, Daniels P, Hostoffer R. Posner-Schlossman Syndrome in Common Variable Immunodeficiency. Case Rep Ophthalmol Med 2020; 2020:8843586. [PMID: 33123397 PMCID: PMC7584931 DOI: 10.1155/2020/8843586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Posner-Schlossman syndrome (PSS) is a rare glaucomatocyclitic crisis with clinical features including recurrent episodes of unilateral elevated intraocular pressure. Autoimmune and infectious causes have been proposed as potential etiologies of PSS. We report the first case of PSS in the setting of common variable immunodeficiency (CVID). Case Report. A sixty-two-year-old Caucasian female with a medical history of CVID and ulcerative colitis presented to the emergency room with complaints of acute right-sided vision changes. She reported image distortion, blurriness, and loss of central vision. Physical exam was significant for mildly injected right conjunctiva, visual acuity of 20/70 in right eye, and 20/25 in left eye. The right intraocular pressure was measured at 34 mmHg and left at 12 mmHg. The gonioscopy and dilated fundus examination were unremarkable. Cup to disc ratio was within normal limits, and no afferent pupillary defects were recorded. The patient was acutely treated with three rounds of dorzolamide/timolol and 0.2% brimonidine which decreased the right eye intraocular pressure to 24 mmHg. On follow-up exam with an ophthalmologist, anterior uveitis including an elevated pressure of 41 mmHg on the right and 18 mmHg on the left eye was noted and a PSS diagnosis was confirmed. CONCLUSION PSS remains a rare condition with uncertain etiology and no associated systemic conditions. PSS has been postulated to be linked to autoimmune conditions. CVID is associated with many autoimmune disorders including Sjogren's, rheumatoid arthritis, and colitis. There have been a few reported CVID-associated ocular diseases including granulomatous uveitis and conjunctivitis, chronic anterior uveitis, and birdshot retinopathy. We describe the first case of PSS in a patient with CVID.
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Affiliation(s)
- Madiha Huq
- University Hospitals Parma Medical Center, Cleveland, Ohio, USA
| | - Neha Sanan
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio, USA
| | - Phuong Daniels
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
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25
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Sewell C, Daniels P, Cottrell J, Hostoffer R. Common Variable Immunodeficiency with the Concomitant Diagnosis of an Inflammatory Myofibroblastic Tumor. J Clin Immunol 2020; 41:230-232. [PMID: 33017039 DOI: 10.1007/s10875-020-00879-3] [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] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Craig Sewell
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Riverside Methodist Hospital, Columbus, OH, USA
| | - Phuong Daniels
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
| | | | - Robert Hostoffer
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
- Allergy/Immunology Associates Inc., Mayfield Heights, OH, USA
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26
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Daniels P, Shilian R, Huq M, Hostoffer R. Eosinophilic fasciitis in common variable immunodeficiency with hypereosinophilia. Ann Allergy Asthma Immunol 2020; 126:99-100. [PMID: 32891788 DOI: 10.1016/j.anai.2020.08.395] [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: 06/25/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Phuong Daniels
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.
