Systemic Treatment Considerations For Psoriasis In Alpha-Gal Syndrome: A Case Report And Ingredient Review, Emily Saurborn, Ian Depew, Madelyn Ross, Mckenzie Lambiotte, Shane Cook

Marshall Journal of Medicine

Background: Psoriasis is a chronic skin condition characterized by an overactive immune system, leading to increased keratinocyte proliferation and angiogenesis. Treatment ranges from topical solutions to systemic therapy and lastly, biologics. However, the latter options are typically manufactured with mammalian-derived ingredients. Alpha-gal syndrome (AGS) is an acquired IgE-mediated hypersensitivity reaction to galactose-alpha-1,3-galactose, an enzyme required for digesting carbohydrates in mammalian products. In addition to dietary avoidance of mammalian products, patients with AGS may need to avoid certain medications due to their formulations.

Case Presentation: We present a case of a 53-year-old female with a severe alpha-gal allergy evaluated in the …

Mitochondrial Nad Metabolism In T Cell Responses, Alicia Marie Bostwick-Galaviz

Dartmouth College Ph.D Dissertations

Metabolism is critical to CD8 T cell differentiation and response to intracellular infections and cancer. Mitochondrial NAD is a key component of cellular metabolism; however, the biology of this metabolite in CD8 T cells is poorly understood due to limitations of existing NAD analysis techniques. In this thesis, we develop the mitochondrial NAD redox index and capacity analysis (RICA) assay, a powerful flow-cytometry based technique for assessing mitochondrial NAD content and redox state in living cells. We use this assay to profile mitochondrial NAD dynamics across the course of CD8 T cell differentiation and in multiple in vitro and ex …

Faktor-Faktor Yang Berhubungan Dengan Infeksi Laten Tuberkulosis Pada Pasien Lupus Eritematosus Sistemik Dan Artritis Reumatoid Di Rsupn Dr. Cipto Mangunkusumo, Fahmi Adnan Musthofa, Herikurniawan Herikurniawan, Ceva Wicaksono Pitoyo, Alvina Widhani, Ari Fahrial Syam, Rudi Putranto, Sally Aman Nasution, Noto Dwimartutie, Suryo Anggoro Kusumo Wibowo

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are at increased risk of latent tuberculosis infection (LTBI) because of immune dysregulation and prolonged immunosuppressive therapy. However, data on the prevalence and factors associated with LTBI among patients with autoimmune diseases in Indonesia remain limited. This study aimed to identify factors associated with LTBI among adult outpatients with SLE and RA at Dr. Cipto Mangunkusumo National General Hospital (RSCM).

Methods. This analytic cross-sectional study was conducted at the Allergy-Immunology and Rheumatology Outpatient Clinic of RSCM from November 2025 to July 2026. Data were obtained through structured …

A Real-World Characterization Of Patients Receiving Biologics For Type 2 Inflammatory Diseases In A Tertiary Rhinology Practice, T. Blaise Marshall, Matthew Lelegren, Joseph K. Han, Kent Lam

Eastern Virginia Medical Journal

Background: Biologic therapies, such as omalizumab, mepolizumab, dupilumab, and benralizumab, are increasingly used in the treatment of various type 2 inflammatory diseases, including chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and atopic dermatitis. While these biologic therapies have demonstrated efficacy and safety in their respective clinical trials, real-world characterization of the use of biologic therapies provides insight into how these treatments are prescribed and utilized among the general population.

Objective: We aim to characterize the patient population in a single tertiary otolaryngology practice that is receiving biologic therapies for all type 2 inflammatory diseases.

Methods: We conducted a retrospective chart …

Reducing Potentially Preventable Emergency Department Visits (Ppvs) Through A Telehealth Intervention In Children With Asthma Within A Managed Care Organization (Mco), Renee A. Roker

Doctor of Nursing Practice Final Project Abstract

Abstract

Purpose:  The purpose of this quality improvement project was to reduce unnecessary ED utilizations among children with asthma enrolled in a Medicaid managed care health plan. The project aimed to improve access to care and enhance asthma self-management.

