Allergy and Immunology Commons^™

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 …

Allergies Coinciding With Central Sensitization Syndromes (Access), Jacqueline Morey, Alemu Fite, Carl Lauter, Matthew Sims

Posters

Significance of Reported Allergies: Many reported drug allergies are mislabeled side effects or misinterpretations, leading to suboptimal treatment, antibiotic resistance, and worse patient outcomes.¹

Central Sensitization Syndromes (CSS): CSSs are chronic pain conditions linked to altered sensory perception, including pain, fatigue, and neurologic dysfunction.² These patients may be more likely to misattribute medication side effects as allergies.

Previous Findings & Hypothesis: Prior research found high allergy reporting in interstitial cystitis and fibromyalgia—both CSS conditions.⁴ We hypothesized that other CSS diagnoses also correlate with increased allergy reporting, emphasizing the need for better allergy evaluation.

An Early Successful Hematopoietic Stem Cell Transplant (Hsct) For A Boy With Ipex Syndrome, Ali H. Alnajim, Salman Aljubran

Posters

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare inborn error of immunity. It affects about one in every 1.6 million people. It is caused by mutations in the forkhead box P3 (FOXP3) gene on chromosome Xp11.23. FOXP3 is a vital regulator of T cell development and function. Dysfunctional FOXP3 allows the hyperactivation of T cells, resulting in skin rash, enteropathy, diabetes, thyroiditis, hemolytic anemia, and thrombocytopenia. The classic clinical presentation is intractable diarrhea, growth problems, dermatitis, and autoimmune endocrinopathy. Case Description: A 4-week-old male was transferred to our hospital’s NICU due to respiratory distress and feeding difficulties. Neurology …

Elevated Tryptase Level Identifies A Case Of Hereditary Alpha Tryptasemia, Ali H. Alnajim, Salman Aljubran

Posters

Introduction Hereditary alpha tryptasemia (HaT) is a rare genetic disorder characterized by elevated serum tryptase levels due to duplication or triplication of the TPSAB1 gene. Affecting 6 to 8 percent of the population, HaT presents with diverse symptoms, including idiopathic anaphylaxis, skin rashes, and gastrointestinal issues. This report highlights a case that underscores the complexities and diagnostic challenges of HaT. Case Description A 4-year-old male presented with recurrent skin rashes and gastrointestinal symptoms following ingestion of certain foods, despite negative allergy tests. Persistent symptoms led to further investigations, revealing elevated tryptase levels of 10.3 ng/ml, 12.1 ng/ml, and 8.3 ng/ml …

Treating Your Child's Springtime Allergies, Maggie Mckay, Jay Portnoy

Parent-ish Podcast

The warmer weather is here...but for some, along with it comes seasonal allergies that can make you child feel a little crummy. Dr. Jay Portnoy discusses the cause of seasonal allergies, the pollens and how you can help your child feel better so they can enjoy springtime.

Click here to stream the podcast episode.

Immunotherapy Serum Mixing: 2023 Best Practice Changes, Eyas Abla Md, Paul Faybusovich Do, Matthew Lies, Mallory Mondloch

Nursing Posters

Background Story:

CentraCare - Plaza Allergy & Asthma Clinic compounds immunotherapy serum with advanced training of licensed nurses. Effective November 1, 2023, USP (797) Pharmaceutical Compounding guidelines were updated and endorsed by the American Academy of Allergy, Asthma & Immunology (AAAI). The Allergy Clinic completed a gap analysis to determine what process needed to change to comply with these latest guidelines.

Ada Deficiency: Improvement In Immune Function After Enzyme Replacement Therapy, Esosa Adah, Nikita Raje

Posters

Introduction: Adenosine deaminase (ADA)-deficient severe combined immunodeficiency (SCID) is characterized by severe lymphocytopenia affecting T-, and B-,lymphocytes, with non-immunological manifestations including neurodevelopmental deficits, sensorineural deafness, and skeletal abnormalities. Treatment modalities include enzyme replacement therapy(ERT) and/or autologous gene therapy or hematopoietic stem cell treatment. We report a 9-month-old female with ADA deficient T-B-NK+ SCID treated with ERT while awaiting stem cell treatment. Case Description: A 9-month-old female with a history of failure to thrive, hypotonia and loss of developmental milestones had genetic testing done that showed variants ADA c.911 T>G, c.302G>A. She was admitted for further work up. Lymphocyte …

