eMedicine Specialties > Allergy and Immunology > Immunodeficiencies

DiGeorge Syndrome: Follow-up

Author: Patrick Htain Win, MD, President/Director, Allergy, Asthma and Immunology Center, SC
Coauthor(s): Sridhar Guduri, MD, Consulting Staff, Allergy and Asthma Clinics of Ohio; Iftikhar Hussain, MD, Director of Allergy, Asthma, and Immunology Center, PC
Contributor Information and Disclosures

Updated: Aug 3, 2009

Follow-up

Further Inpatient Care

  • Close monitoring of the calcium level is required.
  • Prevention of infections should remain a top priority.
  • Treatment of immunodeficiency includes the following:
    • Use the usual prophylactic regimens for T- and B-cell deficiency.
    • Several therapies have been used to treat immunodeficiency associated with DiGeorge anomaly. Cases of immune reconstitution have been reported following transplantation of HLA-identical bone marrow, peripheral-blood mononuclear cells, and fetal thymus. However, some of these patients may have had partial DiGeorge anomaly, and improvement may have been coincidental.
  • Markert et al reported a study of 5 patients with complete DiGeorge anomaly who were treated with allogeneic, cultured, postnatal thymus tissue. Of these patients, 4 developed immune reconstitution with T-cell proliferative responses to mitogens.23
  • Early thymus transplantation (ie, before the onset of infectious complications) may promote successful immune reconstitution. Goldsobel et al reported that the results of thymus transplantation are disappointing. However, a significant number of patients in their group were lost to follow-up, and if their results are corrected accordingly, the benefits of thymus transplantation seem to be more impressive.24 T-cell function may improve in patients with partial DiGeorge anomaly; therefore, thymus transplantation is not indicated.

Further Outpatient Care

  • Genetic counseling and screening
    • Approximately 8% of the patients with DiGeorge anomaly or velocardiofacial (VCFS) studied by Driscoll et al showed familial transmission of 22q11 deletion.26
    • Because subjects with 22q11 deletion have a 50% risk of transmitting the deletion, they should be offered genetic counseling and fluorescent in situ hybridization (FISH) for prenatal detection as early as 10-12 weeks of gestation by chorionic villus sampling.
    • Recent studies show that 22q11 deletions occur in 20-30% of newborns with isolated conotruncal cardiac malformations. Therefore, screen all patients with conotruncal anomalies for 22q11 deletions, identify other family members at risk, and assess the risk in future pregnancies.
  • Multidisciplinary care
    • The complex medical care of patients needs a multidisciplinary approach, and every patient has his own unique clinical features that need a tailored approach. Patients with chromosome 22q11.2 deletion syndrome might have a high level of functioning, but most often need interventions to improve the function of many organ systems.

Prognosis

  • Prognosis depends markedly on the degree of involvement/impairment of cardiac and immune system function.
  • In a large European collaborative study, 558 patients with deletions within the DiGeorge syndrome critical region of chromosome 22q11 were evaluated by questionnaire.27 Eight percent of the patients died; more than half of the deaths occurred within the first month of life, and the majority occurred within 6 months of birth. Of the patients who survived, 62% had only mild learning problems or were developmentally normal. All but one of the deaths were attributable to congenital heart disease. Other clinical features varied as follows:

Miscellaneous

Medicolegal Pitfalls

  • The utmost care must be taken to avoid nonirradiated blood products.
  • Live vaccines are typically contraindicated in patients with DiGeorge anomaly and in household members of such patients because of the risk of shedding of live organisms; however, 2 recent studies show that live viral vaccines (LVVs) may be safe in select populations affected by DiGeorge anomaly.
    • Azzari et al recently evaluated the safety and immunogenicity of measles-mumps-rubella (MMR) vaccine in children with congenital T-cell defect (DiGeorge anomaly).28 No severe adverse reactions were reported in the 14 patients included in the study. Patients and control subjects experienced the same frequency of seroconversion for measles and rubella. The mean titers of antimeasles or antirubella antibodies were the same in patients and controls, and no decrease in CD4 cells was detected after immunization.
    • Moylett et al recently reviewed patients with partial DiGeorge syndrome at Texas Children's Hospital (Baylor College of Medicine).29 Forty-seven percent of the patients with partial DiGeorge syndrome received an LLV. No significant adverse events were recorded in association with administration of LVVs. At initial presentation, the difference between the cellular immune function of patients who received LVVs and of those who did not receive LVVs was not statistically significant. Adequate cellular immune function was documented for 15 of the 25 LVV recipients at the time of vaccine administration without significant change from baseline.

