Dr. Liu is a board-certified, fellowship-trained specialist in allergy/immunology and infectious disease. She is also a clinical associate professor in the Department of Medicine, Division of Infectious Diseases and the Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology at Stanford University School of Medicine.

Dr. Liu treats infections in patients with compromised immune systems, whether due to a primary immune deficiency or a condition like cancer or organ transplant. She helps patients to develop tolerance to medications they are allergic to so that they can receive the best, and sometimes the only, treatments available to them. She also treats allergies to antibiotics, aspirin, NSAIDs, chemotherapy, and more. She sees patients both long term and for urgent referrals, such as in cases of perioperative anaphylaxis. Dr. Liu also helps pediatric patients manage drug and food allergies.

One of Dr. Liu’s areas of focus is helping patients with allergies to antibiotics determine when they have lost an allergy, what antibiotics they can tolerate, and when to induce tolerance to an antibiotic. This not only can benefit the patient, but also have a positive public health impact, as labeling patients with a penicillin allergy may negatively affect their care and increase use
of broad-spectrum antibiotics.

She collaborates closely with colleagues from other disciplines, including pulmonology, otolaryngology, oncology, cardiology, dermatology, anesthesiology, and surgery. Her key objective in working with referring physicians is to help them safely deliver the best care for their patients.

For patients and families, Dr. Liu strives to help them navigate their care journey with as much ease and dignity as possible during what may be the most challenging time of their life. Her goal is to offer patients options, even when it may appear that they have no options left.

Dr. Liu’s research interests include optimizing care of patients with antibiotic allergies, including through use of decision support tools.

Dr. Liu has authored articles in the New England Journal of Medicine, Journal of Immunology, Journal of Allergy and Clinical Immunology in Practice, Clinical and Experimental Allergy, Mucosal Immunology, Diagnostic Microbiology and Infectious Disease, Science, and other publications. Dr. Liu authored the book chapter “Hypersensitivity Reactions to Monoclonal Antibodies” in Drug Allergy Testing.

Dr. Liu is certified in infectious disease by the American Board of Internal Medicine and in allergy and immunology by the American Board of Allergy and Immunology. She is also a member of the American College of Physicians, Infectious Diseases Society of America, and American Academy of Allergy, Asthma, and Immunology.

She has given presentations on antibiotic allergies, drug desensitization, and aspirin-exacerbated respiratory disease, among other topics. Dr. Liu’s honors include recognition from the American Academy of Asthma, Allergy, and Immunology, the American Medical Women’s Association, and the National Institutes of Health.

Clinical Focus

  • Infections in Immunocompromised Hosts
  • Drug Allergy and Desensitization
  • Aspirin Desensitization
  • Antibiotic Allergies
  • Allergy and Immunology
  • Immunocompromised Host

Academic Appointments

Professional Education

  • Fellowship: Brigham and Women's Hospital Allergy and Immunology Fellowship (2011) MA
  • Fellowship: Massachusetts General Hospital Infectious Diseases Fellowship (2011) MA
  • Residency: Brigham and Women's Hospital Internal Medicine Residency (2007) MA
  • Internship: Brigham and Women's Hospital Internal Medicine Residency (2005) MA
  • Medical Education: UCLA David Geffen School Of Medicine Registrar (2004) CA
  • Board Certification: American Board of Internal Medicine, Infectious Disease (2011)
  • Board Certification: American Board of Allergy and Immunology, Allergy and Immunology (2010)

Clinical Trials

  • Presatovir in Hematopoietic Cell Transplant Recipients With Respiratory Syncytial Virus Infection of the Upper Respiratory Tract Not Recruiting

    The primary objective of this study is to evaluate the effect of presatovir on respiratory syncytial virus (RSV) viral load in autologous or allogeneic hematopoietic cell transplant (HCT) recipients with an acute RSV upper respiratory tract infection (URTI), the effect of presatovir on development of lower respiratory tract complication, being free of any supplemental oxygen progression to respiratory failure, and pharmacokinetics (PK), safety, and tolerability of presatovir.

    Stanford is currently not accepting patients for this trial. For more information, please contact Debbie Slamowitz , 650-723-2804.

    View full details

2023-24 Courses

All Publications

  • Maternal Hypertensive Disorders of Pregnancy and the Risk of Childhood Asthma ANNALS OF THE AMERICAN THORACIC SOCIETY Arroyo, A., Robinson, L. B., James, K., Li, S. S., Hsu, S., Dumas, O., Liu, A. Y., Druzin, M., Powe, C. E., Camargo, C. A. 2023; 20 (9): 1367-1370

    View details for Web of Science ID 001064160400024

    View details for PubMedID 37233740

    View details for PubMedCentralID PMC10502887

  • US Drug Allergy Registry (USDAR) grading scale for immediate drug reactions. The Journal of allergy and clinical immunology Khan, D. A., Phillips, E. J., Accarino, J. J., Gonzalez-Estrada, A., Otani, I. M., Ramsey, A., Arroyo, A. C., Banerji, A., Chow, T., Liu, A., Stone, C. A., Blumenthal, K. G. 2023


    There is no accepted grading system classifying the severity of immediate reactions to drugs.The purpose of this article is to present a proposed grading system developed through the consensus of drug allergy experts from the US Drug Allergy Registry (USDAR) Consortium.The USDAR investigators sought to develop a consensus severity grading system for immediate drug reactions that is applicable to clinical care and research.The USDAR grading scale scores severity levels on a scale of 0 to 4. A grade of no reaction (NR) is used for patients who undergo challenge without any symptoms or signs, and it would confirm a negative challenge result. A grade 0 reaction is indicative of primarily subjective complaints that are commonly seen with both historical drug reactions and during drug challenges, and it would suggest a low likelihood of a true drug allergic reaction. Grades 1 to 4 could meet the criteria for a positive challenge result and be considered indicative of a drug allergy. Grade 1 reactions are suggestive of a potential immediate drug reaction with mild symptoms. Grade 2 reactions are more likely to be immediate drug reactions of moderate severity. Grade 3 reactions have features suggestive of a severe allergic reaction, whereas grade 4 reactions are life-threatening reactions such as anaphylactic shock and fatal anaphylaxis.This proposed grading schema for immediate drug reactions improves on prior schemata by being developed specifically for immediate drug reactions and being user-friendly and easy to implement in clinical and research practice.