Investigating The Association Between Mast Cell Activation Syndrome And Irritable Bowel Syndrome, Ishaan Jakhar, Maggie Urschler, Medha Singh, Suman Sahil, Hassan Ahmad

Posters

Investigating the Association between Mast Cell Activation Syndrome and Irritable Bowel Syndrome Introduction Mast Cell Activation Syndrome (MCAS) involves the inappropriate release of chemical mediators resulting in varied episodic symptoms. Irritable Bowel Syndrome (IBS) is a common functional abdominal disorder where mucosal immune alterations play a key role. Since mast cells function as gatekeepers for the intestinal interface, we examined what proportion of patients diagnosed with MCAS also had IBS along with comorbid risk factors. Methods All patients in our study were 18 years of age or older. We used Cerner Healthfacts to gather our cohorts of patients with MCAS, …

Evaluating A Newborn Infant With Pancytopenia For Whim Syndrome, Shayan Sazdar, Thao Le, Nikita Raje

Posters

Introduction Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is a rare immunodeficiency caused by a gain-of-function mutation in CXCR4. A complication of WHIM syndrome is severe neutropenia, which can result in fatal bacterial infections. Given the rarity of the disease and variability of clinical presentations, WHIM syndrome can be difficult to diagnose and manage. Case Description A full term male infant was hospitalized for hypoxic ischemic encephalopathy after delivery. Physical exam was unremarkable. During his hospitalization, he was found to have progressive pancytopenia. Initial lymphocyte subsets showed a significant T cell lymphopenia of 1325 mm3 CD3+, 920 mm3 CD4+, 390 …

Evaluating Patients With Recurrent Fever And Elevated Igd, Thao Le, Nikita Raje

Posters

Introduction: Hyperimmunoglobulinemia D with periodic fever syndrome (HIDS) often presents within the first year of life. Symptoms include fevers, chills, headache, lymphadenopathy, and abdominal pain. Patients may be misdiagnosed as other autoinflammatory syndromes, resulting in delay of treatment. Case: A 16-year-old female presented for evaluation of recurrent fever. Her fevers started at two months of age, occurred one to two times a month, and were associated with headache, abdominal pain, and fatigue . At 18-months, she was diagnosed with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA). She was treated with prednisone and an adenotonsillectomy but her fevers persisted. . At …

Clinical Course Of A Patient With Agammaglobulinemia Caused By Slc39a7 Defect, Thao Le, Emily Farrow, Alvin Singh, Isabelle Thiffault, Nikita Raje

Posters

Case Report: A 10-year-old unimmunized boy initially presented to the hospital at 18-months of age with pneumonia and failure to thrive. He had multiple infections including Escherichia coli urosepsis, viral croup, chronic otitis media with bilateral ruptured tympanic membranes, and bacterial pneumonia. On physical examination, he was ill appearing and had diffuse crackles. His laboratory work-up showed leukocytosis, normocytic anemia, undetectable immunoglobulin (Ig) G, A, and E, low IgM (28 mg/dL), absent B cell with normal T cell (7800 mm3) and NK cell (527 mm3) counts, and low zinc level (63 mcg/dL). Genetic testing was negative for Bruton tyrosine kinase …

Experiences Of Racism Among Black And African Children With Asthma, Esosa Adah, Rayanna Tucker, Bridgette Jones

Posters

Rationale: The relationship between adverse childhood experiences, toxic stress and asthma risk has been previously described in the literature among adult and pediatric populations. Studies have identified experiences of racism as a chronic stressor associated with asthma morbidity however, most studies have focused primarily on adults or parental perspectives. We initiated a pilot study to characterize described experiences of racism among Black/African American children with persistent asthma and describe some of our initial results. Methods: Children were asked to complete the “Perceptions of Racism in Children and Youth,” a validated questionnaire, measuring perceptions of racism and discrimination. Responses were analyzed …

Leukocytes As Mediators Of Gut-Brain Communication, Dilini Ekanayake

Biomedical Sciences Posters and Presentations

Food allergies

▪ Reactions range from mild/delayed to severe/rapid. ▪ People with mild allergic reactions have increased re-exposure risks. ▪ Cow’s milk allergy tends to manifest with milder allergic reactions.