| | - Ryan Shilian
- Department of Pulmonology/Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Madiha Huq
- Department of Internal Medicine, University Hospitals Parma Medical Center, Parma, Ohio
| | - Robert Hostoffer
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; Department of Pulmonology/Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Associates Inc., Mayfield Heights, Ohio
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27
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Fill L, Hadney L, Graven K, Persaud R, Hostoffer R. The clinical observation of a patient with common variable immunodeficiency diagnosed as having coronavirus disease 2019. Ann Allergy Asthma Immunol 2020; 125:112-114. [PMID: 32387167 PMCID: PMC7199724 DOI: 10.1016/j.anai.2020.04.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Lauren Fill
- Department of Internal Medicine, University Hospitals St. John Medical Center, Westlake, Ohio
| | - Lauren Hadney
- Department of Internal Medicine, University Hospitals St. John Medical Center, Westlake, Ohio
| | - Kelsey Graven
- Allergy and Immunology Fellowship, Department of Pulmonary and Critical Care Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Roberta Persaud
- Department of Infectious Disease, University Hospitals St. John Medical Center, Westlake, Ohio
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28
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Abstract
Introduction Interleukin-1 (IL-1) antagonists have been successful in the management of monogenic auto-inflammatory diseases, notably classic hereditary fever syndromes, such as Familial Mediterranean Fever (FMF). Anakinra (Kineret®), a human recombinant IL-1 receptor antagonist (IL-1Ra), has been clinically effective in the management of persistent auto-inflammation, such as FMF. Few studies report anaphylaxis in response to anakinra, which were resolved with an anakinra desensitization or the anti-IL-1β monoclonal antibody canakinumab (ILARIS®). We describe the first reported desensitization protocol to canakinumab. Case Report A 51-year-old man with a prior history of FMF presented with history of failed colchicine, nonsteroidal anti-inflammatory drug, and anakinra trials. Anakinra desensitization and canakinumab intradermal testing (IDT) resulted in anaphylactic and allergic symptoms, respectively. Expedited desensitization to canakinumab was successfully performed with 15-minute intervals between 13 doses of incremental increase to 150 mg. Discussion Biological agents are immune modulators that may evoke unanticipated hypersensitivity reactions, including anaphylaxis. These anaphylactic reactions to biologics have been infrequently reported, but the expanding market may increase the risk of IgE-mediated hypersensitivities and subsequent need for desensitization protocols. The current, expedited desensitization evaluated several published protocols involving anakinra desensitization to determine appropriate dosing for canakinumab. Conclusion We report the gastrointestinal intolerance and continued FMF flares on colchicine, followed by anaphylactic responses to anakinra and allergic reaction to IDT of canakinumab, in the present case of FMF. Our novel, expedited canakinumab desensitization protocol serves as an effective and alternative therapy in cases when other appropriate biologic agents are not tolerated.
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Affiliation(s)
- Neha Sanan
- Department of Pulmonary Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jason Schend
- Department of Pulmonary Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marija Rowane
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
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29
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Jeskey J, Parida A, Graven K, Hostoffer R. Novel Gene Deletion in NLRC4 Expanding the Familial Cold Inflammatory Syndrome Phenotype. Allergy Rhinol (Providence) 2020; 11:2152656720928062. [PMID: 32537258 PMCID: PMC7268108 DOI: 10.1177/2152656720928062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Familial cold inflammatory syndrome (FCAS) is a rare, inherited inflammatory disease characterized by episodes of fever, rash, and arthralgias after exposure to cold stimuli. Previous literature has established FCAS linked to autosomal dominant mutations in the NLRP3 (CIAS1) and NLRP12 genes. Moreover, there has been recent evidence of NLRC4-inflammasomopathies. Although there have been cases of FCAS secondary to missense mutations in NLRC4, we report the first symptomatic case associated with a 93-base-pair in-frame deletion within Exon 5 of the leucine rich repeat domain.
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Affiliation(s)
- Jack Jeskey
- Allergy and Immunology Associates Inc., Mayfield Heights, Ohio.,Lake Erie College of Osteopathic Medicine, Bradenton, Florida
| | - Akash Parida
- Allergy and Immunology Associates Inc., Mayfield Heights, Ohio.,Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Kelsey Graven
- Allergy and Immunology Associates Inc., Mayfield Heights, Ohio.,Cleveland Medical Center, University Hospitals, Cleveland, Ohio
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30
