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Alnaqbi KA, Elezbawy B, Fasseeh AN, Bangash AR, Elshamy A, Shendi H, Aftab MI, AlMarshoodi M, Gebran N, AlDhaheri N, Fahmy SA, Al Dallal S, Al Naeem W, Abaza S, Kaló Z. Development of the Emirates Multi-Criteria Decision Analysis Tool for Orphan Drugs. Cureus 2024; 16:e55215. [PMID: 38558740 PMCID: PMC10981202 DOI: 10.7759/cureus.55215] [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] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background The number of orphan drug approvals is currently increasing globally. This creates a significant burden on payers and healthcare systems. This study aimed to create a multi-criteria decision analysis (MCDA) tool for evaluating orphan drugs within the United Arab Emirates (UAE). The intended result of the tool is to provide evidence-based guidance to decision-makers in reimbursement and procurement decisions. Methods We conducted a literature search and local expert interviews to identify relevant preliminary criteria for the MCDA tool. Then we conducted a structured consensus-building session for healthcare experts and decision-makers in the UAE to develop the Emirati MCDA tool for orphan drugs. The experts voted for the criteria to be included in the tool and their ranking according to importance, as well as the weight of each criterion and its scoring function. To improve understanding and facilitate the voting process, experts were provided with a brief illustration of similar tools conducted in other countries before the voting sessions. Finally, the tool was developed in a Microsoft Excel sheet (Microsoft Corporation, Redmond, Washington, United States), and it was validated and tested based on real case studies, then it was fine-tuned accordingly based on the experts' discussions. The final tool was provided to the attendees to guide their decisions in the reimbursement and procurement of orphan drugs. Results The created tool provides a score for each analyzed orphan drug based on its value. Ten criteria were included in the final MCDA tool. These were cost-effectiveness (25.1% of the weight), magnitude of health gain (20.1%), availability of therapeutic alternative (14.3%), disease severity (11%), budget impact (7.9%), disease rarity (5.6%), strength of clinical evidence (5.6%), burden on households (4.5%), indication uniqueness (3.2%), and patients' age (2.6%). Conclusions Implementation of evidence-based healthcare necessitates assessing the fair value of each health technology. Addressing the high unmet medical needs and improving healthcare for patients with rare diseases are priorities within the UAE. The created Emirates MCDA tool for orphan drugs has the potential to help decision-makers implement value-based and evidence-based reimbursement decisions for orphan drugs.
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Affiliation(s)
- Khalid A Alnaqbi
- Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, ARE
- Internal Medicine/Rheumatology, Tawam Hospital, Al Ain, ARE
| | - Baher Elezbawy
- Evidence Synthesis, Syreon Middle East, Alexandria, EGY
- Doctoral School of Pharmaceutical Sciences, Semmelweis University, Budapest, HUN
| | - Ahmad N Fasseeh
- Modelling, Syreon Middle East, Alexandria, EGY
- Faculty of Pharmacy, Alexandria University, Alexandria, EGY
| | - Abdul Rauf Bangash
- Benefit Design and Strategic Purchasing, Department of Health, Abu Dhabi, ARE
| | - Amin Elshamy
- Wellbeing and Sustainable Development, Ministry of Health and Prevention, Dubai, ARE
| | | | | | | | - Nicole Gebran
- Clinical Pharmacy, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, ARE
| | - Noura AlDhaheri
- Pediatrics/Genetics and Genomics, United Arab Emirates University, Al Ain, ARE
| | - Sahar A Fahmy
- Drugs and Medical Products Regulation, Department of Health, Abu Dhabi, ARE
| | | | - Waeil Al Naeem
- Clinical Pharmacy, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, ARE
| | - Sherif Abaza
- Health Economics, Syreon Middle East, Cairo, EGY
| | - Zoltán Kaló
- Health Economics, Syreon Research Institute, Budapest, HUN
- Health Technology Assessment, Semmelweis Univeristy, Budapest, HUN
