Clinical Focus

  • Allergy and Immunology

Academic Appointments

Professional Education

  • Residency: University of Chicago Hospitals Internal Medicine Residency (2017) IL
  • Board Certification: American Board of Allergy and Immunology, Allergy and Immunology (2021)
  • Fellowship: Stanford University Allergy and Immunology Fellowship (2021) CA
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2017)
  • Internship: University of California Davis (2015) CA
  • Medical Education: Case Western Reserve School of Medicine (2014) OH

All Publications

  • 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

  • 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 : 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

  • Electronic Medication Monitoring vs. Self-Reported Use of Inhaled Corticosteroids and Short Acting Beta2 Agonists in Adult Patients with Uncontrolled Asthma Kaye, L., Gondalia, R., Gonzalez, C., Adams, B., Zhu, L., Quan, P., Olive, N., Shalowitz, M., Stempel, D. MOSBY-ELSEVIER. 2020: AB59
  • A Randomized Controlled Trial of Electronic Medication Monitoring (EMM), Patient Mobile App and Health Care Provider Feedback compared to EMM alone on Inhaled Corticosteroids (ICS) and Short Acting Beta2 Agonists (SABA) Utilization and Asthma Control in Adult Patients with Uncontrolled Asthma Mosnaim, G., Gonzalez, C., Adams, B., Zhu, L., Quan, P., Olive, N., Shalowitz, M., Gondalia, R., Kaye, L., Stempel, D. MOSBY-ELSEVIER. 2020: AB58