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Rowane M, Valencia R, Schend J, Jhaveri D, Hostoffer R. Something to Sweat About: Two Cases of Dupilumab-Induced Hyperhidrosis and Bromhidrosis. Allergy Rhinol (Providence) 2020; 11:2152656720927703. [PMID: 32489715 PMCID: PMC7241203 DOI: 10.1177/2152656720927703] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Atopic dermatitis (AD, eczema) is familial chronic inflammatory skin disease of complex etiology and increasing prevalence. Dupilumab is an IL-4 receptor subunit alpha (IL-4Rα) antagonist that is the first Food and Drug Administration-approved biological therapy for moderate-to-severe adult AD inadequately controlled with topical therapies. Adverse effects reported in the literature include injection site reactions, conjunctivitis, headache, and nasopharyngitis. Objective We report the first cases of hyperhidrosis and bromhidrosis as side effects from dupilumab (Dupixent®) for the treatment of AD. Case Reports Case 1 is a 20-year-old woman with controlled allergic rhinitis and severe AD reported axillary hyperhidrosis with bromhidrosis, comparable to sweat from high-intensity exercise, with no relief from several different over-the-counter antiperspirants. Case 2 is a 61-year-old woman with history of chronic asthma, allergic contact dermatitis, allergic rhinitis, and AD noticed markedly increased sweating with bromhidrosis that was reminiscent of her menopausal symptomology, about 3 months after initiating dupilimab. Discussion Traditional immunosuppressive agents and corticosteroids have limited efficacy, numerous side effects, and increased risk of infection. The safety profile and efficacy of the newly approved IL-4Rα antagonist dupilumab may be favorable to oral immunosuppressants, but its use remains limited to severe recalcitrant cases, due to financial implications and lack of long-term safety data and comparative head-to-head trials. Conclusion We report improved outcomes with dupilumab, in addition to unpublished cases of bromhidrosis and hyperhidrosis in 2 patients with AD. This report of additional complications may inspire further clinical research and assist clinicians in considering the option of dupilumab for uncontrolled AD, despite aggressive traditional treatment.
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Affiliation(s)
- Marija Rowane
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
| | - Reimus Valencia
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jason Schend
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Devi Jhaveri
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Allergy Immunology Associates, Inc., Mayfield Heights, Ohio
| | - Robert Hostoffer
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Allergy Immunology Associates, Inc., Mayfield Heights, Ohio
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31
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Abstract
Historically, osteopathic principles have focused on the appropriate drainage of cranial structures to relieve symptoms of rhinitis, which include nasal congestion, anterior/posterior rhinorrhea, sneezing, and itching. Allergic rhinitis is primarily an aberrant immunologic reaction caused by cytokines secreted from lymphocytes that traverse the lymphatic pathway throughout the body. Several studies have documented that, when manipulated, the lymphatic system enhanced the motion of these lymphocytes to important immune structures in both human and animal models. Additionally, modulation of both sympathetic and parasympathetic outflow has been found either to inhibit or enhance secretion and/or drainage of important allergic sites. Osteopathic approaches to rhinitis play an effective role in the comprehensive management of rhinitis, and techniques based on these approaches are therapeutic options for rhinitis. This article provides an up-to-date literature review about the management of rhinitis using the 5 models of osteopathic medicine: biomechanical, respiratory-circulatory, metabolic, neurologic, and behavioral.
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32
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Kumar N, Graven K, Joseph NI, Johnson J, Fulton S, Hostoffer R, Abboud H. Case Report: Postvaccination Anti-Myelin Oligodendrocyte Glycoprotein Neuromyelitis Optica Spectrum Disorder: A Case Report and Literature Review of Postvaccination Demyelination. Int J MS Care 2020; 22:85-90. [PMID: 32410903 DOI: 10.7224/1537-2073.2018-104] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stimulation of the immune response after vaccination can occasionally result in adverse effects, including demyelination of the central nervous system. The most common presentation of postvaccination demyelination is acute disseminated encephalomyelitis, but cases of optic neuritis, transverse myelitis, and multiple sclerosis relapses have been reported. More recently, an increasing number of postvaccination neuromyelitis optica spectrum disorder (NMOSD) cases have surfaced in the literature, especially in patients with aquaporin-4 antibodies. In this article, we report an unusual case of myelin oligodendrocyte glycoprotein antibody-related NMOSD after the receipt of multiple vaccines in a first-trimester pregnant woman from Africa. We review the reported cases of postvaccination demyelination in the past decade, with a focus on the relationship between NMOSD and vaccination in patients with aquaporin-4 or myelin oligodendrocyte glycoprotein antibodies. Finally, we discuss the clinical relevance of the present case and similar reported cases as it relates to patient care in the neuroimmunology clinic and identify potential areas for future research.