    View details for DOI 10.1016/j.jaci.2023.08.018

    View details for PubMedID 37652140

  • Maternal Hypertensive Disorders of Pregnancy and the Risk of Childhood Asthma. Annals of the American Thoracic Society Arroyo, A. C., Robinson, L., James, K., Li, S., Faridi, M. K., Hsu, S., Dumas, O., Liu, A. Y., Druzin, M., Powe, C. E., Camargo, C. A. 2023

    View details for DOI 10.1513/AnnalsATS.202212-994RL

    View details for PubMedID 37233740

  • High-titer post-vaccine COVID-19 convalescent plasma for immunocompromised patients during the first omicron surge. Transplant infectious disease : an official journal of the Transplantation Society Tayyar, R., Wong, L. K., Dahlen, A., Shu, E., Pandey, S., Liu, A. Y. 2023: e14055


    Transplant and hematologic malignancy patients have high Coronavirus disease 2019 (COVID-19) mortality and impaired vaccination responses. Omicron variant evades several monoclonal antibodies previously used in immunocompromised patients. Polyclonal COVID-19 convalescent plasma (CCP) may provide broader neutralizing capacity against new variants at high titers. Vaccination increases severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) titer in convalescent donors.We conducted a retrospective chart review of hospitalized immunocompromised patients with COVID-19 who received high-titer CCP during the first omicron surge, collected from vaccinated donors within 6 months of pre-omicron COVID-19. Data on safety and outcomes were extracted.A total of 44 immunocompromised patients were included, 59.1% with solid organ transplant, 22.7% with hematopoietic cell transplant, 11.4% with hematologic malignancy, and 6.8% with autoimmune disease. Overall, 95% of CCP units transfused were from recently recovered and vaccinated donors and had SARS-CoV-2 antibody results 8- to 37-fold higher than the Food and Drug Administration's cutoff for high-titer CCP. There were two mild transfusion reactions. A total of 30-day mortality was 4.5%. There were no differences in 100-day mortality by underlying diagnosis, levels of immunosuppression, and timing of CCP administration. Patients with higher immunosuppression had significantly higher mean World Health Organization clinical progression scores at 30-day post-CCP compared to those with lower immunosuppression.CCP is a safe, globally available treatment for immunocompromised patients with COVID-19. Mortality was lower in our cohort than that of COVID-19 patients with similar immunocompromising conditions. Post-vaccine CCP with very high titers should be prioritized for study in immunocompromised patients. Post-vaccine CCP has the potential to keep pace with new variants by overcoming mutations at sufficiently high titer.

    View details for DOI 10.1111/tid.14055

    View details for PubMedID 36929619

  • Digital Antibiotic Allergy Decision Support Tool Improves Management of Beta Lactam Allergies. The journal of allergy and clinical immunology. In practice Dunham, T. B., Gardner, R. M., Lippner, E. A., Fasani, D. E., Moir, E., Halpern-Felsher, B., Sundaram, V., Liu, A. Y. 2023


    BACKGROUND: Frontline providers frequently make time-sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies.OBJECTIVE: We hypothesized that a digital decision support tool could improve antibiotic selection and confidence when managing beta lactam allergies.METHODS: A digital decision support tool was designed to guide non-allergist providers in management of patients with beta lactam allergy labels. Non-allergists were asked to make decisions in clinical test cases without, then with, the tool. These decisions were compared using paired t-tests. Users also completed surveys assessing their confidence in managing antibiotic allergies.RESULTS: The tool's algorithm was validated by confirming its recommendations aligned with that of five allergists. Non-allergist providers (n=102) made antibiotic management decisions in test cases, both with and without the tool. Use of the tool increased the proportion of correct decisions from 0.41 to 0.67, a difference of 0.26 (95% CI: 0.22-0.30, p<0.001). Users were more likely to give full-dose antibiotics in low-risk situations, give challenge doses in medium-risk situations, and avoid the antibiotic and/or consult Allergy in high-risk situations. Ninety-eight (96%) users said the tool would increase their confidence when choosing antibiotics for patients with allergies.CONCLUSION: A point-of-care clinical decision tool provides allergist-designed guidance to non-allergists and is a scalable system for addressing antibiotic allergies, irrespective of allergist availability. This tool encouraged appropriate antibiotic use in low- and medium-risk situations and increased caution in high-risk situations. A digital support tool should be considered in quality improvement and antibiotic stewardship efforts.

    View details for DOI 10.1016/j.jaip.2023.01.026

    View details for PubMedID 36736957

  • Penicillin Allergy Evaluation and Health Equity: A Call to Action. The journal of allergy and clinical immunology. In practice Arasaratnam, R. J., Chow, T. G., Liu, A. Y., Khan, D. A., Blumenthal, K. G., Wurcel, A. G. 2022


    Allergists have been at the forefront of addressing the burden of unverified penicillin allergy labels. Coordinated national efforts with infectious diseases, antimicrobial stewardship experts, and pharmacy societies to advocate for formal evaluation of patient-reported penicillin allergy have resulted in improvements in delabeling efforts. Given the poorer health outcomes associated with the penicillin allergy label and the potential health benefits that can be gained with delabeling, improving access to penicillin allergy evaluation is of the utmost importance. Health disparities are widely recognized to impact all aspects of healthcare, and multilevel interventions at the patient, clinician and systems level are required to ensure equitable care delivery. Structural racism underpins many social determinants of health and is a key driver of racial and ethnic health disparities. In this Rostrum, we use a conceptual framework from the 2015 National Academy of Medicine report Improving Diagnosis in Health Care to explore how inequities are related to the evaluation of penicillin allergy. We use the National Institute on Minority Health and Health Disparities Strategies to Advance Health Disparities to elucidate areas of important study. Building upon existing efforts to address disparities in Allergy/Immunology, we highlight the urgent importance of understanding and eliminating health disparities in penicillin allergy evaluation and delabeling.

