Papers by Daniel DiGiacomo
Journal of Allergy and Clinical Immunology
The Journal of Allergy and Clinical Immunology, Feb 1, 2023
Clinical Immunology, May 1, 2023
Clinical Immunology, May 1, 2023
Clinical Immunology, May 1, 2023
Clinical Pediatrics, Nov 22, 2022
Journal of Clinical Immunology, May 10, 2023
Purpose Predominant antibody deficiency (PAD) disorders, including common variable immunodeficien... more Purpose Predominant antibody deficiency (PAD) disorders, including common variable immunodeficiency (CVID), have been linked to increased risk of gastrointestinal infections and inflammatory bowel diseases. However, there are limited data on the relationship between PAD, specifically CVID, and risk of microscopic colitis (MC). Methods We performed a nationwide case-control study of Swedish adults with MC diagnosed between 1997 and 2017 (n = 13,651). Data on biopsy-verified MC were retrieved from all of Sweden's pathology departments through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study. We defined predominant antibody deficiency using International Union of Immunologic Societies (IUIS) phenotypic classification. Individuals with MC were matched to population controls by age, sex, calendar year, and county. We used logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results The prevalence of PAD in MC was 0.4% as compared to 0.05% in controls. After adjustment for potential confounders, this corresponded to an aOR of 7.29 (95%CI 4.64-11.63). The magnitude of the association was higher for CVID (aOR 21.01, 95% 5.48-137.44) compared to other antibody deficiencies (aOR 6.16, 95% CI 3.79-10.14). In exploratory analyses, the association between PAD and MC was particularly strong among males (aOR 31.73, 95% CI 10.82-135.04). Conclusion In this population-based study, predominant antibody deficiency was associated with increased risk of MC, particularly among males. Clinicians who encounter these patients should consider a detailed infectious history and screening for antibody deficiency.
The Journal of Allergy and Clinical Immunology, Feb 1, 2023
The Journal of Allergy and Clinical Immunology, Feb 1, 2023
Frontiers in Immunology
Data regarding response to SARS-CoV-2 immunization in pediatric patients with predominantly antib... more Data regarding response to SARS-CoV-2 immunization in pediatric patients with predominantly antibody deficiency (PAD) is limited. We evaluated SARS-CoV-2 immunization response by anti-SARS-CoV-2-spike antibody level in 15 pediatric PAD patients. These data were compared to a published cohort of adult PAD patients (n=62) previously analyzed following SARS-CoV-2 immunization at our single center institution. We evaluated demographics, clinical characteristics, immunophenotype, infection history, and past medication use by chart review. Following a two-dose monovalent initial series SARS-CoV-2 immunization, mean anti-SARS-CoV-2-spike antibody levels were significantly higher in pediatric PAD patients compared to adult PAD patients (2,890.7 vs. 140.1 U/mL; p<0.0001). Pediatric PAD patients with low class-switched memory B-cells, defined as <2% of total CD19+ B-cells, had significantly lower mean anti-SARS-CoV-2-spike antibody levels than those without (p=0.02). Following a third-d...
Journal of Allergy and Clinical Immunology, 2022
Gastroenterology, 2012
compared to 22% of ASF/Hp infected mice and 33% Hp infected SPF mice. ASF/Hp infected mice had th... more compared to 22% of ASF/Hp infected mice and 33% Hp infected SPF mice. ASF/Hp infected mice had their gastric contents colonized with the 3 species of ASF when measured by qPCR. Our data demonstrates that specific enteric flora colonizing the achlorhydric stomach enhances progression of gastric cancer development.
Purpose Predominant antibody deficiency (PAD) disorders, including common variable immunodeficien... more Purpose Predominant antibody deficiency (PAD) disorders, including common variable immunodeficiency (CVID), have been linked to increased risk of gastrointestinal infections and inflammatory bowel diseases. However, there are limited data on the relationship between PAD, specifically CVID, and risk of microscopic colitis (MC). Methods We performed a nationwide case-control study of Swedish adults with MC diagnosed between 1997 and 2017 (n = 13,651). Data on biopsy-verified MC were retrieved from Sweden’s all 28-pathology departments through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study. We defined predominant antibody deficiency using International Union of Immunologic Societies (IUIS) phenotypic classification. Individuals with MC were matched to population controls by age, sex, calendar year, and county. We used logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results The prevalence of PAD in MC wa...