Cow’s milk allergy (CMA)

▪ CMA has been associated with behavioral and neurological disorders. ▪ How allergic inflammatory signals from the gut reach the brain is unclear

Continuous Consumption Of Whey Protein Affects Motor And Cognitive Functions In A Mouse Model Of Cow’S Milk Hypersensitivity, Geetika Verma

Biomedical Sciences Posters and Presentations

Hypersensitization to a food allergen can occur in the absence of immediate allergic reactions, a condition referred to as asymptomatic sensitization. Using mice asymptomatically sensitized to a bovine whey allergen, β-lactoglobulin (BLG, Bos d 5), we have previously shown that chronic exposure to the allergen results in behavior changes with increased neuroinflammation and cortical demyelination. However, whether allergen avoidance can resolve these pathologies is unknown. Thus, we aimed to compare immunological and behavioral changes in sham- or BLG-sensitized mice with or without the removal of dietary whey after the mice had consumed either a control diet (CTL) or a whey-protein-containing …

Continued Food-Allergen Consumption Exacerbates Beta-Amyloid Accumulation In Allergen-Sensitized Appnl-G-Fmice., Afrina Brishti

Biomedical Sciences Posters and Presentations

Alzheimer’s disease (AD) is the most common neurodegenerative disease, with β-amyloid(Aβ) plaque deposition being one of the hallmark pathologies. However, the etiology of AD remains elusive. While chronic inflammation from recurrent infections or injury seems to contribute to AD development, it is unclear whether atopic diseases, such as allergies, are associated with AD. We previously reported that continuous consumption of a whey protein(WP) -containing diet led to lasting neuro inflammation in C57BL/6J mice that were sensitized but tolerant to a bovine milk allergen, β-lactoglobulin (BLG;Bosd5). Thus, we hypothesized that the persisting neuroinflammation due to repeated allergen consumption would exacerbate AD …

Histamine H3 Receptor Antagonism Mitigates Food-Hypersensitivity-Associated Depressive Behavior And Neuropathology In A Mouse Model Of Cow’S Milk Allergy, Danielle Germundson-Hermanson

Biomedical Sciences Posters and Presentations

Background Histamine is best known for causing allergy symptoms, but it also regulates blood-brain barrier permeability1 and oligodendrocyte differentiation2. Thus, brain histamine levels are tightly controlled.

Previous Findings We demonstrated that histamine and histamine H3 receptor (H3R) levels were elevated in a mouse model of cow’s milk allergy (CMA) in association with intracranial mast cell activation, depression-like behaviors, and cortical demyelination3,4.

Gaps in Knowledge In humans, food allergies are often associated with neuropsychiatric disorders5-7, but the involvement of allergy induced histamine in triggering behavioral changes is unclear.

Hypothesis Repeated allergen consumption can lead to central histaminergic dysfunction through H3R, ultimately …

Continuous Consumption Of Whey Protein Maintains Neuroinflammation In A Mouse Model Of Asymptomatic Cow’S Milk Allergy, Geetika Verma

Biomedical Sciences Posters and Presentations

Using a mouse model of cow’s milk allergy (CMA), we previously showed that C57BL/6J mice sensitized to a bovine whey allergen, β-lactoglobulin (BLG), exhibited anxiety/depression-like behavior and neuroinflammation in the absence of overt anaphylaxis upon allergen exposure

Milk Allergen Increases Intestinal Immune Cells In Association With Neuroinflammation And Behavioral Changes, Dilini Ekanayake

Biomedical Sciences Posters and Presentations

Cow’s milk allergy (CMA)

 CMA h as been associated with neurological disorders.

 How allergic inflammatory signals from the gut reach the brain is unclear.

Repeated Allergen Exposure Induces Histaminergic Dysregulation And Depression-Like Behaviors In A Non-Anaphylactic Food Allergy Mouse Model, Danielle Germundson-Hermanson

Biomedical Sciences Posters and Presentations

▪ Food allergy is often comorbid with neuropsychiatric disorders such as anxiety1,2, depression1,2, OCD3, ADD/ADHD4, and autism5. ➢ The mechanism of how food allergy may impact brain function and behavior in certain allergic individuals has yet to be elucidated.