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33
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Jeskey J, Parida A, Graven K, Hostoffer R. Specific Antibody Immunodeficiency Presenting With Streptococcal pneumonia-Induced Spontaneous Bacterial Peritonitis. Allergy�Rhinol (Providence) 2020; 11:2152656720928065. [PMID: 32537259 PMCID: PMC7268137 DOI: 10.1177/2152656720928065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Specific antibody immunodeficiency (SAD) is a primary immunodeficiency disorder characterized by normal levels of serum immunoglobulins (IgG, IgA, and IgM) associated with a dysfunctional immune response. SAD is associated with recurrent infections in the setting of an insufficient response to polysaccharide vaccinations. Streptococcus pneumoniae is a well-established cause of respiratory infections in SAD. However, there has been a paucity of evidence of pneumococcal peritonitis in SAD patients, being reported as spontaneous in acquired immunodeficiency such as AIDS. We report the first case of S. pneumoniae-induced peritonitis as the presenting sign for SAD.
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Affiliation(s)
- Jack Jeskey
- Allergy and Immunology Associates Inc., Mayfield Heights, Ohio
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida
| | - Akash Parida
- Allergy and Immunology Associates Inc., Mayfield Heights, Ohio
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Kelsey Graven
- Allergy and Immunology Associates Inc., Mayfield Heights, Ohio
- Cleveland Medical Center, University Hospitals, Cleveland, Ohio
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34
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Rowane M, Valencia R, Stewart-Bates B, Casselman J, Hostoffer R. No Bull: A Case of Alpha-Gal Syndrome Associated With Buffalo Meat Sensitivity. Allergy Rhinol (Providence) 2019; 10:2152656719893366. [PMID: 31840005 PMCID: PMC6902388 DOI: 10.1177/2152656719893366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Alpha (⍺)-gal syndrome (AGS) is an immunoglobulin E (IgE) antibody response against the glycoprotein carbohydrate galactose-⍺-1,3-galactose-β-1-(3)4-N-acetylglucosamine-R (Gal⍺-1,3Galβ1-(3)4GlcNAc-R or ⍺-gal) that is present in Ixodida (tick) saliva and noncatarrhine mammals as well as cetuximab, antivenom, and the zoster vaccine. The most frequently observed anaphylactic reactions in AGS are observed after beef, pork, lamb, and deer meat consumption. We present the first case of anaphylaxis to buffalo meat. Case Report A 55-year-old man presented with a history of recurrent urticaria that only developed approximately 7 hours after buffalo consumption. The patient denied history of Ixodidae bites but admitted to frequent hiking outdoors. Anti-⍺-1,3-gal IgE was positive (30.80 kU/L). The patient was advised to strictly avoid red meat. Discussion The prevalence of AGS has been increased in all continents in the past decade, and several Ixodidae species have been associated with this hypersensitivity. The list of IgE-mediated reactions to various types of meat has expanded to kangaroo, whale, seal, and crocodile, although these have not been associated with AGS. van Nunen only cautioned against consumption of exotic meats, such as buffalo, but no published case report describes AGS associated with anaphylaxis to this type of meat. Conclusion AGS is a mammalian meat allergy that has been increasingly prevalent worldwide, especially in Ixodidae endemic regions of Australia and the United States. Multiple AGS case reports published in the past decade demonstrate rapidly increasing understanding of underlying mechanisms provoking ongoing sensitization to help devise management strategies and dietary information. We offer the first case report of delayed anaphylaxis to buffalo meat.
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Affiliation(s)
- Marija Rowane
- Heritage College of Osteopathic Medicine, Ohio University, Cleveland, Ohio.,Allergy Immunology Associates, Inc., Mayfield Heights, Ohio
| | - Reimus Valencia
- Department of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Jason Casselman
- Department of Internal Medicine-Allergy & Immunology, Reid Health, Richmond, Indiana
| | - Robert Hostoffer
- Allergy Immunology Associates, Inc., Mayfield Heights, Ohio.,Department of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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35
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Thoonkuzhy C, Shilian R, Hostoffer R. A case of cutaneous Mycobacterium chelonae in common variable immunodeficiency. Ann Allergy Asthma Immunol 2019; 124:210-211. [PMID: 31816394 DOI: 10.1016/j.anai.2019.11.031] [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: 09/11/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Christina Thoonkuzhy
- Department of Medicine, Case Western Reserve University Hospital Cleveland Medical Center, Cleveland, Ohio.