    View details for DOI 10.1016/j.jaip.2022.12.001

    View details for PubMedID 36521831

  • Asian American Patients With Allergic Diseases: Considerations for Research and Clinical Care. The journal of allergy and clinical immunology. In practice Chen, M., Feng, C., Liu, A. Y., Zhu, L., Camargo, C. A., Arroyo, A. C. 2022; 10 (4): 950-952

    View details for DOI 10.1016/j.jaip.2022.01.031

    View details for PubMedID 35397816

  • A One Day Outpatient Aspirin Desensitization Protocol With Home Dose Escalation For Patients With Aspirin Exacerbated Respiratory Disease (AERD) Salgado, C., Hsu, C., McGhee, S., Liu, A. MOSBY-ELSEVIER. 2022: AB171
  • The United States Drug Allergy Registry: A Prospective Longitudinal Cohort Study of Patients Tested for Drug Allergies Blumenthal, K., Ramsey, A., Samarakoon, U., Otani, I., Gonzalez-Estrada, A., Banerji, A., Liu, A., Wickner, P., Stone, C., Park, M., Mancini, C., Judd, A., Ahola, C., Fu, X., Zhang, Y., Donelan, K., Mustafa, S., Blue, H., Sheflin, D., Harkness, T., Khan, D., Garzon-Siatoya, W., Morgenstern-Kaplan, D., Marks, M., Kerrigan, A., Rukasin, C., Phillips, E. MOSBY-ELSEVIER. 2022: AB151
  • Maternal hypertensive disorders of pregnancy and the risk of childhood asthma Arroyo, A., Robinson, L., James, K., Li, S., Hsu, S., Liu, A., Druzin, M., Powe, C., Camargo, C. MOSBY-ELSEVIER. 2022: AB88
  • Road Less Traveled: Drug Hypersensitivity to Fluoroquinolones, Vancomycin, Tetracyclines, and Macrolides. Clinical reviews in allergy & immunology Zhu, L. J., Liu, A. Y., Wong, P. H., Arroyo, A. C. 1800


    While fluoroquinolones, vancomycin, macrolides, and tetracyclines are generally safe antibiotics, they can induce both immediate and delayed hypersensitivity reactions (HSRs). Historically, less has been published on allergies to these antibiotics compared to beta lactams, but the prevalence of non-beta lactam HSRs is increasing. To fluoroquinolones, immediate HSRs are more common than delayed reactions. Both IgE and non-IgE mechanisms, such as the mast cell receptor Mas-related G protein-coupled receptor X2 (MRGPRX2), have been implicated in fluoroquinolone-induced anaphylaxis. Skin testing for fluoroquinolones is controversial, and the gold standard for diagnosis is a graded dose challenge. To vancomycin, the most common reaction is vancomycin infusion reaction (previously called "red man syndrome"), which is caused by infusion rate-dependent direct mast cell degranulation. Severity can range from flushing and pruritis to angioedema, bronchospasm, and hypotension that mimic type I HSRs. MRGPRX2 has been implicated in vancomycin infusion reactions. IgE-mediated HSRs to vancomycin are rare. Vancomycin skin testing yields high false positive rates. Thus, direct provocation challenge with slower infusion rate and/or antihistamine pre-treatment is preferred if symptoms are mild to moderate, and desensitization can be considered if symptoms are severe. To tetracyclines, non-IgE-mediated and delayed HSRs predominate with cutaneous reactions being the most common. There is no standardized skin testing for tetracyclines, and avoidance is generally recommended after a severe reaction because of the paucity of data for testing. Graded dose challenges and desensitizations can be considered for alternative or index tetracyclines if there are no alternatives. With macrolides, urticaria/angioedema is the most common immediate HSR, and rash is the most common delayed HSR. The predictive value for skin testing to macrolides is similarly poorly defined. In general, HSRs to fluroquinolones, vancomycin, macrolides, and tetracyclines are challenging to diagnose given the lack of validated skin testing and in vitro testing. Direct provocation challenge remains the gold standard for diagnosis, but the benefits of confirming an allergy may not outweigh the risk of a severe reaction. Skin testing, direct provocation challenge, and/or desensitization to the index non-beta lactam antibiotic or alternatives in its class may be reasonable approaches depending on the clinical context and patient preferences.

    View details for DOI 10.1007/s12016-021-08919-5

    View details for PubMedID 35092578

  • Elexacaftor/tezacaftor/ivacaftor outpatient desensitization ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Balijepally, R., Kwong, D., Zhu, L., Camacho, J., Liu, A. 2022; 128 (1): 104-105
  • Elexacaftor/Tezacaftor/Ivacaftor Outpatient Desensitization. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Balijepally, R., Kwong, D., Zhu, L., Valdes Camacho, J., Liu, A. 2021

    View details for DOI 10.1016/j.anai.2021.08.010

    View details for PubMedID 34391901

  • Drug-induced hypersensitivity syndrome like reaction with angioedema and hypotension associated with BRAF inhibitor use and antecedent immune checkpoint therapy. JAAD case reports Rana, J., Maloney, N. J., Rieger, K. E., Pugliese, S. B., Strelo, J. L., Liu, A., Zaba, L. C., Kwong, B. Y. 2021; 13: 147-151

    View details for DOI 10.1016/j.jdcr.2021.04.033

    View details for PubMedID 34195327

  • How important is the second dose of the COVID-19 mRNA vaccine? The journal of allergy and clinical immunology. In practice Liu, A. Y. 2021; 9 (6): 2537

    View details for DOI 10.1016/j.jaip.2021.02.061

    View details for PubMedID 34112480

  • Online Antibiotic Allergy Decision Support Tool Improves Management of Beta Lactam Allergies Dunham, T., Fasani, D., Lippner, E., Moir, E., Halpern-Felsher, B., Gardner, R., Sundaram, V., Liu, A. MOSBY-ELSEVIER. 2021: AB7
  • Interferon-gamma release assay testing to assess COVID-19 vaccination response in a SARS-CoV-2 seronegative patient on rituximab: a case report. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases Ferguson, J., Murugesan, K., Banaei, N., Liu, A. 2021


    We describe the case of a 44-year-old female on Rituximab for treatment of multiple sclerosis with undetectable SARS-CoV-2 IgG specific antibodies eighteen days after second dose of SARS-CoV-2 vaccine. Interferon-gamma release assay testing for SARS-CoV-2 was positive on day nineteen, demonstrating robust T-cell mediated response despite lack of antibody-mediated response.