Background:  Asthma is one of the leading causes of Emergency Department (ED) utilization, among vulnerable populations. Members experience barriers to timely primary and specialist care, contributing to Potentially Preventable ED Visits (PPV) rates. This places managed care organizations (MCOs) at risk for financial penalties if not meeting the Texas PPV benchmark.

Methodology:  Guided by the Chronic Care Model, Lean Six Sigma …

Plasma And Extracellular Vesicle–Enriched Protein Profiles In Chronic Rhinosinusitis, Aryana Amin, Rutviben P. Shah Bds, Dhvani Parikh Mph, Niki Mirhosseini Bs, Baharan Fekry Phd, Donyea L. Moore, Mahboobeh Mahdavinia Md, Phd

Summer Research Program Abstracts

No abstract provided.

Vaccination For Patients With Immunosuppression And Altered Immunity: A Workgroup Report From The Aaaai Adverse Reactions To Drugs, Biologics, And Vaccines Committee And The Autoimmunity And Altered Immune Response Committee, Sam Pope Phd, Jd

Faculty Publications

Abstract

Vaccination, a fundamental strategy for infectious disease prevention, presents unique challenges in individuals with altered immunity. These populations include individuals with inborn errors of immunity, autoimmune and inflammatory diseases, solid organ transplants, hematopoietic stem cell transplants, biologic and immunosuppressive therapies, and pregnancy. Despite concerns regarding variable vaccine responses, altered efficacy, and safety profiles, these groups remain under-represented in clinical trials. This review synthesizes current evidence on immunization outcomes in medically complex populations, highlighting strengths and limitations in existing research. We describe how altered immunity affects vaccine responses, summarize data on adverse reactions, and examine the influence of biologic therapies …

The Prevalence And Effects Of Gestational Maternal Allergy: A Narrative Review, Alice Werynski Bs, Kang Chen Phd

Medical Student Research Symposium

Title:

The Prevalence and Effects of Gestational Maternal Allergy: A Narrative Review

Authors:

Alice Werynski B.S, Kang Chen Ph.D

Background:

Maternal allergies are a prevalent yet overlooked category of gestational disease. Pregnancy is characterized by a Th2 dominant immunological environment, and because many allergic diseases also rely on Th2 cytokines and IgE-mediated pathways, allergy during pregnancy may impact symptoms and influence maternal and fetal outcomes.

Methods:

This narrative review summarizes and compares literature on the prevalence of allergic conditions in pregnancy, their immunologic mechanisms, and their effects on maternal health, fetal development, and treatment safety. The search was conducted through …

Environmental Mercury Alters Immune Pathways Linked To Autoimmune Risk In Mice Mirroring Humans, Maurgan Lee, Paul Stemmer, Randall Gill, Allen Rosenspire, Anil Aranha, Heather Gibson

Medical Student Research Symposium

Background and Purpose: Mercury is a pervasive environmental contaminant, and human epidemiologic studies have linked chronic low-level exposure to increased autoimmune disease-risk. Dysregulated lymphocyte activation and impaired signaling tolerance are central mechanisms in human autoimmunity. Protein phosphorylation governs lymphocyte differentiation and function, alterations in phosphoproteomic networks may represent a signature of immune disruption. This study evaluates how low dose mercury exposure modifies B and T cell abundance and intracellular signaling patterns in BALB/c and Diversity Outbred (DO) mice.

Methods: BALB/c and DO mice were exposed to low dose HgCl2 in their water for two weeks or provided standard water controls. …

Impact Of Dietician Counseling On Outcomes In Newly Diagnosed Celiac Disease, Andreas Mozny B.A., Alyusuf Elnaggar B.A., James Mo M.D., Suraj Suresh M.D.

Medical Student Research Symposium

Title: Impact of Dietician Counseling on Outcomes in Newly Diagnosed Celiac Disease

Background: Dietician counseling is routinely recommended for newly diagnosed celiac disease (CD), yet its measurable impact is not well defined. This study examined whether early dietician involvement improves clinical symptoms or serologic outcomes.