| | - Ryan Shilian
- Adult and Pediatric Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Associates Inc, Mayfield Heights, Ohio
| | - Robert Hostoffer
- Department of Medicine, Case Western Reserve University Hospital Cleveland Medical Center, Cleveland, Ohio; Adult and Pediatric Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Associates Inc, Mayfield Heights, Ohio
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Rowane M, Shilian R, Jhaveri DK, Tcheurekdjian HH, Sher TH, Hostoffer R. Familial Success in Allergen Desensitization. Allergy Rhinol (Providence) 2019; 10:2152656719890315. [PMID: 31819808 PMCID: PMC6883665 DOI: 10.1177/2152656719890315] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Allergic rhinitis (AR) is a widely prevalent immunoglobulin E-mediated
inflammatory nasal condition resulting from reexposure to an allergen in a
sensitized individual. The genetic associations behind AR and other allergic
conditions have been studied. However, familial success with AR therapies,
specifically allergen desensitization through subcutaneous immunotherapy
(SCIT), has never been reported in the literature. Pharmocogenetics has been
gradually applied to link heritable genetic variants with drug responses,
such as intergenic region variants APOBEC3B and APOBEC3C and β2-adrenergic
receptor and glycoprotein ADAM33 polymorphisms as predictive biomarkers for
biologic treatment response in asthma. We provide the first reported survey
of familial success with SCIT. Methods We administered a month-long, institutional review board-approved (20190493)
questionnaire to 200 adult patients receiving SCIT in a suburban
allergy/immunology practice. The anonymous survey inquired about
demographics, target allergens for their SCIT, current symptom improvement
on SCIT, and family history of allergies and SCIT management. Results Twenty-six percent (52 of 200, 26%) SCIT patients reported familial success
with the same allergy treatment modality. AR diagnosis and symptom
improvement from SCIT was similar among previous/same (18 of 52, 38%; 26 of
52, 54%) and subsequent (10 of 52, 21%; 19 of 52, 40%) generations of family
members. A combination of seasonal and perennial allergies was most
prevalent (81%) among this population. Conclusion In a subpopulation of SCIT patients, there appears to be a familial success
rate with this allergen desensitization treatment. This is the first
reported pharmocogenetic evidence of assessing hereditary influence on
effective AR therapy. Understanding pharmacogenetic associations involved
with SCIT may improve allergists’ recommendations for this treatment
option.
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Affiliation(s)
- Marija Rowane
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
| | - Ryan Shilian
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Devi K Jhaveri
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Allergy Immunology Associates, Inc., Mayfield Heights, Ohio
| | | | | | - Robert Hostoffer
- Department of Pulmonary & Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Allergy Immunology Associates, Inc., Mayfield Heights, Ohio
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Rowane M, Schend J, Patel J, Hostoffer R. Rapid desensitization of hydroxychloroquine. Ann Allergy Asthma Immunol 2019; 124:97-98. [PMID: 31606403 DOI: 10.1016/j.anai.2019.10.001] [Citation(s) in RCA: 2] [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: 06/03/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Marija Rowane
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
| | - Jason Schend
- Pulmonary Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jaimin Patel
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Robert Hostoffer
- Pulmonary Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Allergy Immunology Associates Inc, Mayfield Heights, Ohio
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Horbal A, McGarry D, Reznick S, Hostoffer R, Tcheurekdjian H. Isolated parenchymal pulmonary presentation of familial Mediterranean fever. Ann Allergy Asthma Immunol 2019; 123:603-604. [PMID: 31494232 DOI: 10.1016/j.anai.2019.08.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Alexander Horbal
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - David McGarry
- Department of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Stephanie Reznick
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Robert Hostoffer
- Allergy/Immunology Associates Inc, Mayfield Heights, Ohio; Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Haig Tcheurekdjian
- Department of Medicine, Case Western Reserve University, Cleveland, OH; Allergy/Immunology Associates Inc, Mayfield Heights, Ohio; Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
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39