Special Concerns

  • The neurological and psychiatric manifestations of 22q11DS require careful monitoring by experts as part of the multidisciplinary team approach to care.
  • Psychiatric disorders are common in all patients with developmental delay; however, the association is stronger in patients with chromosome 22q11.2 deletion.
  • The behavioral aspects of chromosome 22q11.2 deletion syndromes include attention deficit hyperactivity disorder, poor social interaction skills, impulsivity, and bland affect. Bipolar disorder, autistic spectrum disorder, schizophrenia, and schizoaffective disorder are reported in 10–30% of teenagers and adults.
 


More on DiGeorge Syndrome

Overview: DiGeorge Syndrome
Differential Diagnoses & Workup: DiGeorge Syndrome
Treatment & Medication: DiGeorge Syndrome
Follow-up: DiGeorge Syndrome
References
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References

  1. Harrington LH. Absence of the thymus gland. Lond Med Gaz. 1929;3:314.

  2. Lobdell DH. Congenital absence of the parathyroid glands. AMA Arch Pathol. Apr 1959;67(4):412-5. [Medline].

  3. DiGeorge AM. Congenital absence of the thymus and its immunologic consequences: concurrence with congenital hypoparathyroidism. IV(1). White Plains, NY: March of Dimes-Birth Defects Foundation; 1968:116-21.

  4. de la Chapelle A, Herva R, Koivisto M, Aula P. A deletion in chromosome 22 can cause DiGeorge syndrome. Hum Genet. 1981;57(3):253-6. [Medline].

  5. Meechan DW, Maynard TM, Gopalakrishna D, Wu Y, LaMantia AS. When half is not enough: gene expression and dosage in the 22q11 deletion syndrome. Gene Expr. 2007;13(6):299-310. [Medline].

  6. Lammer EJ, Opitz JM. The DiGeorge anomaly as a developmental field defect. Am J Med Genet Suppl. 1986;2:113-27. [Medline].

  7. Saitta SC, Harris SE, Gaeth AP, et al. Aberrant interchromosomal exchanges are the predominant cause of the 22q11.2 deletion. Hum Mol Genet. Feb 15 2004;13(4):417-28. [Medline].

  8. Ryan AK, Goodship JA, Wilson DI, et al. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet. Oct 1997;34(10):798-804. [Medline].

  9. Rommel N, Davidson G, Cain T, Hebbard G, Omari T. Videomanometric evaluation of pharyngo-oesophageal dysmotility in children with velocardiofacial syndrome. J Pediatr Gastroenterol Nutr. Jan 2008;46(1):87-91. [Medline].

  10. Sieberer M, Runte I, Wilkening A, Pabst B, Ziegenbein M, Haltenhof H. [Spectrum of neuropsychiatric features associated with velocardiofacial syndrome (Deletion 22q11.2)]. Fortschr Neurol Psychiatr. May 2006;74(5):263-74. [Medline].

  11. Marcinkowski M, Bauer K, Stoltenburg-Didinger G, Vogel M, Versmold H. Fatal aspergillosis with brain abscesses in a neonate with DiGeorge syndrome. Pediatr Infect Dis J. Dec 2000;19(12):1214-6. [Medline].

  12. Sanchez-Velasco P, Ocejo-Vinyals JG, Flores R, et al. Simultaneous multiorgan presence of human herpesvirus 8 and restricted lymphotropism of Epstein-Barr virus DNA sequences in a human immunodeficiency virus-negative immunodeficient infant. J Infect Dis. Jan 15 2001;183(2):338-342. [Medline].

  13. Kawamura T, Nimura I, Hanafusa M, et al. DiGeorge syndrome with Graves' disease: A case report. Endocr J. Feb 2000;47(1):91-5. [Medline].

  14. Ham Pong AJ, Cavallo A, Holman GH, Goldman AS. DiGeorge syndrome: long-term survival complicated by Graves disease. J Pediatr. Apr 1985;106(4):619-20. [Medline].

  15. DePiero AD, Lourie EM, Berman BW, Robin NH, Zinn AB, Hostoffer RW. Recurrent immune cytopenias in two patients with DiGeorge/velocardiofacial syndrome. J Pediatr. Sep 1997;131(3):484-6. [Medline].