    View details for DOI 10.1016/j.ijid.2021.06.054

    View details for PubMedID 34216738

  • Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis. Emerging infectious diseases Puing, A. G., Epstein, D. J., Banaei, N., Subramanian, A. K., Liu, A. Y. 2021; 27 (10): 2734-2736


    Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Of 25 immunocompromised patients receiving alternative prophylaxis in whom nocardiosis developed, 16 subsequently tolerated TMP/SMX treatment. Clinicians should consider TMP/SMX allergy evaluation and rechallenging to assess patient tolerance.

    View details for DOI 10.3201/eid2710.210620

    View details for PubMedID 34545802

    View details for PubMedCentralID PMC8462344

  • Dupilumab use in recalcitrant allergic fungal rhinosinusitis ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Lo, R. M., Liu, A. Y., Valdez, T. A., Gernez, Y. 2020; 125 (5): 617–19
  • Dupilumab use in recalcitrant allergic fungal rhinosinusitis. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Lo, R. M., Liu, A. Y., Valdez, T. A., Gernez, Y. 2020

    View details for DOI 10.1016/j.anai.2020.07.014

    View details for PubMedID 32707161

  • Infectious Implications of Interleukin-1, Interleukin-6, and T Helper Type 2 Inhibition. Infectious disease clinics of North America Liu, A. Y. 2020


    Targeting interleukins that drive innate inflammation has expanded treatments of autoinflammatory and autoimmune disorders. Interleukin (IL)-1 inhibition has proven useful for monogenic autoinflammatory syndromes, and IL-6 inhibition for autoimmune arthritides. Biological therapies impeding these pathways impair detection and containment of pathogens, particularly invasive bacteria, reflecting the importance of IL-1 and IL-6 in communicating danger throughout the immune system. Biologics targeting T helper type 2 inflammation are used to treat specific allergic, atopic, and eosinophilic diseases. They may impair protections against local herpesvirus reactivations while augmenting antiviral responses to respiratory viruses. Their risks with helminth exposures have yet to be defined.

    View details for DOI 10.1016/j.idc.2020.02.003

    View details for PubMedID 32334983

  • A Case Of Disseminated Cryptococcosis Gattii Due To Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) Autoantibodies Lee, I., Anjum, S., Liu, A., Williamson, P., Holland, S., Gernez, Y. SPRINGER/PLENUM PUBLISHERS. 2020: S77–S78
  • Disseminated Pneumocystis jirovecii Infection with Osteomyelitis in a Patient with CTLA-4 Haploinsufficiency. Journal of clinical immunology Siddiqi, A. E., Liu, A. Y., Charville, G. W., Kunder, C. A., Uzel, G. n., Sadighi Akha, A. A., Oak, J. n., Martin, B. n., Sacha, J. n., Lewis, D. B., Gernez, Y. n. 2020

    View details for DOI 10.1007/s10875-020-00748-z

    View details for PubMedID 31955317

  • Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. The journal of allergy and clinical immunology. In practice Broyles, A. D., Banerji, A. n., Barmettler, S. n., Biggs, C. M., Blumenthal, K. n., Brennan, P. J., Breslow, R. G., Brockow, K. n., Buchheit, K. M., Cahill, K. N., Cernadas, J. n., Chiriac, A. M., Crestani, E. n., Demoly, P. n., Dewachter, P. n., Dilley, M. n., Farmer, J. R., Foer, D. n., Fried, A. J., Garon, S. L., Giannetti, M. P., Hepner, D. L., Hong, D. I., Hsu, J. T., Kothari, P. H., Kyin, T. n., Lax, T. n., Lee, M. J., Lee-Sarwar, K. n., Liu, A. n., Logsdon, S. n., Louisias, M. n., MacGinnitie, A. n., Maciag, M. n., Minnicozzi, S. n., Norton, A. E., Otani, I. M., Park, M. n., Patil, S. n., Phillips, E. J., Picard, M. n., Platt, C. D., Rachid, R. n., Rodriguez, T. n., Romano, A. n., Stone, C. A., Torres, M. J., Verdú, M. n., Wang, A. L., Wickner, P. n., Wolfson, A. R., Wong, J. T., Yee, C. n., Zhou, J. n., Castells, M. n. 2020; 8 (9S): S16–S116

    View details for DOI 10.1016/j.jaip.2020.08.006

    View details for PubMedID 33039007

  • Case series of sebelipase alfa hypersensitivity reactions and successful sebelipase alfa rapid desensitization. JIMD reports Huffaker, M. F., Liu, A. Y., Enns, G. M., Vijay, S., Amor, A. J., Adkinson, N. F. 2019; 49 (1): 30–36


    Allergic immune-mediated hypersensitivity reactions are known potential complications of enzyme replacement therapy. Sebelipase alfa, recombinant lysosomal acid lipase (LAL), is a potentially life-altering treatment for patients with LAL deficiency. There is very little information on the diagnosis and management of immediate hypersensitivity reactions to this drug. Here we present three unique cases of hypersensitivity reactions to sebelipase alfa, spanning a broad age spectrum from infancy to adulthood, each managed with successful rapid desensitization.

    View details for DOI 10.1002/jmd2.12066

    View details for PubMedID 31497479

  • Eculizumab hypersensitivity and desensitization in a toddler with atypical hemolytic uremic syndrome JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE Lo, R., Alexander, S., Moss, J., Siddiqi, A., Liu, A. 2019; 7 (7): 2409–10
  • Eremothecium coryli bloodstream infection in a patient with acute myeloid leukemia: first case report of human infection DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE Multani, A., Rustagi, A., Epstein, D. J., Gomez, C. A., Budvytiene, I., Banaei, N., Brown, J. M., Liu, A. Y. 2019; 95 (1): 77–79
  • Successful eradication of chronic symptomatic Candida krusei urinary tract infection with increased dose micafungin in a liver and kidney transplant recipient: case report and review of the literature. Transplant infectious disease : an official journal of the Transplantation Society Multani, A., Subramanian, A. K., Liu, A. Y. 2019: e13118