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Sanan N, Lee J, Baxter C, Jeskey J, Hostoffer R. Delayed and protracted allergic reaction to oral lidocaine. Ann Allergy Asthma Immunol 2019; 123:413-414. [PMID: 30878625 DOI: 10.1016/j.anai.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/19/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Neha Sanan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Jenny Lee
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Christina Baxter
- Nova Southeastern University College of Osteopathic Medicine Davie, Florida
| | - Jack Jeskey
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida
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Abstract
This protocol for rapid desensitization to intravenous radiographic contrast material (RCM) improves the strategy first reported by Uppal et al. Desensitization is a validated preventative measure for medical emergencies, such as cardiac catheterization, when patients present with histories of anaphylactoid reactions to the allergen of concern. The patient required another catheterization that was modified to repeat the final dosage of 320 mg/mL of Visipaque®, accommodating cardiac catheterization postponement, contrary to readministration of doses 4 (0.625 mg/mL) and 8 (10 mg/mL) as reported in Uppal et al. Our risk score calculations suggested that the patient was at low risk of contrast-induced nephropathy (CIN) that did not necessitate reduced dosage. No complications were reported following catheterization. We propose repetition of the final RCM dosage as a more effective and efficient desensitization strategy, as long as the scoring system does not indicate high risk for CIN.
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Affiliation(s)
- Neha Sanan
- Department of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marija Rowane
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
| | - Robert Hostoffer
- Department of Pulmonary and Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Allergy/Immunology Associates, Inc., Mayfield Heights, Ohio
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41
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Schend J, McGarry D, Johnson J, Hostoffer R. Common variable immunodeficiency associated with stiff-person syndrome. Ann Allergy Asthma Immunol 2018; 120:444. [PMID: 29407421 DOI: 10.1016/j.anai.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/30/2017] [Accepted: 01/03/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Jason Schend
- Mercy Health Hospital, Mercy Campus Muskegon, Michigan.
| | - Dave McGarry
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - John Johnson
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Association, Inc, Mayfield Heights, Ohio
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42
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Doll R, McGarry D, Jhaveri D, Hostoffer R, Tcheurekdjian H. HETEROZYGOUS MUTATIONS OF THE MAJOR HISTOCOMPATIBILITY CLASS-II ASSOCIATED MOLECULES. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.329] [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: 11/24/2022]
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43
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Horbal A, McGarry D, Tcheurekdjian H, Hostoffer R, Reznick S. ATYPICAL PARENCHYMAL PULMONARY PRESENTATION OF STEROID-RESISTANT FAMILIAL MEDITERRANEAN FEVER TREATED WITH COLCHICINE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.321] [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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44
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Joseph N, Hostoffer R, Tcheurekdjian H. A NOVEL GENE MUTATION ASSOCIATED WITH COMMON VARIABLE IMMUNODEFICIENCY AND PYODERMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Doll R, Friedman K, Hostoffer R. Aseptic Abscess Syndrome, a Case of Prolonged Remission Following Splenectomy. Am J Gastroenterol 2018; 113:1264-1265. [PMID: 29904157 DOI: 10.1038/s41395-018-0163-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Rayna Doll
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Allergy and Immunology Associates, Mayfield Heights, OH, USA
| | - Kenneth Friedman
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Allergy and Immunology Associates, Mayfield Heights, OH, USA
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, OH, USA. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Allergy and Immunology Associates, Mayfield Heights, OH, USA
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46
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Oh J, McGarry DP, Joseph N, Peppers B, Hostoffer R. Salivary IgA deficiency in a patient with cystic fibrosis (genotype M470V/V520F). Ann Allergy Asthma Immunol 2018; 121:619-620. [PMID: 30392531 DOI: 10.1016/j.anai.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Jessica Oh
- Department of Internal Medicine, University Hospitals, Cleveland Medical Center, Cleveland, Ohio.
