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Why You Should Care About Implicit Bias as an Allergist-Immunologist and Ways We Can Address It

Jacobs, Samantha; Brar, Kanwaljit; Nowak-Wegrzyn, Anna; Louisias, Margee
PMID: 36972799
ISSN: 2213-2201
CID: 5502582

Atopic Dermatitis: Diagnosis, Disparity, and Management in Children of Color

Brar, Kanwaljit K; Singh, Anne Marie; De Guzman, Nancy; Aquino, Marcella
Atopic dermatitis (AD), sometimes referred to as eczema, is the most common chronic skin condition in children. Children of color have a higher reported prevalence of AD compared with their White counterparts. The purpose of this article is to discuss the differences of AD in skin of color (SOC), including clinical findings and management, with an emphasis on early recognition to avoid more severe, persistent disease. School nurses are on the frontline for these students with their ability to guide families and help support students with AD in the school setting.
PMID: 36688411
ISSN: 1942-6038
CID: 5419452

Food Allergy Evaluation for Dermatologic Disorders

Brar, Kanwaljit K
Food allergy evaluation for dermatologic disorders is warranted when Type 1 allergy is suspected, and includes skin prick testing (SPT) or measurement of specific immunoglobulin E (IgE) levels. The utility of these tests for identifying triggers is improved with clinical correlation, especially for contact urticaria, and protein contact dermatitis, which are mixed mechanism diseases. In atopic dermatitis (AD), patients are at risk for development of food allergy, and screening with SPT or IgE may be considered in severe AD, especially to guide early food introduction. Management of food-related AD exacerbations should focus on modifications in skincare before evaluating for allergy.
PMID: 34225904
ISSN: 1557-8607
CID: 4965142

Management of Anaphylaxis During the SARS-CoV-2 Pandemic

Brar, Kanwaljit K; Harizaj, Albana; Nowak-Wegrzyn, Anna
Purpose of Review/UNASSIGNED:Management of anaphylaxis during the SARS-CoV-2 pandemic should consider local infection rates so as to not burden local ED at times of pandemic, while also protecting patients from infection risks and progression of anaphylaxis. In this review, we identify a treatment strategy for anaphylaxis that balances the risks versus benefits of ED versus home management in this unprecedented time. Recent Findings/UNASSIGNED:Physicians and patients have had to adapt new approaches to medical care during the SARS-CoV-2 pandemic due to restricted access to health care facilities. Telemedicine has substituted in-person visits, and such a drastic change in the patient care paradigm presents a need to revise the acute management of anaphylaxis. Summary/UNASSIGNED:Physicians should utilize telemedicine during this time to engage in shared decision-making with patients and their families to devise an anaphylaxis plan of management that emphasizes home care when symptoms are mild with an exception for ED care if a patient has had severe, near-fatal anaphylaxis episodes in the past. Previous anaphylaxis recommendations should remain in place despite the pandemic, including prompt use of epinephrine when needed, avoidance of known allergens, training of patients and their caregivers, and carrying of epinephrine autoinjector devices at all times to remain prepared in the event of an anaphylaxis episode. Supplementary Information/UNASSIGNED:The online version contains supplementary material available at 10.1007/s40521-021-00284-0.
PMCID:7946336
PMID: 33723499
ISSN: 2196-3053
CID: 4823482

A review of contact dermatitis

Brar, Kanwaljit K
OBJECTIVE:To familiarize the reader with the mechanisms and causes of contact dermatitis. DATA SOURCES/METHODS:Recent research articles, relevant review articles, and case series/reports in English from PubMed database, mostly from 2010 onwards. STUDY SELECTIONS/METHODS:Most data were in the form of retrospective studies. Efforts were made to include clinical trials; however, for newer allergens and data on biologics, case series and case reports were included. Older studies regarding the mechanism were included if they were of particular importance. RESULTS:An understanding of this review should enable the reader to approach the patient with unknown dermatitis with a better understanding of the cause and management. CONCLUSION/CONCLUSIONS:Clinical suspicion for relevant allergens combined with the interpretation of patch tests are important in the diagnosis and treatment of patients with contact dermatitis.
PMID: 33091591
ISSN: 1534-4436
CID: 4721512

Biologics for the Treatment of Food Allergies

Brar, Kanwaljit K; Lanser, Bruce J; Schneider, Amanda; Nowak-Wegrzyn, Anna
Food allergy is increasingly prevalent and poses a life-threatening risk to those afflicted. The health care costs associated with food allergies are also increasing. Current and emerging treatments for food allergies aim at protecting against reactions caused by accidental ingestion and increasing the food allergen reaction threshold, although this protection is often temporary. In the future, ideal biologic therapies would target key mediators of the type II immune pathway, essential in development of the atopic march to prevent development of food allergies. Biologics offering long-term protection against allergic reactions to food are needed, and several agents are already in development.
PMID: 33012321
ISSN: 1557-8607
CID: 4629932