    Treatment of symptomatic candiduria is notoriously challenging because of the limited repository of antifungals that achieve adequate urinary concentrations. Fluconazole, amphotericin B-based products, and flucytosine are established treatment options for most Candida species. Candida krusei exhibits intrinsic resistance to fluconazole and decreased susceptibility to amphotericin B and flucytosine. In transplant patients, both amphotericin B-based products and flucytosine are less desirable due to their toxicities. Other triazole antifungals are unappealing because they do not achieve adequate urinary concentrations, have multiple toxicities, and interact with transplant-related immunosuppressive medications. Echinocandins are well-tolerated but have been traditionally deferred in the treatment of symptomatic funguria because of their poor urinary concentrations but there is a small but emerging body of literature supporting their use. Here, we present a case of successful eradication of chronic symptomatic Candida krusei urinary tract infection with micafungin 150 milligrams daily in a liver and kidney transplant recipient, and we review the literature on treatment of symptomatic candiduria. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/tid.13118

    View details for PubMedID 31111613

  • An Evaluation of Barriers to Inpatient Medication Allergy Documentation Chollet, M. B., Shieh, L., Liu, A. Y. MOSBY-ELSEVIER. 2019: AB280
  • A Case of Disseminated Pneumocystis Jiroveci in a Non-Human Immunodeficiency Virus Infected Patient Siddiqi, A. E., Sacha, J., Saenz, R., Liu, A., Kunder, C., Uzel, G., Martin, B., Lewis, D. B., Gernez-Goldhammer, Y. SPRINGER/PLENUM PUBLISHERS. 2019: S73–S74
  • West Nile virus encephalitis in GATA2 deficiency ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY Rosa, J. S., Kappagoda, S., Hsu, A. P., Davis, J., Holland, S. M., Liu, A. Y. 2019; 15
  • Eculizumab Hypersensitivity and Desensitization in a Toddler with Atypical Hemolytic Uremic Syndrome. The journal of allergy and clinical immunology. In practice Lo, R. n., Alexander, S. n., Moss, J. n., Siddiqi, A. n., Liu, A. n. 2019

    View details for PubMedID 30946976

  • Eremothecium coryli bloodstream infection in a patient with acute myeloid leukemia: first case report of human infection. Diagnostic microbiology and infectious disease Multani, A. n., Rustagi, A. n., Epstein, D. J., Gomez, C. A., Budvytiene, I. n., Banaei, N. n., Brown, J. M., Liu, A. Y. 2019


    Eremothecium coryli is a dimorphic fungus of the Saccharomycetes class. While species within this class are known to cause human infection, Eremothecium species have previously only been known as phytopathogens and never been isolated from a human sample. Here, we report the first known case of human E. coryli infection.

    View details for PubMedID 31005402

  • West Nile virus encephalitis in GATA2 deficiency. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology Rosa, J. S., Kappagoda, S., Hsu, A. P., Davis, J., Holland, S. M., Liu, A. Y. 2019; 15: 5


    We report a male with longstanding warts who presented with severe West Nile virus encephalitis (WNVE) and recovered after interferon alfa-2b and intravenous immunoglobulin. He was later found to have GATA2 deficiency and underwent successful hematopoietic stem cell transplant.

    View details for PubMedID 30697248

  • A novel outpatient desensitization protocol for recombinant human erythropoietin allergy in a pediatric patient ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY Rosa, J. S., Vuong, V. B., Haskin, O., Liu, A. Y. 2018; 14: 8


    Recombinant human erythropoietin, such as epoetin alfa and darbepoetin alfa, is an important therapy for anemia due to chronic renal failure. Allergy to recombinant human erythropoietin and the need for desensitization are rare.We report here a novel epoetin alfa outpatient desensitization protocol in a girl who developed delayed cutaneous hypersensitivity to subcutaneous epoetin alfa and intravenous darbepoetin alfa. An initial attempt at traditional epoetin alfa desensitization failed, so we created a slower 17-day outpatient desensitization that succeeded and allowed treatment continuation.This case highlights the notion that delayed-type hypersensitivity to recombinant human erythropoietin can occur as evident by reproducible reactions after repeated exposures and slow outpatient desensitization can be considered when a trial of more rapid induction of tolerance is unsuccessful.

    View details for PubMedID 29545827

    View details for PubMedCentralID PMC5846227

  • Scedosporium apiospermum infection of the urinary system with a review of treatment options and cases in the literature TRANSPLANT INFECTIOUS DISEASE Benamu, E., Yu, A., Xie, L., Fernandez-Pol, S., Liu, A. Y., Ho, D. Y. 2018; 20 (1)


    Infection with Scedosporium species is associated with a significant morbidity and mortality and is becoming increasingly common, especially in immunocompromised patients. We describe the presentation and successful management of an immunocompromised patient with Scedosporium apiospermum infection of the upper urinary tract system, a rare disease manifestation. The current literature on urinary tract scedosporiosis is further reviewed with emphasis on treatment options and limitations of current antifungal therapy.

    View details for PubMedID 29111602

    View details for PubMedCentralID PMC5871223

  • Hypersensitivity Reactions to Monoclonal Antibodies Drug Allergy Testing Liu, A. edited by Khan, D., Banerji, A. Elsevier. 2018; 1
  • Delayed Diagnosis of Tuberculous Meningitis Misdiagnosed as Herpes Simplex Virus-1 Encephalitis With the FilmArray Syndromic Polymerase Chain Reaction Panel. Open forum infectious diseases Gomez, C. A., Pinsky, B. A., Liu, A., Banaei, N. 2017; 4 (1): ofw245-?


    The FilmArray meningitis/encephalitis (ME) panel is a novel syndromic, nucleic acid amplification test for diagnosis of acute meningitis and encephalitis. Emerging data on its performance are concerning for false-positive results. We present a case of tuberculous meningitis misdiagnosed as herpes simplex virus-1 encephalitis with the FilmArray ME panel. Strategies to mitigate erroneous results are discussed.