▪ Mast cells (MCs) are not only the effector cell of the hypersensitivity response but are also important in maintaining brain homeostasis6. ➢ MCs have been implicated in neuropsychiatric and neurodegenerative disorders such as multiple sclerosis7,8.

▪ We have previously found in a mouse model of cow’s milk allergy (CMA) that intracranial MC numbers9 and histamine 3 receptor (H3R)10 increased after …

Cortical Demyelination And Depression-Like Behavior Are Associated With Histaminergic Dysregulation In A Mouse Model Of Peripheral Inflammation, Danielle Germundson-Hermanson

Biomedical Sciences Posters and Presentations

▪ Demyelinating diseases of the central nervous system are increasing in prevalence world-wide1,2 and manifest as motor, behavioral, and/or cognitive defects3 . The etiology and pathophysiology of demyelinating diseases remain unclear.

▪ We have previously observed cortical demyelination in our mouse model of non-anaphylactic cow’s milk allergy4 . The demyelination was associated with depression-like behaviors and region-specific increases in brain histamine and H3 receptor (H3R) levels4,5 .

❖ The brain’s central histaminergic system is tightly controlled and regulates many behaviors. Additionally, signaling through H3R plays a crucial role in oligodendrocyte differentiation, and thus, demyelination and remyelination6 .

▪ We hypothesized …

Dietary Whey Protein Increases Brain Leukocytes In Mice Regardless Of Their Hypersensitivity Status, Dilini Ekanayake

Biomedical Sciences Posters and Presentations

Cow’s milk allergy (CMA) often manifests as milder reactions and may be linked to neurological problems. Previously, we demonstrated that C57BL/6J mice sensitized to a bovine whey allergen, β-lactoglobulin (BLG, Bos d 5), moderately increased BLG-specific IgE levels and exhibited behavioral changes without severe allergic reactions. When these non-anaphylactic CMA mice were placed on a whey-protein (WP)-containing diet for 2 weeks to simulate continuous dairy consumption, we found neuropathology indicative of neuroinflammation and cortical demyelination. Since immune cells migrate to the central nervous system (CNS) and promote neuroinflammation in demyelinating conditions such as multiple sclerosis, we hypothesized that the number …

Investigating The Potential Role Of Akkermansia Muciniphila Supplementation In Neuroinflammation: A Progress Report, Geetika Verma

Biomedical Sciences Posters and Presentations

Gut bacteria are important for proper development and function of the host immune system (1). Recent studies have provided association of altered microbiome in both food allergy and neuropsychiatric disorders (2, 3) indicating potential role of microbiome in regulating Gut-Brain-Axis. Akkermansia muciniphila belongs to the phylum Verrucomicrobia, is a commensal mucin degrading bacterial species (4). A. muciniphila protects the gut barrier by facilitating host mucus production. Since patients with food allergy have increased gut permeability, protection of intestinal barrier by increased mucus production may be beneficial in preventing allergen and pathogen infiltrations, hence, minimizing inflammation. A. muciniphila is well known …

Malignancy Masquerading As Steroid Resistant Hypereosinophilic Syndrome, Sonya Parashar, Aarti Pandya

Posters

Introduction: Hypereosinophilia syndrome (HES) is defined as 1500 eosinophils/mL or above with evidence of end-organ damage due to the eosinophils at least 4 weeks apart. Case description: A 3-year-old male was admitted for newly found anterior mediastinal mass and left pleural effusion. About 6 weeks prior to admission, he was seen in his primary care office for difficulty breathing. Despite the appropriate treatment for his symptoms, the patient continued to have significant respiratory symptoms and a chest x-ray showed a large left pleural effusion. He was immediately transferred to a tertiary care center and a CT chest showed large left …

A Rare Cause Of Urticaria In An Nsaid Tolerant Patient, Thao Le, Mary K. Mcleod, Laurianne Wild