Methods: We retrospectively reviewed adults with biopsy-confirmed CD at a single center from 2020–2024. Demographics, symptoms, and laboratory data were collected by chart review with ≥6 months of follow-up. Patients who met with a dietician formed the dietician group; all others were assigned to the non-dietician group. Fisher's Exact tests evaluated abdominal …

When Optimal Therapy Becomes High Risk: A Risk-Benefit Framework For Beta-Lactam Desensitization In Life-Threatening Mssa Infection, Rana Amoush, Aaron Kobernick

Conference Presentation Abstracts

Background Beta-lactam antibiotics are preferred for invasive methicillin-sensitive Staphylococcus aureus (MSSA) infections, especially those involving prosthetic material. Management is challenging in patients with severe beta-lactam hypersensitivity, as alternative agents may be less effective or poorly tolerated. Limited guidance exists on reassessing desensitization risk when second-line therapies become untenable. Purpose To present a case-based risk-benefit framework for evaluating beta-lactam desensitization in medically complex patients with life-threatening MSSA infections. Methods We retrospectively reviewed a patient with recurrent MSSA prosthetic graft infection and severe beta-lactam hypersensitivity. Clinical decision-making was analyzed using a structured risk–benefit framework incorporating infection severity, therapeutic superiority of beta-lactams, tolerance …

Novel Biomarker Discovery In Multiple Sclerosis, Manisha Gangasani

Honors Theses

Multiple Sclerosis (MS) is a chronic neuroinflammatory disorder affecting the brain, spinal cord, and optic nerve. Patients experience cognitive, motor, autonomic, and emotional symptoms that often overlap with other neurological conditions, making early diagnosis challenging. Current diagnostic criteria require evidence of lesions with dissemination in time and space. Racial disparities in MS outcomes are well documented, with Black individuals often exhibiting greater disease severity, higher relapse rates, and increased disability compared to White individuals. These differences likely reflect a combination of genetic, biological, environmental, and healthcare access factors, underscoring the need to improve early diagnosis and reduce inequities in care. …

Determining Zap-70 Signaling Pathways Mediated By Ccr7 In Tcr T Cell Activation, Vivian Torres

Open Access Theses & Dissertations

Activation of T lymphocytes is the main event that occurs in the adaptive immune response after engagement of the T cell receptor (TCR) with the peptide of the major histocompatibility complex (pMHC) molecules that are demonstrated by antigen presenting cells [1]. A key step in this process is the recruitment and activation of the zeta chain associated protein of 70 kDa (ZAP-70). ZAP-70 couples TCR engagement to downstream intracellular signaling pathways through phosphorylation of tyrosine residues within intracellular tyrosine activation motifs (ITAMs) [2]. Although there have been extensive studies on the signaling response through TCR activation, the regulatory influence of …

Detection And Quantification Of Allergen Cross-Contact In Shared Frying Oil Using Targeted Mass Spectrometry, Francisca Asigri

Department of Food Science and Technology: Dissertations, Theses, and Student Research

Cow’s milk and egg allergies are prevalent IgE-mediated food allergies that pose significant public health concerns worldwide. Although strict avoidance remains the primary management strategy, unintended exposure can still occur through allergen cross-contact, particularly in commercial and industrial food operations that utilize shared frying oils. The objective of this study was to identify and quantify allergen transfer in shared frying oil and assess the robustness of existing targeted mass spectrometry methods (LC-MS/MS) for detecting milk and egg proteins in heated oil matrices.

Heated oil spikes were developed by incorporating non-fat dry milk (NFDM) and whole egg powder (WEP) into oil …

Perioperative Anaphylaxis In A Healthy Adolescent After First Lifetime Surgery, Shayan Sazdar, Salman Aljubran

Posters

Introduction: Perioperative anaphylaxis is a rare life-threatening event. Its evaluation poses complex considerations inherent to the use of multiple medications. Patient presentation: A healthy 11-year-old boy developed anaphylaxis shortly after discharge home from first lifetime surgery for orchiopexy. Perioperative medications included rocuronium, propofol, fentanyl, bupivacaine, sugammadex, ondansetron, dexamethasone, dexmedetomidine, and ketorolac. No antibiotics. After surgery, he consumed fast food dinner and ice cream. Within 2 hours after discharge home, he returned to our Emergency Department (ED) with facial and tongue angioedema, hives, and respiratory distress. He received multiple doses of intramuscular epinephrine and briefly required epinephrine drip in the ED. …

