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Textbook of Diagnostic and
A SCIENCE PUBLISHERS BOOK
Therapeutic Procedures in Allergy
Editors
Pudupakkam K. Vedanthan
University of Colorado Anschutz Campus
Aurora, Colorado USA
Harold S. Nelson
National Jewish Health
Denver, Colorado, USA
Hugo P.S. Van Bever
National University, Singapore
Mandakolathur R. Murali
Massachusetts General Hospital
and
Harvard Medical School
Boston, Massachusetts, USA
Cover picture credit: Personal Collections of the following authors. From Left to Right Pictures:
1. Hibiscus flower: Dr. Saibal Moitra (saibal.moitra@gmail.com)
2. Alair Catheter Expanding basket: Dr. Ali Musani (ALI.MUSANI@cuanschutz.edu)
3. Nasal Polyp: Dr. Jerald Koepke (jwkmlk@gmail.com), Dr. William K. Dolen (BDOLEN@augusta.edu)
4. CT Sinuses: Dr. Mary Beth Cunnane (MaryBeth_Cunnane@meei.harvard.edu)
First edition published 2024
by CRC Press
2385 NW Executive Center Drive, Suite 320, Boca Raton FL 33431
and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
© 2024 Pudupakkam K. Vedanthan, Harold S. Nelson, Hugo P.S. Van Bever and Mandakolathur R. Murali
CRC Press is an imprint of Taylor & Francis Group, LLC
Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot
assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers
have attempted to trace the copyright holders of all material reproduced in this publication and apologize to
copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been
acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or
utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying, microfilming, and recording, or in any information storage or retrieval system, without written
permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or contact
the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works
that are not available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for
identification and explanation without intent to infringe.
Library of Congress Cataloging‑in‑Publication Data (applied for)
ISBN: 978-1-032-21653-9 (hbk)
ISBN: 978-1-032-21654-6 (pbk)
ISBN: 978-1-003-26942-7 (ebk)
DOI: 10.1201/9781003269427
Typeset in Times New Roman
by Radiant Productions
Late Dr. Henry Neumann Claman
December 13, 1930–September 3, 2016.
“A Renaissance Man”
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Preface
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National Jewish Health & University of Colorado, Denver, Colorado USA
It is my privilege to introduce the first edition of this novel and exciting textbook Diagnostic and
Therapeutic Procedures in Allergy. This was a vision by the editors to provide a comprehensive yet
practical reference, targeted at the clinician, for the commonly encountered procedures within the
field of allergy and immunology. The textbook is truly unique since it provides a single source for
both the commonly and uncommonly used tests within the field, while providing the advantages
and limitations for the various tests. Additionally, for each test, rational, indications, precautions and
interpretation are provided. The textbook is comprised of 15 chapters authored by an international
faculty and laid out by clinical disease area, diagnostics in, asthma, food sensitivity, urticaria, allergic
contact dermatitis, atopic dermatitis, drug sensitivity, immune deficiency, allergen immunotherapy,
insect allergy, aerobiology, environmental control measures, biologics and concluding with
controversial procedures in allergy. Another unique feature of this textbook is the amalgamation
of eastern and western medicine through two chapter on the role of yoga and acupuncture. The
reader will find the book not only illuminating but serve as an ongoing reference for their clinical
practice. The textbook covers the breadth and depth of diagnostic testing while written by world
renowned faculty with expertise in their respective areas of focus. I would like to thank the editors
P.K. Vedanthan, H. Nelson, H Van Bever and M. Murali. I also want to thank the authors and coauthors for their tireless work in submitting overviews of the highest quality in a timely manner.
Finally, I would like to acknowledge the publisher CRC Press (Taylor & Francis) for the guidance,
and assistance in bringing to fruition a one-of-a-kind textbook.
Rohit Katial, MD, FAAAAI, FACAAI, FACP
Professor of Medicine
Associate Vice President of Education
Director, Center for Clinical Immunology
Irene J, and Dr. Abraham E. Goldminz,
Chair In Immunology and Respiratory Medicine
National Jewish Health & University of Colorado, Denver
International Asthma Services (www.saahns.org) (IAS)
International Asthma Services (IAS) under the chairmanship of Dr. Pudupakkam K. Vedanthan
(Dr. PK) is proud to continue its global educational outreach. IAS is fortunate and thankful for the
opportunity to present this unique ‘textbook of diagnostic and therapeutic procedures in allergy’.
The uniqueness of this textbook is that, it is the FIRST book of its kind and quality in the field
of allergy.
IAS has been active in several developing nations with the main hub being in India. IAS has
successfully partnered with major educational institutions and universities across the globe to
initiate several training programs for physicians, physician assistants, and allergy technicians to
cater to the burgeoning needs of the specialty especially in the developing world. IAS is highly
indebted to dedicated faculty, advisory board of academicians as well as volunteers across the globe.