  16. Levy A, Michel G, Lemerrer M, Philip N. Idiopathic thrombocytopenic purpura in two mothers of children with DiGeorge sequence: a new component manifestation of deletion 22q11?. Am J Med Genet. Apr 14 1997;69(4):356-9. [Medline].

  17. Sullivan KE, McDonald-McGinn DM, Driscoll DA, et al. Juvenile rheumatoid arthritis-like polyarthritis in chromosome 22q11.2 deletion syndrome (DiGeorge anomalad/velocardiofacial syndrome/conotruncal anomaly face syndrome). Arthritis Rheum. Mar 1997;40(3):430-6. [Medline].

  18. Archer E, Chuang TY, Hong R. Severe eczema in a patient with DiGeorge's syndrome. Cutis. Jun 1990;45(6):455-9. [Medline].

  19. Staple L, Andrews T, McDonald-McGinn D, Zackai E, Sullivan KE. Allergies in patients with chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome) and patients with chronic granulomatous disease. Pediatr Allergy Immunol. May 2005;16(3):226-30. [Medline].

  20. Xu H, Morishima M, Wylie JN, et al. Tbx1 has a dual role in the morphogenesis of the cardiac outflow tract. Development. Jul 2004;131(13):3217-27. [Medline].

  21. Kobrynski LJ, Sullivan KE. Velocardiofacial syndrome, DiGeorge syndrome: the chromosome 22q11.2 deletion syndromes. Lancet. Oct 20 2007;370(9596):1443-52. [Medline].

  22. Selim MA, Markert ML, Burchette JL, Herman CM, Turner JW. The cutaneous manifestations of atypical complete DiGeorge syndrome: a histopathologic and immunohistochemical study. J Cutan Pathol. Apr 2008;35(4):380-5. [Medline].

  23. Markert ML, Boeck A, Hale LP, et al. Transplantation of thymus tissue in complete DiGeorge syndrome. N Engl J Med. Oct 14 1999;341(16):1180-9. [Medline].

  24. Goldsobel AB, Haas A, Stiehm ER. Bone marrow transplantation in DiGeorge syndrome. J Pediatr. Jul 1987;111(1):40-4. [Medline].

  25. Markert ML, Devlin BH, Alexieff MJ, et al. Review of 54 patients with complete DiGeorge anomaly enrolled in protocols for thymus transplantation: outcome of 44 consecutive transplants. Blood. May 15 2007;109(10):4539-47. [Medline].

  26. Driscoll DA, Spinner NB, Budarf ML, et al. Deletions and microdeletions of 22q11.2 in velo-cardio-facial syndrome. Am J Med Genet. Sep 15 1992;44(2):261-8. [Medline].

  27. Ryan AK, Goodship JA, Wilson DI, et al. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet. Oct 1997;34(10):798-804. [Medline].

  28. Azzari C, Gambineri E, Resti M, Moriondo M, Betti L, Saldias LR. Safety and immunogenicity of measles-mumps-rubella vaccine in children with congenital immunodeficiency (DiGeorge syndrome). Vaccine. Feb 25 2005;23(14):1668-71. [Medline].

  29. Moylett EH, Wasan AN, Noroski LM, Shearer WT. Live viral vaccines in patients with partial DiGeorge syndrome: clinical experience and cellular immunity. Clin Immunol. Jul 2004;112(1):106-12. [Medline].

  30. Ammann AJ, Wara DW, Cowan MJ, Barrett DJ, Stiehm ER. The DiGeorge syndrome and the fetal alcohol syndrome. Am J Dis Child. Oct 1982;136(10):906-8. [Medline].

  31. August CS, Berkel AI, Levey RH, Rosen FS, Kay HE. Establishment of immunological competence in a child with congenital thymic aplasia by a graft of fetal thymus. Lancet. May 23 1970;1(7656):1080-3. [Medline].

  32. Barrett DJ, Ammann AJ, Wara DW, Cowan MJ, Fisher TJ, Stiehm ER. Clinical and immunologic spectrum of the DiGeorge syndrome. J Clin Lab Immunol. Jul 1981;6(1):1-6. [Medline].

  33. Bastian J, Law S, Vogler L, et al. Prediction of persistent immunodeficiency in the DiGeorge anomaly. J Pediatr. Sep 1989;115(3):391-6. [Medline].