Asthma Phenotypes And Control In 22q11.2 Deletion Syndrome: A Single-Center Retrospective Study, Cody Shopper, Katey Campbell, Nikita S. Raje

Posters

Background: Patients with 22q11.2 deletion syndrome have increased rates of atopy and immune dysregulation and may experience a higher burden of asthma; however, real-world data describing asthma control, severity, and treatment patterns in this population are limited. We hypothesized that asthma control and severity patterns in patients with 22q11.2 deletion syndrome differ from those observed in the general asthma population. Objectives/Goal: To characterize asthma control, severity, and treatment patterns among patients with 22q11.2 deletion syndrome and to compare observed patterns with those typically reported in the general asthma population. Methods/Design: We conducted a retrospective observational cohort study of patients with …

Losartan-Induced Angioedema: A Case Report And Review Of Literature, Leila C. Tou, Audrey Nourse, Rachel Cox, Spencer Stanford

Journal of Community Hospital Internal Medicine Perspectives

Angiotensin receptor blockers (ARBs) are frequently prescribed as alternatives to angiotensin-converting enzyme inhibitors (ACEIs), particularly in patients who experience ACEI-induced adverse effects including cough. Although ARBs are associated with a lower incidence of angioedema, rare cases have been reported in patients without prior ACEI exposure. Here, we describe a 58-year-old Black male who developed lip and facial swelling six months after starting losartan. His symptoms did not improve with antihistamines or corticosteroids but resolved after discontinuation of losartan, which was replaced with amlodipine without recurrence. This case emphasizes the need for clinician awareness of ARB-induced angioedema and the importance of …

Z Variant Heterozygosity In Alpha-1 Antitrypsin Deficiency: Disease Risk And Treatment Implications, Craig P. Hersh, Jeffrey H. Teckman, Pavel Strnad, Aaron Hakim, Tomás P. Carroll, Ian P. Hall, Auyon J. Ghosh, Igor Barjaktarevic, Noel G. Mcelvaney, Joseph E. Kaserman, David A. Lomas, Charlie Strange, M Bradley Drummond, Stephen I. Rennard, Kathi E. Hanna, Virginia C. Clark, Monica P. Goldklang, Peg Iverson, Andrew A. Wilson

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Individuals heterozygous for alpha-1 antitrypsin deficiency (AATD) have one copy of the normal "M" allele and one copy of an abnormal allele ("Z", "S", or another variant) in the SERPINA1 gene. Historically, evidence has been lacking to support the concept that heterozygotes are at increased risk for liver and/or lung complications compared to individuals homozygous for the M allele. However, growing evidence suggests that inheritance of a single Z allele increases the risk of disease in some individuals. The Alpha-1 Foundation convened a workshop on October 27, 2023, in Bethesda, Maryland that included stakeholders from the research, pharmaceutical, and …

Bayesian Reanalysis Of Early Remdesivir For The Treatment Of Covid-19 In Outpatients With High Risk Of Progression To Severe Disease, Mazin Abdelghany, Fang Yu, Stephen I. Rennard, Yeongjin Gwon

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Though Bayesian methods are flexible, intuitive, and readily incorporated into clinical decision-making, with particular utility when prior information is available, they remain underutilized in the analysis of clinical trials.

METHODS: In PINETREE, a Phase 3 randomized controlled trial (RCT) of remdesivir (RDV) for the treatment of outpatients with COVID-19 at high risk of severe disease, the primary outcome of COVID-19-related hospitalization or all-cause death was reanalyzed using a range of reference and data-driven priors. Posterior probability distributions were used to calculate the probability that the estimated hazard ratio (HR) was below a range of clinically meaningful specified thresholds and …

Accidental Daily Dosing: Severe Methotrexate Toxicity In A Patient With Rheumatoid Arthritis, Sidra Memon, Kavitha Vemuri, Syed Uzair Mahmood, Darshit Patel

Advances in Clinical Medical Research and Healthcare Delivery

This case highlights a crucial complication of oral methotrexate therapy: toxicity due to dosing errors. A patient’s daily dosing regimen, instead of the intended weekly schedule, led to a significantly excessive cumulative dose of methotrexate over a short period, resulting in severe hematologic and mucosal toxicity. This underscores the importance of clear patient education and vigilant prescription practices to prevent such errors.