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Al-Herz W, Ziyab AH, Adeli M, Al Farsi T, Al-Hammadi S, Al Kuwaiti AA, Al-Nesf M, Al Sukaiti N, Al-Tamemi S, Shendi H. Epidemiology of combined immunodeficiencies affecting cellular and humoral immunity- a multicentric retrospective cohort study from the Arabian Peninsula. Clin Immunol 2023; 254:109696. [PMID: 37481010 DOI: 10.1016/j.clim.2023.109696] [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: 05/09/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
AIMS To understand the characteristics of combined immunodeficiency disorders that affect cellular and humoral immunity (CID) in the Arabian Peninsula. METHODS Retrospective study of 236 patients with CID from the region were enrolled from 2004 to 2022. RESULTS 236 patients were included with a majority being profound CID. Among patients with a family history of CID, the ages at onset and diagnosis, and the delay in diagnosis were lower compared to those with no family history of CID, but this did not affect time to transplant. HSCT was performed for 51.27% of the patients with median time from diagnosis to HSCT of 6.36 months. On multivariate analysis, patients who underwent early transplant had increased odds of having CD3 count ≤1000 cell/μl, diagnosed by screening or erythroderma. CONCLUSION There is a delay in diagnosis and treatment of CID in our region. Establishing newborn screening programs and HSCT units in our region are the urgent need.
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Affiliation(s)
- Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait.
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mehdi Adeli
- Division of Immunology and Allergy, Sidra Medicine and Hamad Medical Corporation, Doha, Qatar
| | - Tariq Al Farsi
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Suleiman Al-Hammadi
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates; Al Jalila Children's Hospital, Dubai, United Arab Emirates
| | - Amna Ali Al Kuwaiti
- Division of Paediatric Allergy and Immunology, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Maryam Al-Nesf
- Division of Allergy and Immunology, Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nashat Al Sukaiti
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hiba Shendi
- Division of Paediatric Allergy and Immunology, Tawam Hospital, Al-Ain, United Arab Emirates
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Maurer M, Abuzakouk M, Al-Ahmad M, Al-Herz W, Alrayes H, Al-Tamemi S, Arnaout R, Binghadeer H, Gutta R, Irani C, Mobayed H, Nasr I, Shendi H, Zaitoun F. Consensus on diagnosis and management of Hereditary Angioedema in the Middle East: A Delphi initiative. World Allergy Organ J 2022; 16:100729. [PMID: 36601261 PMCID: PMC9803817 DOI: 10.1016/j.waojou.2022.100729] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/10/2022] [Accepted: 11/23/2022] [Indexed: 12/25/2022] Open
Abstract
Background Hereditary angioedema (HAE), a potentially life-threatening genetic disorder due to C1 inhibitor deficiency in most cases, is characterized by sudden and/or recurrent attacks of angioedema (subcutaneous/submucosal swellings). The global World Allergy Organization (WAO)/European Academy of Allergy and Clinical Immunology (EAACI) International guideline for HAE management is comprehensive, but the implementation of this guideline may require regional adaptation considering the diversity in disease awareness, type of medical care systems, and access to diagnostics and treatment. The aim of this Delphi initiative was to build on the global guideline and provide regional adaptation to address the concerns and specific needs in the Middle East. Methods The Consensus panel comprised 13 experts from the Middle East (3 from the United Arab Emirates, 3 from Saudi Arabia, 2 from Lebanon, 2 from Kuwait, 2 from Oman and 1 from Qatar) who have more than 2 decades of experience in allergy and immunology and are actively involved in managing HAE patients. The process that was carried out to reach the consensus recommendation included: 1.) A systematic literature review for articles related to HAE management using Ovid MEDLINE. 2.) The development of a questionnaire by an internationally acclaimed expert, with 10 questions specific to HAE management in the Middle East. 3.) Experts received the questionnaire via email individually and their answers were recorded (email/interview). 