  34. Belohradsky BH. [Thymus aplasia and hypoplasia with hypoparathyroidism, heart and vascular abnormalities (Di-George syndrome)]. Ergeb Inn Med Kinderheilkd. 1986;54:35-105. [Medline].

  35. Bowers DC, Lederman HM, Sicherer SH, Winkelstein JA, Chen AR. Immune constitution of complete DiGeorge anomaly by transplantation of unmobilised blood mononuclear cells. Lancet. Dec 19-26 1998;352(9145):1983-4. [Medline].

  36. Cleveland WW, Fogel BJ, Brown WT, Kay HE. Foetal thymic transplant in a case of Digeorge's syndrome. Lancet. Dec 7 1968;2(7580):1211-4. [Medline].

  37. Conley ME, Beckwith JB, Mancer JF, Tenckhoff L. The spectrum of the DiGeorge syndrome. J Pediatr. Jun 1979;94(6):883-90. [Medline].

  38. Driscoll DA, Budarf ML, Emanuel BS. A genetic etiology for DiGeorge syndrome: consistent deletions and microdeletions of 22q11. Am J Hum Genet. May 1992;50(5):924-33. [Medline].

  39. Driscoll DA, Salvin J, Sellinger B, et al. Prevalence of 22q11 microdeletions in DiGeorge and velocardiofacial syndromes: implications for genetic counselling and prenatal diagnosis. J Med Genet. Oct 1993;30(10):813-7. [Medline].

  40. Farrell MJ, Stadt H, Wallis KT, et al. HIRA, a DiGeorge syndrome candidate gene, is required for cardiac outflow tract septation. Circ Res. Feb 5 1999;84(2):127-35. [Medline].

  41. Fernandez L, Lapunzina P, Arjona D, et al. Comparative study of three diagnostic approaches (FISH, STRs and MLPA) in 30 patients with 22q11.2 deletion syndrome. Clin Genet. Oct 2005;68(4):373-8. [Medline].

  42. Francis IR, Glazer GM, Bookstein FL, Gross BH. The thymus: reexamination of age-related changes in size and shape. AJR Am J Roentgenol. Aug 1985;145(2):249-54. [Medline].

  43. Gidding SS, Minciotti AL, Langman CB. Unmasking of hypoparathyroidism in familial partial DiGeorge syndrome by challenge with disodium edetate. N Engl J Med. Dec 15 1988;319(24):1589-91. [Medline].

  44. Goldmuntz E, Clark BJ, Mitchell LE, et al. Frequency of 22q11 deletions in patients with conotruncal defects. J Am Coll Cardiol. Aug 1998;32(2):492-8. [Medline].

  45. Goldmuntz E, Driscoll D, Budarf ML, et al. Microdeletions of chromosomal region 22q11 in patients with congenital conotruncal cardiac defects. J Med Genet. Oct 1993;30(10):807-12. [Medline].

  46. Goldmuntz E, Driscoll DA, Emanuel BS. Microdeletions of chromosome 22 in patients with conotruncal cardiac defects. Am J Cardiol. 1992;70:557.

  47. Greenberg F, Courtney KB, Wessels RA, et al. Prenatal diagnosis of deletion 17p13 associated with DiGeorge anomaly. Am J Med Genet. Sep 1988;31(1):1-4. [Medline].

  48. Greenberg F, Elder FF, Haffner P, Northrup H, Ledbetter DH. Cytogenetic findings in a prospective series of patients with DiGeorge anomaly. Am J Hum Genet. Nov 1988;43(5):605-11. [Medline].

  49. Guris DL, Fantes J, Tara D, Druker BJ, Imamoto A. Mice lacking the homologue of the human 22q11.2 gene CRKL phenocopy neurocristopathies of DiGeorge syndrome. Nat Genet. Mar 2001;27(3):293-8. [Medline].

  50. Haire RN, Buell RD, Litman RT, et al. Diversification, not use, of the immunoglobulin VH gene repertoire is restricted in DiGeorge syndrome. J Exp Med. Sep 1 1993;178(3):825-34. [Medline].

  51. Hasegawa T, Hasegawa Y, Yokoyama T, Koto S, Asamura S, Tsuchiya Y. Unmasking of latent hypoparathyroidism in a child with partial DiGeorge syndrome by ethylenediaminetetraacetic acid infusion. Eur J Pediatr. Apr 1993;152(4):316-8. [Medline].