Giant Cell Arteritis After Mrna Covid Vaccines: Concerning Or A False Alarm?-A Retrospective Cohort Study, Syed M. F. Zabiullah, Rutwik Pradeep Sharma, Roshan Subedi, Viqarunnisa Faaiza Zahid, Yasir Loai, Sarathlal Mannumbethlal, Aatifa Aatifa

Advances in Clinical Medical Research and Healthcare Delivery

Background: The coronavirus disease (COVID-19) pandemic led to the first large-scale rapid deployment of novel messenger RNA (mRNA) vaccines. Although the effectiveness and safety of these vaccines were rigorously studied, post-vaccination adverse events such as giant cell arteritis (GCA) continue to be reported. More than two hundred and sixty three cases of new-onset GCA occurring after mRNA vaccine administration are listed in the Vaccine Adverse Events Reporting System as of October 2024. We aimed to explore the incidence of GCA after mRNA vaccines among patients in our health system and study their characteristics and outcomes.

Methods: We conducted a …

Allergy In Dentistry: Mechanisms Of Development And Effective Treatment Methods, Maria Zofia Lisiecka

International Arab Journal of Dentistry

Objectives: This study is conducted to analyse the mechanisms of allergic reaction development in dentistry and the effectiveness of their treatment methods.

Methods: During it, a review of current scientific sources on allergology, immunology, dentistry, pharmacology, and materials science is conducted, mechanisms for the development of allergies of various types are established, the effectiveness of treatment methods is evaluated, and clinical recommendations for allergy therapy in dentistry are formed.

Results: The results show that the development of allergic reactions occurs by two mechanisms. Immediate-type immunoglobulin E-mediated (IgE-mediated) responses are triggered by the release of histamine, serotonin, and …

Vcd-Induced Model Of Menopause To Study Effects Of Sleep Fragmentation On Atherogenesis, Sarah Shackelford B.S, Alina Moriarty M.S., Basudha Habisyasi M.S., Kathleen Coleman B.S., Pavla Brachova Phd, Diane Duffy Phd, Elena Galkina Phd

Cardiovascular Research Symposium

Introduction: Atherosclerosis is a chronic disease characterized by plaque buildup within arteries, leading to cardiovascular diseases. Sleep fragmentation (SF), defined as less than seven hours of uninterrupted sleep, is a recognized risk factor and is commonly observed in menopausal women. Menopause causes a decline in estrogen and ovarian follicles, resulting in the loss of estrogen’s protective anti-atherogenic effects. SF exacerbates atherosclerosis by promoting oxidative stress and inflammation. Since SF contributes to atherosclerosis, and menopausal women are particularly affected by disturbed sleep, we aim to examine how menopause affects atherogenesis in the conditions of disturbed sleep.

Methods: We used the 4-vinylcyclohexene …

Alfred Russel Wallace Notes 37. What About Wallace On Vaccination . . . ?, Charles H. Smith

Faculty/Staff Personal Papers

Best known for his natural history studies on evolution and biogeography, Alfred Russel Wallace (1823−1913) had a significant second career as a social critic. One of his most controversial stances was his position on (smallpox) vaccination. Anti-vaxxers of the present frequently bring up his name as a resource for their side, but the situation is not so easily reducible to that.

Identification And Preclinical Assessment Of Novel Therapeutic Modalities In Environmental Exposure-Induced Lung Disease, Aaron D. Schwab

Theses & Dissertations

Environmental lung diseases are preventable respiratory conditions either caused or made worse by inhaled environmental exposures. Contemporarily, environmental lung diseases are most associated with workplace exposures given specific occupational processes aerosolize inflammatory agents that can be inhaled at high concentrations. Although a considerable amount is known regarding immunoglobulin (Ig)E-mediated responses to environmental exposures, little is known about non-IgE mediated respiratory conditions resulting from lipopolysaccharide (LPS)-enriched organic dust exposure(s). Chronic respiratory diseases such as asthma, hypersensitivity pneumonitis, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis have all been identified as environmental lung diseases caused or exacerbated by such environmental dusts. Therapeutic …

