Hello from steaming Jackson, Mississippi. We are experiencing the high-level temperatures and humidity so common this time of year in most of our country. The grass pollens are in full bloom, and the pop-up thunderstorms provide plenty of moisture for abundant mold spore dispersal after the ever-present grass cutting. It is a perfect time to retreat into a cooler indoor setting and curl up with a good periodical to inform and intrigue. I can highly recommend the July issue of the Annals of Allergy, Asthma, and Immunology. This month’s emphasis is on diagnostic testing in allergy. There have been considerable advances in testing on both the allergy and immunology sides of our practices, and this month’s issue features several of these.
First is a CME review by Jeffrey M. Wilson, MD, PhD, and colleagues that provides an overview of multiplex technologies for the diagnosis of allergen sensitivity. There is a long history of single plex technology aimed at identifying allergen specific IgE in patient plasma or serum. The classic RAST technology has been largely replaced clinically by the much more sensitive ImmunoCAP, but still suffers from expense and size of sample needed to identify a comprehensive sensitivity profile. In contrast, there are several multiplex platforms currently in use (mostly in research settings but some in clinical use in Europe and Asia) that can identify large numbers of IgE sensitivities on very small sample sizes. This developing technology is headed for the clinical setting, and the authors discuss the strengths and limitations of such future clinical technology.
On the immunology side of our practice, Theodore K. Lee, MD, and colleagues provide an excellent overview of the use of various laboratory tools for the diagnosis of common variable immunodeficiency (CVID) and its potential noninfectious complications. As we all know, CVID presents not only with frequent infections, but also with noninfectious complications, such as autoimmunity, gastrointestinal disease, chronic lung disease, granulomas, liver disease, lymphoid hyperplasia, splenomegaly, and/or malignancy. The risk of morbidity and mortality is higher in patients with CVID and noninfectious complications. Detailed diagnostic approaches, which may incorporate genetic testing, can aid characterization of individual CVID cases and shape treatment in some instances. Moreover, continued evaluation after CVID diagnosis is key to optimal management of this complex disorder. These post-diagnostic evaluations include pulmonary function testing, radiologic studies, and laboratory evaluations that may be conducted at frequencies determined by disease activity.
I hope you have time to read the expanding pages of this month’s Annals issue. We enjoy hearing from you with your comments, criticisms and correspondence. Remember, feel free to comment on any of our articles by sending an email with your comments (500 words or less) to me for publication in a future issue of the Annals. Stay safe and cool.
Gailen D. Marshall, Jr., MD, PhD, FACAAI