4.) A virtual consensus meeting was organized to discuss the questionnaire, make amends if needed, vote, and achieve consensus. Results The questionnaire comprised 10 questions, each with 2 or more statements/recommendations on which the regional experts voted. A consensus was reached based on a 70% agreement between the participants. The key highlights include: 1) HAE experts in the Middle East emphasized the importance of a positive family history for arriving at a diagnosis of HAE. 2) The number of episodes per month or per 6-month period and severity should be used, together with other markers, to determine the need for prophylaxis. 3) Disease status should be monitored by periodic visits and the use of patient-reported outcome measures such as the angioedema activity score and the angioedema control test. 4) Attenuated androgens and tranexamic acid may be considered for long-term prophylaxis, if lanadelumab, C1-Inhibitor or berotralstat are not available. Conclusion This consensus recommendation may help to educate healthcare practitioners in the Middle East and unify their approach to the diagnosis and management of HAE.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany,Corresponding author. Prof. Marcus Maurer Charité – Universitätsmedizin Berlin
- Institute of Allergology
| | | | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Kuwait,Microbiology department, College of Medicine, Kuwait University, Kuwait
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait
| | - Hassan Alrayes
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Rand Arnaout
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hend Binghadeer
- King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Saudi Arabia
| | - Ravi Gutta
- Adult and Pediatric Allergy and Immunology Department, Mediclinic City Hospital, DHCC, Dubai
| | - Carla Irani
- Hotel Dieu de France Hospital, St Joseph University, Beirut, Lebanon
| | - Hassan Mobayed
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Hiba Shendi
- Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Fares Zaitoun
- Clemenceau Medical Center, Dubai, United Arab Emirates
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Al-Herz W, Ziyab AH, Adeli M, Al Farsi T, Al-Hammadi S, Al Kuwaiti AA, Al-Nesf M, Al Sukaiti N, Al-Tamemi S, Shendi H. Predictors of early death risk among untransplanted patients with combined immunodeficiencies affecting cellular and humoral immunity: A multicenter report. Pediatr Allergy Immunol 2022; 33:e13901. [PMID: 36564872 DOI: 10.1111/pai.13901] [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: 09/12/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is an increased demand for hematopoietic stem cell transplant (HSCT) to treat various diseases including combined immunodeficiencies (CID), with limited worldwide availability. Variables affecting the decision regarding CID patients' prioritization for HSCT are not known. We aimed to determine general, clinical, and immunologic factors associated with the higher risk of early death (≤6 months after diagnosis) in untransplanted CID patients. METHODS Data collection was done retrospectively from five centers and included general patients' information, and clinical and laboratory variables. Inclusion criteria were untransplanted patients who are either dead or alive with a follow-up period ≥6 months after diagnosis. RESULTS Two hundred and thirty-six CID patients were reported by participating centers, of whom 111 were included in the study with a cumulative follow-up period of 278.6 years. Seventy-two patients died with the median age of death of 10.5 months. 35.1% of the patients succumbed within 6 months after the diagnosis. Having a history of Candida infections, sepsis or hepatomegaly was associated with an increased risk of early death. None of the other general or clinical variables was associated with such risk. Bivariate analysis of lymphocyte subsets showed that patients with the following counts: CD3+ < 100, CD4+ < 200, CD8+ < 50, or CD16+ CD56+ <200 cells/μl had increased risk of early death. In adjusted analysis, increased risk of early death was observed among patients with CD3+ count <100 cells/μl. CONCLUSION Combined immunodeficiencies patients with a history of Candida infections, sepsis, hepatomegaly, or severe T-lymphopenia should be given priority for HSCT to avoid early death.