| | - David P McGarry
- Department of Pulmonary and Critical Care, Allergy/Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Nancy Joseph
- Department of Pulmonary and Critical Care, Allergy/Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Brian Peppers
- Department of Pulmonary and Critical Care, Allergy/Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Robert Hostoffer
- Department of Pulmonary and Critical Care, Allergy/Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Associates Inc., Mayfield Heights, Ohio
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Peppers BP, Vatsayan A, Dalal J, Bonfield T, Tcheurekdjian H, Hostoffer R. A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis. Immun Inflamm Dis 2018; 6:377-381. [PMID: 29701015 PMCID: PMC6113765 DOI: 10.1002/iid3.224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/08/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022]
Abstract
Introduction Anaphylaxis is a life threatening systemic inflammatory process that share mediators involved in the coagulation cascade. Platelet activating factor, known to increase platelet aggregation, has also been implicated as an important mediator of anaphylaxis. Although other inflammatory reactions are associated with an increased risk of thrombosis, anaphylaxis is currently not reported as one of them. Furthermore the role platelets may have in the perianaphylaxis period is not well understood. We here in present a retrospective case series of three patients that had platelet aberrations suggestive of PAF involvement and clinically significant thrombosis in close relationship with anaphylaxis. Objective To investigate platelet response before and after anaphylaxis and indirect observation evidence of platelet activating factors involvement with possible increased risk of thrombosis. Methods A retrospective investigation into medical records including medication administrations times, laboratory, and radiology results. Platelet levels pre‐ and post‐ anaphylaxis were statistically analyzed. Results Case 1, a 44 year old man had an anaphylactic reaction shortly after envenomation and subsequently suffered an acute infarction with thrombus in a cerebral artery. Case 2 is a 49 year old man with idiopathic anaphylaxis who developed a deep vein thrombosis after a protracted anaphylaxis event. Case 3 involved an 18 year old female with acute myeloid leukemia was found to have a thrombus in the celiac trunk following anaphylaxis. A paired two‐tailed Wilcoxon test on the subjects pre and post anaphylactic platelet levels resulted in a overall P < 0.0001. Conclusions and Clinical Relevance These three cases illustrate the potential role platelets may have in anaphylaxis and possible increased secondary risk for the development of thrombosis. Larger studies are required to determine incidence and risk factors for blood clots following anaphylaxis in order to provide management or screening recommendations.
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Affiliation(s)
- Brian P Peppers
- Adult and Pediatric ACGME Osteopathic Recognized Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Anant Vatsayan
- Department of Pediatrics, Hematology/Oncology and Bone Marrow Transplant Fellowship Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Jignesh Dalal
- Department of Pediatrics, Hematology/Oncology and Bone Marrow Transplant Fellowship Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Tracey Bonfield
- Department of Immunology, Case Western Reserve University, Cleveland, Ohio
| | - Haig Tcheurekdjian
- Adult and Pediatric ACGME Osteopathic Recognized Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio.,Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio
| | - Robert Hostoffer
- Adult and Pediatric ACGME Osteopathic Recognized Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio.,Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio
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48
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Schend J, Doll R, Sandhu M, Rodgers M, Hostoffer R. Mannose-binding lectin deficiency associated with numerous paraspinal neurofibromas. Ann Allergy Asthma Immunol 2017; 120:222-223. [PMID: 29162315 DOI: 10.1016/j.anai.2017.10.017] [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: 07/28/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jason Schend
- Mercy Health Hospital, Mercy Campus, Muskegon, Michigan.
| | - Rayna Doll
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Monica Sandhu
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Mark Rodgers
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Robert Hostoffer
- University Hospitals, Cleveland Medical Center, Cleveland, Ohio; Allergy/Immunology Association Inc, Mayfield Heights, Ohio
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49
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Johnson J, Abraham T, Sandhu M, Peppers B, Lyman B, Knorzer C, Romanello G, Tcheurekdjian H, Hostoffer R. OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.022] [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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50
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Peppers B, Jhaveri D, Hostoffer R, Bonfield T. OR061 Stratification of peanut-murine model into anaphylaxis severity risk groups using intradermal testing read by thermography. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.049] [Citation(s) in RCA: 1] [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: 10/18/2022]
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