Drug-Induced Hypersensitivity Syndrome Resulting In Hepatotoxicity And Epstein-Barr Virus Reactivation Following Initiation Of Levetiracetam, Zechariah Jung, Xavier Zonna, Samuel J. Wlasowicz, Conor Banta, Lawrence Canale, Joseph Bielecki

Advances in Clinical Medical Research and Healthcare Delivery

A 28-year-old male with a past medical history of alcohol abuse had new-onset seizures suspected to be caused by alcohol use. Twelve days after starting levetiracetam for seizure prophylaxis, he began to develop a pruritic rash, darkening of his urine, periods of jaundice, and hot flashes that correlated with the timing of his levetiracetam dosing. He was subsequently found to have lymphocyte-predominant leukocytosis, elevated aminotransferases, and alkaline phosphatase. Following discontinuation of his levetiracetam, he was found to have positive Epstein-Barr virus (EBV) serology suggestive of reactivation. This case demonstrates levetiracetam as a rare cause of drug-induced hypersensitivity syndrome (DIHS) along …

Ai Model For Predicting Asthma Prognosis In Children, Elham Sagheb, Chung-Il Wi, Katherine S King, Bhavani Singh Agnikula Kshatriya, Euijung Ryu, Hongfang Liu, Miguel A Park, Hee Yun Seol, Shauna M Overgaard, Deepak K Sharma, Young J Juhn, Sunghwan Sohn

Faculty, Staff and Student Publications

BACKGROUND: Childhood asthma often continues into adulthood, but some children experience remission. Utilizing electronic health records (EHRs) to predict asthma prognosis can aid health care providers and patients in developing effective prioritized care plans.

OBJECTIVE: We aimed to develop artificial intelligence (AI) models using various clinical variables extracted from EHRs to predict childhood asthma prognosis (remission vs no remission) in different age groups.

METHODS: We developed AI models utilizing patients' EHRs during the first 6, 9, or 12 years of their lives to predict their asthma prognosis status at ages 6 to 9, 9 to 12, or 12 to 15 …

Case Report: A Case Of Transient Dress Syndrome (Drug Rash With Eosinophilia And Systemic Symptoms), Dip Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 41-year-old female with a history of hypertension who presented with fever and a diffuse erythematous rash after taking trimethoprim-sulfamethoxazole (TMP-SMX) for an ear infection. Due to her symptoms, mild eosinophilia, and elevated liver function tests, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) was suspected. Although the patient’s rash had resolved by the time of initial evaluation, it recurred overnight, reinforcing suspicion for DRESS syndrome. TMP-SMX was discontinued, and acetylcysteine was administered due to the patient’s high-dose use of acetaminophen in the days prior to her hospital presentation. Infectious and autoimmune workups were negative. …

Case Report: Cold Urticaria Diagnosed In The Emergency Department, Philip Carhart, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Cold urticaria can be primary (idiopathic) or can be due to underlying hematologic or infectious diseases. Here we present the case of a young female patient with no past medical history who was diagnosed with cold urticaria in the emergency department setting, using a cold stimulation test. Most cases are idiopathic. The reaction can be triggered in individual cases by exposure to cold objects or to generalized cold ambient temperatures, as was the case in the patient presented here. The physical response is most commonly pruritic wheals (urticaria). However, more severe symptoms may occur up to angioedema with hoarseness and …

Case Report: Alpha Gal Syndrome, Eric Haljasmaa, David Parkes, Wayne Tamaska

Rowan-Virtua Research Day

We report a case of a 40-year-old male who presented with sensation of throat closing and shortness of breath while at work at a meat processing facility. The differential diagnosis of shortness of breath is throat closing includes, but is not limited to, allergic reactions to antibiotics in meat, allergy to food additives, Symptom triggers are useful in identifying causes and a good supporting history and exposures can help with diagnosis. In this case, the patient had a known diagnosis of Alpha-gal syndrome (AGS) which is a tick-bite associated, possibly life-threatening immunoglobin E-mediated (IgE) hypersensitivity to galactose-alpha-1,3-galactose (alpha-gal). The patient …