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Affiliation(s)
- Waleed Al-Herz
- Department of Pediatrics, College of Medicine, Kuwait University, Kuwait City, Kuwait.,Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mehdi Adeli
- Division of Immunology and Allergy, Sidra Medicine and Hamad Medical Corporation, Doha, Qatar
| | - Tariq Al Farsi
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Suleiman Al-Hammadi
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates.,Al Jalila Children's Hospital, Dubai, United Arab Emirates
| | | | - Maryam Al-Nesf
- Division of Allergy and Immunology, Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nashat Al Sukaiti
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hiba Shendi
- Department of Pediatrics, Tawam Hospital, Al-Ain, United Arab Emirates
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Alosaimi MF, Shendi H, Beano A, Stafstrom K, El Hawary R, Meshaal S, Galal N, Pai SY, El-Marsafy A, Geha RS, Chou J. T-cell mitochondrial dysfunction and lymphopenia in DOCK2-deficient patients. J Allergy Clin Immunol 2019; 144:306-309.e2. [PMID: 30826364 DOI: 10.1016/j.jaci.2019.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Mohammed F Alosaimi
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Department of Pediatrics, Allergy/Immunology Division, King Saud University, Riyadh, Saudi Arabia
| | - Hiba Shendi
- Department of Pediatrics, Allergy/Immunology Division, Tawam Hospital and College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Abdallah Beano
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Kelsey Stafstrom
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Rabab El Hawary
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Safa Meshaal
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Galal
- Pediatrics Department, Cairo University, Cairo, Egypt
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Department of Pediatric Oncology, Dana Farber Cancer Institute, and Harvard Medical School, Boston, Mass
| | | | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
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Ben Farhat K, Alosaimi MF, Shendi H, Al-Hammadi S, Jones J, Schwarz K, Schulz A, Alawdah LS, Burchett S, Albuhairi S, Whangbo J, Kwatra N, Shamseldin HE, Alkuraya FS, Chou J, Geha RS. Immunologic reconstitution following hematopoietic stem cell transplantation despite lymph node paucity in NF-κB-inducing kinase deficiency. J Allergy Clin Immunol 2019; 143:1240-1243.e4. [PMID: 30445060 PMCID: PMC6408971 DOI: 10.1016/j.jaci.2018.11.003] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023]
Abstract
This case demonstrates successful immune reconstitution following hematopoietic stem cell transplantation in NIK deficiency.
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Affiliation(s)
- Khaoula Ben Farhat
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Mohammed F Alosaimi
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia.
| | - Hiba Shendi
- Department of Allergy/Immunology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Suleiman Al-Hammadi
- Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Jennifer Jones
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Klaus Schwarz
- Institute for Transfusion Medicine, Ulm University and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg - Hessen, Ulm, Germany
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | - Laila S Alawdah
- Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Sandra Burchett
- Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Sultan Albuhairi
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Jennifer Whangbo
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital and the Dana Farber Cancer Institute, Boston, Mass
| | - Neha Kwatra
- Division of Nuclear Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Hanan E Shamseldin
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fowzan S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Mass
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Steele CL, Doré M, Ammann S, Loughrey M, Montero A, Burns SO, Morris EC, Gaspar B, Gilmour K, Bibi S, Shendi H, Devlin L, Speckmann C, Edgar DM. X-linked Inhibitor of Apoptosis Complicated by Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) and Granulomatous Hepatitis. J Clin Immunol 2016; 36:733-8. [DOI: 10.1007/s10875-016-0320-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
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Conlon N, Devlin L, Steele C, Shendi H, Doré M, Thompson J, Donnelly A, Edgar JDM. Molecular‐based allergy diagnostics in the real world: evidence for a cost explosion and an impact vacuum. Clin Transl Allergy 2015. [PMCID: PMC4412523 DOI: 10.1186/2045-7022-5-s3-o3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Niall Conlon
- Centre for Infection and ImmunityQueen's University BelfastIreland
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
| | - Lisa Devlin
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
| | - Cathal Steele
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
| | - Hiba Shendi
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
| | - Matthew Doré
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
| | - John Thompson
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
| | - Alison Donnelly
- Department of ImmunologyRoyal Victoria HospitalBelfastIreland
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