Posters

Introduction: Acetaminophen is one of the most used anti-pyretics to mitigate fever. Few cases have been reported of hypersensitivity reactions to acetaminophen without non-steroidal anti-inflammatory drug (NSAID) intolerance. It is recommended that if there is suspected drug hypersensitivity then the patient should undergo an oral drug challenge. Case Description: A 49-year-old male presented for evaluation of urticaria that occurred with acetaminophen ingestion. He reported several episodes where he developed diffuse urticaria within 15 minutes of ingestion, but no other symptoms concerning for anaphylaxis. He was unsure of the dose. He also noted urticaria with Excedrin migraine, which contains acetaminophen, aspirin, …

Timing Of Testing For Ige-Mediated Food Allergy After Systemic Reaction, Jordan Pitt, Paul J. Dowling, Christopher Miller, Ashley Sherman, Salman Aljubran

Posters

Rationale: A refractory period of falsely negative testing can occur following a systemic allergic reaction to Hymenoptera sting. As a result, blood specific IgE and/or skin prick tests (SPT) for other allergens are often delayed. This retrospective chart review aims to identify the proportion of patients with falsely negative test results in the 6 weeks following an allergic reaction to food, and factors that may affect it. Methods: One hundred fourteen pediatric subjects met inclusion criteria. Each had a convincing history of food allergy with a systemic allergic reaction and was tested to the culprit food within 6 weeks. The …

Evaluation Of The Outcomes Of Oral Challenges To Azithromycin, Cephalexin And Trimethoprim-Sulfamethoxazole In Pediatrics, Hannah N. Neuhaus, Jordan Heath Md, Salman Aljubran

Posters

Rationale: Antibiotic hypersensitivity complicates treatment for various infections and leads to long-term healthcare costs and antibiotic resistance. Data regarding the outcomes of oral challenges to trimethoprim-sulfamethoxazole, azithromycin and cephalexin are limited in Pediatrics.  The goal of this study was to characterize the outcomes and safety of oral challenges to these antibiotics in Pediatrics.

Methods: A retrospective chart review was performed of pediatric patients who underwent oral challenges to cephalexin, azithromycin and trimethoprim-sulfamethoxazole in Allergy Clinic over the last 12 years.

Results: Ten patients underwent oral challenge to trimethoprim-sulfamethoxazole and all were successful. Thirteen patients underwent oral challenge to azithromycin and …

The Effects Of Celiac Disease On Oral Health In Children And Adults, Marissa Balducci, Katarina Jones

Dental Hygiene Student Scholarship

Objectives: Celiac disease (CD) is an autoimmune disorder characterized by intolerance to dietary gluten in genetically predisposed subjects. To ensure affected patients receive optimal dental care, it is necessary for dental professionals to recognize the oral manifestations of celiac disease in both children and adults. Upon associating oral conditions with celiac disease, the dental provider should be able to present recommendations to the patient, contributing to an improvement in their oral health.

Methods: This review of the literature used PubMed to identify relevant professional research articles with publication after 2017. MesH terms utilized in the search process were …

Evaluation Of The Outcomes Of Trimethoprim-Sulfamethoxazole Oral Challenges In The Pediatric Population, Hannah N. Neuhaus, Salman Aljubran

Posters

Introduction: Trimethoprim-sulfamethoxazole allergy can complicate treatment for various infections. While trimethoprim-sulfamethoxazole hypersensitivity, desensitization/oral challenges are frequently reported in adults, data is limited on the outcomes/safety of oral challenges to trimethoprim-sulfamethoxazole in Pediatrics. The goal of this study was to characterize the outcomes and safety of trimethoprim-sulfamethoxazole oral challenges in Pediatrics.

Methods: An IRB-exempt retrospective chart review was performed of pediatric patients who underwent oral challenge to trimethoprim-sulfamethoxazole in Allergy Clinic over the last 12 years. We assessed characteristics including age, sex, reaction (IgE-mediated/non-IgE-mediated/indeterminate), skin testing, challenge outcome and complications to draw a conclusion regarding the overall safety of the procedure …

A Case Of An Elevated Tryptase, Sonya Parashar, Nikita Raje

Posters

Hereditary Alpha Tryptasemia (HαT) is an autosomal dominant disorder characterized by an elevated baseline tryptase that occurs up to 3% of the population and clinically resembles mast cell activation syndrome.