Frontiers in Immunology, May 6, 2022
Nodular regenerative hyperplasia (NRH) is associated with high morbidity and mortality in patient... more Nodular regenerative hyperplasia (NRH) is associated with high morbidity and mortality in patients with common variable immunodeficiency (CVID). While liver biopsy is the gold standard for NRH diagnosis, a non-invasive technique could facilitate early disease recognition, monitoring, and/or immune intervention. We performed a cross-sectional analysis of ultrasound-based transient elastography (TE) in patients with CVID to evaluate liver stiffness and compared this between patients with (N = 12) and without (N = 6) biopsy-proven NRH. Additionally, these data were compared to a cohort followed at our institution for non-alcoholic fatty liver disease (NAFLD) (N = 527), a disease for which TE has routine diagnostic use. Clinical and pathologic features of NRH were evaluated as correlates of liver stiffness, and receiver operating characteristic curves were used to define a liver stiffness cutoff with diagnostic utility for NRH among CVID patients. CVID patients with NRH had a more severe disease presentation compared to those without. This included increased autoinflammatory disease comorbidities, combined B-cell and T-cell dysfunction, and abnormal liver biochemistries (specifically an increased mean alkaline phosphatase level [proximal to TE, 250 vs. 100 U/L; p = 0.03; peak, 314 vs. 114 U/L; p = 0.02). Results of TE demonstrated a significantly elevated liver stiffness in CVID patients with NRH (mean 13.2 ± 6.2 kPa) as compared to both CVID patients without NRH (mean 4.6 ± 0.9 kPa) and non-CVID patients with NAFLD (mean 6.9 ± 5.5 kPa) (p < 0.01).
Journal of Allergy and Clinical Immunology, 2019
The effects of Omalizumab on food allergy thresholds are poorly studied out of the context of Ora... more The effects of Omalizumab on food allergy thresholds are poorly studied out of the context of Oral Immunotherapy. This real life study aims to assess the effect of Omalizumab on food tolerance in children treated for severe asthma. METHODS: We review the food thresholds of patients with severe asthma and anaphylactic reactions to 2+ foods before and after a 4-month-long Omalizumab treatment. We also report their asthma control and quality of life, measured by PedSQL. RESULTS: Fifteen children-allergic to 37 foods-got a threshold increase for milk, egg, wheat and hazelnut from 1221.1 6 1736.7 mg to 8553.7 6 8063.6 mg eliciting dose (p<0.001). Patients reached full tolerance for 70.4% of the tested foods, which were reintroduced in the patients' diet without necessity of oral immunotherapy procedures. The remaining foods were partially tolerated. The number of reactions to unintended ingestion of allergenic foods over 4 months dropped from 47 to two. The PedSQL increased from 60.47 6 5.32 to 87.25 6 7.33 (parental judgement; p<0.001) and from 62.99 6 7.39 to 89.71 6 4.54 (patients' judgement; p<0.001). Omalizumab costed a mean of V 1,311.63 per month. CONCLUSIONS: Food tolerance increased by 7 times during Omalizumab treatment for severe uncontrolled asthma. The patients' quality of life increased, due to better asthma control and reduction of dietary restrictions. The cost/benefit ratio of such treatment for selected cases of severe food allergy remains to be evaluated.
Journal of Allergy and Clinical Immunology, 2019
Expression profiling of atopic dermatitis patients with a history of recurrent eczema herpeticum ... more Expression profiling of atopic dermatitis patients with a history of recurrent eczema herpeticum reveals dysregulation of type 2inflammation and barrier-related pathways in uninvolved skin
Clinical and Translational Gastroenterology, 2016
OBJECTIVES: Early-onset colorectal cancer (CRC) incidence rates are rising. This group is suscept... more OBJECTIVES: Early-onset colorectal cancer (CRC) incidence rates are rising. This group is susceptible to heritable conditions (i.e., Lynch syndrome (LS)) and inflammatory bowel disease (IBD) with high metachronous CRC rates after segmental resection. Hence, extended colonic resection (ECR) is often performed and considered generally in young patients. As there are no population-based studies analyzing resection extent in early-onset CRC, we used CDC Comparative Effectiveness Research (CER) data to assess state-wide operative practices. METHODS: Using CER and Louisiana Tumor Registry data, all CRC patients aged ≤ 50 years, diagnosed in Louisiana in 2011, who underwent surgery in 2011-2012 were retrospectively analyzed. Prevalence of, and the factors associated with operation type (ECR including subtotal/total/proctocolectomy vs. segmental resection) were evaluated. RESULTS: Of 2,427 CRC patients, 274 were aged ≤ 50 years. In all, 234 underwent surgery at 53 unique facilities and 6.8% underwent ECR. Statistically significant ECR-associated factors included age ≤ 45 years, polyposis, synchronous/metachronous LS-associated cancers, and IBD. Abnormal microsatellite instability (MSI) was not ECR-associated. ECR was not performed in sporadic CRC. CONCLUSIONS: ECR is performed in the setting of clinically obvious associated high-risk features (polyposis, IBD, synchronous/ metachronous cancers) but not in isolated/sporadic CRC. However, attention must be paid to patients with seemingly lower risk characteristics (isolated CRC, no polyposis), as LS can still be present. In addition, the presumed sporadic group requires further study as metachronous CRC risk in early-onset sporadic CRC has not been well-defined, and some may harbor undefined/ undiagnosed hereditary conditions. Abnormal MSI (LS risk) is not associated with ECR; abnormal MSI results often return postoperatively after segmental resection has already occurred, which is a contributing factor.