    View details for DOI 10.1093/ofid/ofw245

    View details for PubMedID 28540320

  • Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies. The journal of allergy and clinical immunology. In practice Sloane, D., Govindarajulu, U., Harrow-Mortelliti, J., Barry, W., Hsu, F. I., Hong, D., Laidlaw, T., Palis, R., Legere, H., Bunyavanich, S., Breslow, R., Wesemann, D., Barrett, N., Brennan, P., Chong, H. J., Liu, A., Fernandez, J., Fanning, L., Kyin, T., Cahill, K., Bankova, L., Lynch, A., Berlin, S., Campos, S., Fuchs, C., Mayer, R., Matulonis, U., Castells, M. 2016


    Rapid drug desensitization (RDD) is used to address hypersensitivity reactions to chemotherapeutics and monoclonal antibodies, allowing patients to be treated with optimal pharmacological agents. RDD protocols are tailored to each individual patient's reaction and needs, and protect against anaphylaxis, but overall risks, costs, and benefits have not been determined.We investigated the safety, efficacy, costs, and life expectancy of patients in a large population undergoing RDD.We analyzed 2177 RDD procedures performed in 370 patients with cancer, vasculitis, and hematological and connective tissue diseases who presented 402 reactions. A subgroup of carboplatin allergic patients with ovarian cancer treated with RDD was analyzed for costs and life expectancy and compared with a nonallergic control group.RDD allowed all patients to receive safely the full dose of the medication to which they were reactive. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification. Of the 2177 desensitizations, 93% had no or mild reactions whereas 7% had moderate to severe reactions, which did not preclude the completion of the treatment, and there were no deaths. Overall health costs in the carboplatin allergic group were not higher than those in the nonallergic group treated with standard of care. Administration of carboplatin through RDD was as effective as standard administration with a nonsignificant increase in life expectancy in desensitized patients as compared with nonallergic, nondesensitized controls.RDD is cost effective and safe for allergic patients with cancer and chronic disease to remain on first line therapy.

    View details for DOI 10.1016/j.jaip.2015.12.019

    View details for PubMedID 26895621

  • Delayed Diagnosis of Tuberculous Meningitis Misdiagnosed as Herpes Simplex Virus-1 Encephalitis With the FilmArray Syndromic Polymerase Chain Reaction Panel Open Forum Infectious Diseases Gomez, C. A., Pinsky, B. A., Liu, A., Banaei, N. 2016: ofw245


    The FilmArray meningitis/encephalitis (ME) panel is a novel syndromic, nucleic acid amplification test for diagnosis of acute meningitis and encephalitis. Emerging data on its performance are concerning for false-positive results. We present a case of tuberculous meningitis misdiagnosed as herpes simplex virus-1 encephalitis with the FilmArray ME panel. Strategies to mitigate erroneous results are discussed.

    View details for DOI 10.1093/ofid/ofw245

    View details for PubMedCentralID PMC5437853

  • Maturation of mast cell progenitors to mucosal mast cells during allergic pulmonary inflammation in mice. Mucosal immunology Bankova, L. G., Dwyer, D. F., Liu, A. Y., Austen, K. F., Gurish, M. F. 2015; 8 (3): 596-606


    In contrast to resident constitutive mast cells (CMCs), mucosal MCs (MMCs) appear in the lung and trachea of sensitized mice only following inhalation challenge. We monitored the influx and maturation of MCs by their expression of Kit, FcɛRI, β7-integrin and side scatter (SSC) by flow cytometry. Influx of MC progenitors (MCps) (FcɛRI(lo), Kit(int), β7(hi), and SSC(lo)) peaks 1 day after challenges and subsides to baseline by day 7 after challenge. The mature MMCs appear as a distinct population on day 7 and peak at day 14 with higher SSC and FcɛRI expression, but lower β7 and Kit expression. A distinct transitional population is present between 1 and 7 days after challenge. Maturation occurs more rapidly in the trachea. The resident tracheal CMCs had higher SSC, FcɛRI, and Kit and lower β7-integrin expression than the MMCs. By histology, the MMCs follow similar kinetics to the flow cytometry-identified mature MMCs and are notably persistent for >42 days. Steroid treatment reduced inflammation and MCp influx but had no effect on established MMCs. Thus, changes in SSC, FcɛRI, and Kit together with the expression of αE/α4:β7-integrins characterizes the development of induced MMCs from MCps and distinguishes them from resident CMCs in the trachea and large airways.

    View details for DOI 10.1038/mi.2014.91

    View details for PubMedID 25291985

  • Induced Long-Lived Mucosal Mast Cells In The Airways Arise From Circulating Mast Cell Progenitors Bankova, L., Dwyer, D., Liu, A. Y., Jones, T., Austen, K., Gurish, M. MOSBY-ELSEVIER. 2014: AB145
  • Mast Cells Recruited to Mesenteric Lymph Nodes during Helminth Infection Remain Hypogranular and Produce IL-4 and IL-6 JOURNAL OF IMMUNOLOGY Liu, A. Y., Dwyer, D. F., Jones, T. G., Bankova, L. G., Shen, S., Katz, H. R., Austen, K. F., Gurish, M. F. 2013; 190 (4): 1758-1766


    Mast cells (MC) and basophils share expression of the high-affinity receptor for IgE (FcεRI) but can be distinguished by their divergent expression of KIT and CD49b. In BALB/c mice, MC lineage cells expressing high levels of FcεRI by flow cytometry were seen only in bone marrow whereas those expressing intermediate levels of FcεRI were present in bone marrow and spleen of naive mice and in mesenteric lymph nodes (mLN) of Trichinella spiralis-infected mice. These FcεRI(+)KIT(+)CD49b(-) cells had a membrane phenotype similar to i.p. connective tissue-type MC, but were smaller and hypogranular by flow cytometry forward and side scatter profiles, respectively. Consistent with this, they lacked the prominent secretory granules identified by histochemistry and immunodetection for the MC-specific granule proteases that are readily seen in mature jejunal mucosal MC that also are induced by the infection and present at the same time. The concentration of these MC lineage cells in mLN determined by flow cytometry was comparable to that of MC progenitors (MCp) measured by limiting dilution and clonal expansion with maturation. We observed upregulation of IL-4 transcription by MCp in mLN and spleens of helminth-infected 4get mice, and we demonstrated by intracellular cytokine staining production of IL-4 and IL-6 by the mLN MCp in helminth-infected mice. Furthermore, treatment of helminth-infected mice with anti-FcεRI mAb, a protocol known to deplete basophils, also depleted mLN MCp. Thus, this study identifies a hypogranular subset of MCp recruited to mLN by helminth infection that may be an important unrecognized source of cytokines.