Hyperlinear palms as a clinical finding in peanut allergy

Brar, Kanwaljit K; Calatroni, Agustin; Berdyshev, Evgeny; Palombi, Shirley; Goleva, Elena; Leung, Donald Y M
PMID: 32376483
ISSN: 2213-2201
CID: 4533602

The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype

Leung, Donald Y M; Calatroni, Agustin; Zaramela, Livia S; LeBeau, Petra K; Dyjack, Nathan; Brar, Kanwaljit; David, Gloria; Johnson, Keli; Leung, Susan; Ramirez-Gama, Marco; Liang, Bo; Rios, Cydney; Montgomery, Michael T; Richers, Brittany N; Hall, Clifton F; Norquest, Kathryn A; Jung, John; Bronova, Irina; Kreimer, Simion; Talbot, C Conover; Crumrine, Debra; Cole, Robert N; Elias, Peter; Zengler, Karsten; Seibold, Max A; Berdyshev, Evgeny; Goleva, Elena
Skin barrier dysfunction has been reported in both atopic dermatitis (AD) and food allergy (FA). However, only one-third of patients with AD have FA. The purpose of this study was to use a minimally invasive skin tape strip sampling method and a multiomics approach to determine whether children with AD and FA (AD FA+) have stratum corneum (SC) abnormalities that distinguish them from AD without FA (AD FA-) and nonatopic (NA) controls. Transepidermal water loss was found to be increased in AD FA+. Filaggrin and the proportion of ω-hydroxy fatty acid sphingosine ceramide content in nonlesional skin of children with AD FA+ were substantially lower than in AD FA- and NA skin. These abnormalities correlated with morphologic changes in epidermal lamellar bilayer architecture responsible for barrier homeostasis. Shotgun metagenomic studies revealed that the nonlesional skin of AD FA+ had increased abundance of Staphylococcus aureus compared to NA. Increased expression of keratins 5, 14, and 16 indicative of hyperproliferative keratinocytes was observed in the SC of AD FA+. The skin transcriptome of AD FA+ had increased gene expression for dendritic cells and type 2 immune pathways. A network analysis revealed keratins 5, 14, and 16 were positively correlated with AD FA+, whereas filaggrin breakdown products were negatively correlated with AD FA+. These data suggest that the most superficial compartment of nonlesional skin in AD FA+ has unique properties associated with an immature skin barrier and type 2 immune activation.
PMID: 30787169
ISSN: 1946-6242
CID: 4533592

Strategies for Successful Management of Severe Atopic Dermatitis

Brar, Kanwaljit K; Nicol, Noreen H; Boguniewicz, Mark
Patients with severe atopic dermatitis (AD) are reported to represent between 10% and 18% of all patients with AD. However, in this subgroup of patients, quality of life is significantly affected and patients may have a number of atopic and nonatopic comorbidities. Treatment of this severe population has often been reactive with inappropriate use of systemic corticosteroids and unapproved immunosuppressants. Recent insights point to the systemic nature of AD, which has important therapeutic implications. Management of severe AD requires a comprehensive approach that incorporates proper diagnosis, assessment of disease severity, and impact on patient's and caregiver's quality of life, along with education regarding the chronic relapsing nature of the disease as well as treatment options. Biologics such as dupilumab offer a novel, targeted therapeutic approach for this systemic disease.
PMID: 30598172
ISSN: 2213-2201
CID: 4533582

A multi-omics evaluation of the non-lesional skin surface identifies atopic dermatitis with food allergy (AD FA plus ) as a unique endotype [Meeting Abstract]

Leung, Donald Y. M.; Calatroni, Agustin; Zaramela, Livia S.; Dyjack, Nathan T.; Brar, Kanwaljit K.; LeBeau, Petra; David, Gloria L.; Johnson, Keli; Leung, Susan B.; Kreimer, Simion; Talbot, C. Conover, Jr.; Cole, Robert N.; Ramirez-Gama, Marco A.; Liang, Bo; Rios, Cydney; Montgomery, Michael T.; Jung, John; Bronova, Irina; Seibold, Max A.; Zengler, Karsten; Berdyshev, Evgeny; Goleva, Elena
ISI:000457771200371
ISSN: 0091-6749
CID: 4533642