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Contents
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Preface v
1. Principles of Diagnostic Tests
Vijaya Knight and Mandakolathur R. Murali
2. Routine Laboratory Tests
Vijaya Knight and Mandakolathur R. Murali
3A. Diagnosis of Allergy and Asthma
Kwiat C., Nelson H. and Hoyte F.
3B. Diagnosis of Allergies and Asthma
Sundeep Salvi, Deesha Ghorpade and Monica Barne
3C. Sinus Imaging for Patients with Allergy and Asthma
Mary Beth Cunnane
3D. Endoscopic Examination of the Upper Airway
Jerald W. Koepke and William K. Dolen
3E. Bronchial Thermoplasty
Nishil Dalsania, Sandeep Jewani and Ali Musani
4A. Food Challenges
Soh Jian Yi and Hugo Van Bever
4B. Oral Immunotherapy
Soh Jian Yi
1
17
34
42
60
70
80
87
98
4C. PartI-FoodAllergy:SpecicIgE
Hugo Van Bever
4C. Part ll-Component-Resolved Diagnostics (CRD)
Hugo Van Bever
4D. Eosinophilic Oesophagitis
Marion M. Aw
5. Acute and Chronic Urticaria/Angioedema
Vinay Mehta
6. Allergic Contact Dermatitis and Atopic Dermatitis
Luz Fonacier, Hope Jin, Jake Rosenblum and Sonam Sani
108
111
115
121
138
viii Textbook of Diagnostic and Therapeutic Procedures in Allergy
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7. Drug Allergy 163
Saad Alshareef, William Bermingham, Rashmeet Bhogal, Mohamed Omar and
Mamidipudi Thirumala Krishna
8. LaboratoryAnalysisofPrimaryImmunodeciency 179
Vijaya Knight and Mandakolathur R. Murali
9. Allergy Immunotherapy for Inhalant Allergens 207
Harold S. Nelson
10. Targeted and Biologic Therapeutics for Allergic and Immunologic Diseases 219
Bindon, Brittany, Zahid, Soombal, Chapman, Nicholas and Wang, Eileen
11. Environmental Control in Allergic Diseases 279
Sitesh Roy and Thomas Platts‑Mills
12. Insect Allergy: Diagnostic Procedures and Venom Immunotherapy 300
Karla E. Adams and David B.K. Golden
13A. Role of Yoga and Ayurveda in the Management of Allergic Disorders 328
Kashinath G. Metri and Pudupakkam K. Vedanthan
13B. Role of Acupuncture in Allergic Disorders 342
Parin Niranjan Parmar and Pudupakkam K. Vedanthan
14. Controversial Techniques in the Practice of Allergy 355
Hugo Van Bever and Pudupakkam K. Vedanthan
15. Aerobiology for Clinicians 361
Saibal Moitra and Kavitha B.
Index 375
About the Editors 377
Chapter 1
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Principles of Diagnostic Tests
Vijaya Knight1 and Mandakolathur R. Murali2,*
Introduction
The utility of diagnostic tests lies in their interpretation within a clinical context. To make
effective use of diagnostic test results, the clinician should understand the terminology used to
describe the performance of a diagnostic test and the application of test performance parameters to
clinical diagnosis.
Evaluation of a diagnostic test’s performance falls into three categories:
1) Preanalytical variables that have an impact on laboratory test results include characteristics
such as the age of the subject, gender, body mass index and dietary factors, timing of blood
samples and interference with assay characteristics.
2) Analytic test characteristics that describe the performance of the test within the laboratory
environment.
3) Diagnostic test characteristics that describe the test performance in relevant clinical populations.
The scope of this chapter is to describe briefly the analytical characteristics of a diagnostic test
and, to discuss in more detail, the clinical performance characteristics of diagnostic tests and
how to interpret laboratory data in the context of disease.
4) Understanding heterogeneity of clinical and laboratory data across patient populations.
a) AGE: The normal ranges for some laboratory tests depend on the “age” of the patient and are
best seen in pediatric populations. Examples include the levels of some coagulation factors and
serum immunoglobulins which do not reach adult levels for many months after birth.
b) GENDER: The normal range of hormones depends on “gender,” exemplified by levels of
testosterone and estradiol. Variations in levels of estrogen and progesterone during the various
phases of the menstrual cycle have an impact on evaluating women with cyclical urticaria.
1
Associate Professor, University of Colorado School of Medicine, Department of Pediatrics, Section of Allergy, and
Immunology, Children’s Hospital, Colorado, Translational and Diagnostic Immunology Laboratory, 13123 East
16th Avenue, Aurora, Colorado 80045.
2
Director of Clinical Immunology laboratory, Departments of Medicine and Pathology, Massachusetts General Hospital,
Assistant Professor of Medicine, Harvard University, Boston, Massachusetts 02114.
Email: vijaya.knight@childrenscolorado.org
* Corresponding author: murali50@aol.com
Preanalytical Variables
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