World Journal of Gastroenterology, 2013
DiGiacomo D designed the study, ran the statistical analyses and wrote the manuscript; Santonicol... more DiGiacomo D designed the study, ran the statistical analyses and wrote the manuscript; Santonicola A, Zingone F, Troncone E, Caria MC, Borgheresi P and Parrilli G selected the patients in the outpatient clinics involved in the study and provided the collection of all human materials; and Ciacci C designed the study, provided financial support for the study and edited the manuscript.
Journal of Clinical Neuromuscular Disease, 2012
Objectives: An association between celiac disease (CD) and peripheral neuropathy (PN) has been re... more Objectives: An association between celiac disease (CD) and peripheral neuropathy (PN) has been reported. Methods: Patients with CD and/or inflammatory bowel disease (IBD) were recruited from the gastroenterology clinics at a medical center and local support groups. Control subjects without CD or IBD were recruited from the staff of the medical center as well as relatives and attendees at support groups. Each participant completed a survey that used two validated PN instruments to define and characterize PN. Results: In the CD group, 38.9% met criteria for PN compared with 38.7% in the IBD group (P = 0.97) and 20.5% in the control group (P < 0.001). On multiple logistic regression, the odds of PN after adjusting for age, gender, diabetes, vitamin B12 deficiency, and cancer history were increased for CD (odds ratio, 2.51; 95% confidence interval, 1.82-3.47) and IBD (odds ratio, 2.78; 95% confidence interval, 1.85-4.18). Conclusions: PN is more often found in patients with CD and/or IBD than in the general population.
The Journal of Allergy and Clinical Immunology: In Practice
Background SARS-CoV-2 infection in patients with predominant antibody deficiency (PAD) is associa... more Background SARS-CoV-2 infection in patients with predominant antibody deficiency (PAD) is associated with high morbidity, yet data regarding response to SARS-CoV-2 immunization in PAD patients, including additional dose vaccine, is limited. Objective We sought to characterize antibody response to SARS-CoV-2 vaccine in PAD patients and define correlates of vaccine response. Methods We assessed levels and function of anti-SARS-CoV-2 antibodies in 62 PAD patients compared to matched healthy controls at baseline, at 4-6 weeks following initial series immunization - a single dose of Ad26.COV2.S (Janssen) or two doses of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) - and at 4-6 weeks following additional dose immunization, if received. Results Following initial series SARS-CoV-2 vaccination, PAD patients had lower mean anti-spike antibody levels compared to matched healthy controls (140.1 U/mL vs. 547.3 U/mL; p=0.02). Patients with secondary PAD (e.g., use of B-cell depletion therapy) and patients with severe primary PAD (e.g., common variable immunodeficiency with autoinflammatory complications) had the lowest mean anti-spike antibody levels. Immune correlates of a low anti-spike antibody response included low CD4+ helper T cells, low CD19+ total B cells, and low class-switched memory (CD27+IgD/M-) B cells. Additionally, a low (< 100 U/mL) anti-spike antibody response was associated with prior exposure to B-cell depletion therapy, both at any time in the past (OR 5.5; CI 1.5-20.4; p=0.01) and proximal to vaccination (OR 36.4; CI 1.7-791.9; p=0.02). Additional dose immunization with an mRNA vaccine in a subset of 31 PAD patients increased mean anti-spike antibody levels (76.3 U/mL pre- to 1065 U/mL post-additional dose; p<0.0001). Conclusions Patients with secondary and severe primary PAD, characterized by low helper T cells, low B cells, and/or low class-switched memory B cells, were at risk for low antibody response to SARS-CoV-2 immunization, which improved following additional dose vaccination in the majority of patients.
Uploads
Papers by Daniel DiGiacomo