    View details for DOI 10.4049/jimmunol.1202567

    View details for Web of Science ID 000314825400039

    View details for PubMedID 23319739

  • Desensitization regimens for drug allergy: state of the art in the 21st century CLINICAL AND EXPERIMENTAL ALLERGY Liu, A., Fanning, L., Chong, H., Fernandez, J., SLOANE, D., Sancho-Serra, M., Castells, M. 2011; 41 (12): 1679-1689


    Adverse reactions to drugs are increasingly being recognized as important contributions to disease in their own right as well as impediments to the best treatment of various conditions, including infectious, autoimmune, and neoplastic maladies. Rapid drug desensitization (RDD) is an effective mechanism for safely administering important medications while minimizing or entirely circumventing such adverse reactions in sensitized patients. We reviewed the literature on RDD in the last 10 years, including our experience from the Brigham and Women's Hospital Desensitization Program with hundreds of patients desensitized to a broad variety of drugs. RDD in our programme has been uniformly successful in patients with hypersensitivity reactions to antibiotics, chemotherapeutics, and monoclonal antibodies. Any reactions that occur during desensitization are generally much less severe than the initial hypersensitivity reaction to the drug, and patients have received the full dose of the desired medication 99.9% of the time out of (796) desensitizations. To date, there have been no fatalities. RDD is a safe and highly effective method for treating sensitized patients with the optimal pharmacologic agents. Its use should be expanded, but because patient safety is paramount, protocols must be created, reviewed, and overseen by allergist-immunologists with special training and experience in modern techniques of desensitization.

    View details for DOI 10.1111/j.1365-2222.2011.03825.x

    View details for Web of Science ID 000297283800005

    View details for PubMedID 21883538

  • The Major Genetic Determinants of HIV-1 Control Affect HLA Class I Peptide Presentation SCIENCE Pereyra, F., Jia, X., McLaren, P. J., Telenti, A., de Bakker, P. I., Walker, B. D., Ripke, S., Brumme, C. J., Pulit, S. L., Carrington, M., Kadie, C. M., Carlson, J. M., Heckerman, D., Graham, R. R., Plenge, R. M., Deeks, S. G., Gianniny, L., Crawford, G., Sullivan, J., Gonzalez, E., Davies, L., Camargo, A., Moore, J. M., Beattie, N., Gupta, S., Crenshaw, A., Burtt, N. P., Guiducci, C., Gupta, N., Carrington, M., Gao, X., Qi, Y., Yuki, Y., Piechocka-Trocha, A., Cutrell, E., Rosenberg, R., Moss, K. L., Lemay, P., O'Leary, J., Schaefer, T., Verma, P., Toth, I., Block, B., Baker, B., Rothchild, A., Lian, J., Proudfoot, J., Alvino, D. M., Vine, S., Addo, M. M., Allen, T. M., Altfeld, M., Henn, M. R., Le Gall, S., Streeck, H., Haas, D. W., Kuritzkes, D. R., Robbins, G. K., Shafer, R. W., Gulick, R. M., Shikuma, C. M., Haubrich, R., Riddler, S., Sax, P. E., Daar, E. S., Ribaudo, H. J., Agan, B., Agarwal, S., Ahern, R. L., Allen, B. L., Altidor, S., Altschuler, E. L., Ambardar, S., Anastos, K., Anderson, B., Anderson, V., Andrady, U., Antoniskis, D., Bangsberg, D., Barbaro, D., Barrie, W., Bartczak, J., Barton, S., Basden, P., Basgoz, N., Bazner, S., Bellos, N. C., Benson, A. M., Berger, J., Bernard, N. F., Bernard, A. M., Birch, C., Bodner, S. J., Bolan, R. K., Boudreaux, E. T., Bradley, M., Braun, J. F., Brndjar, J. E., Brown, S. J., Brown, K., Brown, S. T., Burack, J., Bush, L. M., Cafaro, V., Campbell, O., Campbell, J., Carlson, R. H., Carmichael, J. K., Casey, K. K., Cavacuiti, C., Celestin, G., Chambers, S. T., Chez, N., Chirch, L. M., Cimoch, P. J., Cohen, D., Cohn, L. E., Conway, B., Cooper, D. A., Cornelson, B., Cox, D. T., Cristofano, M. V., Cuchural, G., Czartoski, J. L., Dahman, J. M., Daly, J. S., Davis, B. T., Davis, K., Davod, S. M., Deeks, S. G., deJesus, E., Dietz, C. A., Dunham, E., Dunn, M. E., Ellerin, T. B., Eron, J. J., Fangman, J. J., Farel, C. E., Ferlazzo, H., Fidler, S., Fleenor-Ford, A., Frankel, R., Freedberg, K. A., French, N. K., Fuchs, J. D., Fuller, J. D., Gaberman, J., Gallant, J. E., Gandhi, R. T., Garcia, E., Garmon, D., Gathe, J. C., Gaultier, C. R., Gebre, W., Gilman, F. D., Gilson, I., Goepfert, P. A., Gottlieb, M. S., Goulston, C., Groger, R. K., Gurley, T. D., Haber, S., Hardwicke, R., Hardy, W. D., Harrigan, P. R., Hawkins, T. N., Heath, S., Hecht, F. M., Henry, W. K., Hladek, M., Hoffman, R. P., Horton, J. M., Hsu, R. K., Huhn, G. D., Hunt, P., Hupert, M. J., Illeman, M. L., Jaeger, H., Jellinger, R. M., John, M., Johnson, J. A., Johnson, K. L., Johnson, H., Johnson, K., Joly, J., Jordan, W. C., Kauffman, C. A., Khanlou, H., Killian, R. K., Kim, A. Y., Kim, D. D., Kinder, C. A., Kirchner, J. T., Kogelman, L., Kojic, E. M., Korthuis, T., Kurisu, W., Kwon, D. S., Lamar, M., Lampiris, H., Lanzafame, M., Lederman, M. M., Lee, D. M., Lee, J. M., Lee, M. J., Lee, E. T., Lemoine, J., Levy, J. A., Llibre, J. M., Liguori, M. A., Little, S. J., Liu, A. Y., Lopez, A. J., Loutfy, M. R., Loy, D., Mohammed, D. Y., Man, A., Mansour, M. K., Marconi, V. C., Markowitz, M., Marques, R., Martin, J. N., Martin, H. L., Mayer, K. H., McElrath, M. J., McGhee, T. A., McGovern, B. H., McGowan, K., McIntyre, D., Mcleod, G. X., Menezes, P., Mesa, G., Metroka, C. E., Meyer-Olson, D., Miller, A. O., Montgomery, K., Mounzer, K. C., Nagami, E. H., Nagin, I., Nahass, R. G., Nelson, M. O., Nielsen, C., Norene, D. L., O'Connor, D. H., Ojikutu, B. O., Okulicz, J., Oladehin, O. O., Oldfield, E. C., Olender, S. A., Ostrowski, M., Owen, W. F., Pae, E., Parsonnet, J., Pavlatos, A. M., Perlmutter, A. M., Pierce, M. N., Pincus, J. M., Pisani, L., Price, L. J., Proia, L., Prokesch, R. C., Pujet, H. C., Ramgopal, M., Rathod, A., Rausch, M., Ravishankar, J., Rhame, F. S., Richards, C. S., Richman, D. D., Robbins, G. K., Rodes, B., Rodriguez, M., Rose, R. C., Rosenberg, E. S., Rosenthal, D., Ross, P. E., Rubin, D. S., Rumbaugh, E., Saenz, L., Salvaggio, M. R., Sanchez, W. C., Sanjana, V. M., Santiago, S., Schmidt, W., Schuitemaker, H., Sestak, P. M., Shalit, P., Shay, W., Shirvani, V. N., Silebi, V. I., Sizemore, J. M., Skolnik, P. R., Sokol-Anderson, M., Sosman, J. M., Stabile, P., Stapleton, J. T., Starrett, S., Stein, F., Stellbrink, H., Sterman, F. L., Stone, V. E., Stone, D. R., Tambussi, G., Taplitz, R. A., Tedaldi, E. M., Telenti, A., Theisen, W., Torres, R., Tosiello, L., Tremblay, C., Tribble, M. A., Trinh, P. D., Tsao, A., Ueda, P., Vaccaro, A., Valadas, E., Vanig, T. J., Vecino, I., Vega, V. M., Veikley, W., Wade, B. H., Walworth, C., Wanidworanun, C., Ward, D. J., Warner, D. A., Weber, R. D., Webster, D., Weis, S., Wheeler, D. A., White, D. J., Wilkins, E., Winston, A., Wlodaver, C. G., van't Wout, A., Wright, D. P., Yang, O. O., Yurdin, D. L., Zabukovic, B. W., Zachary, K. C., Zeeman, B., Zhao, M. 2010; 330 (6010): 1551-1557


    Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.

    View details for DOI 10.1126/science.1195271

    View details for Web of Science ID 000285153500069

    View details for PubMedID 21051598

  • Clinical problem-solving. A rash hypothesis. New England journal of medicine Liu, A. Y., Lowe, R. C., Levy, B. D., Katz, J. T., Loscalzo, J. 2010; 363 (1): 72-78

    View details for DOI 10.1056/NEJMcps0708369

    View details for PubMedID 20592300

  • Interactive medical case. A rash hypothesis. New England journal of medicine Ross, J. J., Saavedra, A., Vleugels, R. A., Liu, A., Castells, M. C. 2010; 362 (24)

    View details for DOI 10.1056/NEJMimc0903117

    View details for PubMedID 20560180

  • Hodgkin's lymphoma masquerading as vertebral osteomyelitis in a man with diabetes: a case report. Journal of medical case reports Bender Ignacio, R. A., Liu, A. Y., Sohani, A. R., Vyas, J. M. 2010; 4: 102-?


    Infection and malignancy often have common characteristics which render the differential diagnosis for a prolonged fever difficult. Imaging and tissue biopsy are crucial in making a correct diagnosis, though differentiating between chronic osteomyelitis and malignancy is not always straightforward as they possess many overlapping features.A 52-year-old Caucasian man was treated with antibiotics for his diabetic foot infection after a superficial culture showed Staphylococcus aureus. He had persistent fevers for several weeks and later developed acute onset of back pain which was treated with several courses of antibiotics. Radiographic and pathological findings were atypical, and a diagnosis of Hodgkin's lymphoma was made 12 weeks later.Clinicians should maintain a suspicion for Hodgkin's lymphoma or other occult malignancy when features of presumed osteomyelitis are atypical. Chronic vertebral osteomyelitis in particular often lacks features common to acute infectious disease processes, and the chronic lymphocytic infiltrates seen on histopathology have very similar features to Hodgkin's lymphoma, highlighting a similar inflammatory microenvironment sustained by both processes.

    View details for DOI 10.1186/1752-1947-4-102

    View details for PubMedID 20370895

  • Brugia malayi microfilariae induce cell death in human dendritic cells, inhibit their ability to make IL-12 and IL-10, and reduce their capacity to activate CD4(+) T cells JOURNAL OF IMMUNOLOGY Semnani, R. T., Liu, A. Y., Sabzevari, H., Kubofcik, J., Zhou, J., Gilden, J. K., Nutman, T. B. 2003; 171 (4): 1950-1960


    Parasite Ag-specific T cell unresponsiveness and diminished IFN-gamma production are immunologic hallmarks of patent infection with lymph-dwelling filarial nematodes. Although this diminished responsiveness is directed primarily against the intravascular microfilarial (MF) parasite stage and mediated in part by reduced APC function, the mechanisms involved are not fully understood. In this report, we demonstrate that human dendritic cells (DC) exposed to live MF up-regulate both the cell surface and gene expression of CD54 (ICAM-1). Moreover, live MF result in a 3-fold increase in DC death compared with MF-unexposed DC, primarily due to apoptosis. Notably, microarray and real-time RT-PCR data indicate that live MF concurrently up-regulate mRNA expression of proinflammatory molecules such as IL-8, RANTES, IL-1alpha, TNF-alpha, and IL-beta in DC, the presence of which is also detected at the protein level, while inhibiting the production of IL-12 (p40 and p70) and IL-10. Soluble excretory-secretory products from live MF diminished IL-12 and IL-10 production and induced DC death, although to a lesser degree. Moreover, exposure of DC to live MF resulted in a decrease in the ability of DC to promote CD4(+) T cell production of IFN-gamma and IL-5. Our findings clearly suggest that the interaction between live MF and DC is complex but contributes to the hyporesponsiveness and parasite persistence associated with the MF(+) state in the infected human. These data further suggest that MF induce an orchestrated response in APC that leads to a diminished capacity to function appropriately, which in turn has significant consequences for CD4(+) T cells.

    View details for Web of Science ID 000184667400044

    View details for PubMedID 12902498