  52. Hong R. The DiGeorge anomaly (CATCH 22, DiGeorge/velocardiofacial syndrome). Semin Hematol. Oct 1998;35(4):282-90. [Medline].

  53. Jerome LA, Papaioannou VE. DiGeorge syndrome phenotype in mice mutant for the T-box gene, Tbx1. Nat Genet. Mar 2001;27(3):286-91. [Medline].

  54. Jose DG, Barnes G, Rossiter EJ, Myers NA, Fitzgerald MG. Reconstitution of cellular immune function in a child with thymic aplasia by foetal thymus grafting. Aust N Z J Med. Jun 1974;4(3):267-73. [Medline].

  55. Junker AK, Driscoll DA. Humoral immunity in DiGeorge syndrome. J Pediatr. Aug 1995;127(2):231-7. [Medline].

  56. Kelley RI, Zackai EH, Emanuel BS, Kistenmacher M, Greenberg F, Punnett HH. The association of the DiGeorge anomalad with partial monosomy of chromosome 22. J Pediatr. Aug 1982;101(2):197-200. [Medline].

  57. Lane HC, Depper JM, Greene WC, Whalen G, Waldmann TA, Fauci AS. Qualitative analysis of immune function in patients with the acquired immunodeficiency syndrome. Evidence for a selective defect in soluble antigen recognition. N Engl J Med. Jul 11 1985;313(2):79-84. [Medline].

  58. Lindsay EA, Vitelli F, Su H, et al. Tbx1 haploinsufficieny in the DiGeorge syndrome region causes aortic arch defects in mice. Nature. Mar 1 2001;410(6824):97-101. [Medline].

  59. Mayumi M, Kimata H, Suehiro Y, et al. DiGeorge syndrome with hypogammaglobulinaemia: a patient with excess suppressor T cell activity treated with fetal thymus transplantation. Eur J Pediatr. Apr 1989;148(6):518-22. [Medline].

  60. Minier F, Carles D, Pelluard F, Alberti EM, Stern L, Saura R. [DiGeorge syndrome, a review of 52 patients]. Arch Pediatr. Mar 2005;12(3):254-7. [Medline].

  61. Muller W, Peter HH, Wilken M, et al. The DiGeorge syndrome. I. Clinical evaluation and course of partial and complete forms of the syndrome. Eur J Pediatr. Jun 1988;147(5):496-502. [Medline].

  62. Murphy KC. Annotation: velo-cardio-facial syndrome. J Child Psychol Psychiatry. Jun 2005;46(6):563-71. [Medline].

  63. Müller W, Peter HH, Kallfelz HC, Franz A, Rieger CH. The DiGeorge sequence. II. Immunologic findings in partial and complete forms of the disorder. Eur J Pediatr. Nov 1989;149(2):96-103. [Medline].

  64. Saitta SC, Harris SE, McDonald-McGinn DM, et al. Independent de novo 22q11.2 deletions in first cousins with DiGeorge/velocardiofacial syndrome. Am J Med Genet A. Jan 30 2004;124A(3):313-7. [Medline].

  65. Scambler P. HIRA, a DiGeorge syndrome candidate gene, is required for normal embryogenesis. Am J Hum Genet. 1998;63:A7.

  66. Scambler PJ, Carey AH, Wyse RK, et al. Microdeletions within 22q11 associated with sporadic and familial DiGeorge syndrome. Genomics. May 1991;10(1):201-6. [Medline].

  67. Smith CA, Driscoll DA, Emanuel BS, McDonald-McGinn DM, Zackai EH, Sullivan KE. Increased prevalence of immunoglobulin A deficiency in patients with the chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). Clin Diagn Lab Immunol. May 1998;5(3):415-7. [Medline].

  68. Sobin C, Kiley-Brabeck K, Karayiorgou M. Lower prepulse inhibition in children with the 22q11 deletion syndrome. Am J Psychiatry. Jun 2005;162(6):1090-9. [Medline].

  69. Stiehm ER. Immunodeficiency disorders: General considerations. In: Stiehm ER, ed. Immunologic disorders in Infants and Children. Philadelphia, Pa: WB Saunders; 1989:157-95.

  70. Stoller JZ, Epstein JA. Identification of a novel nuclear localization signal in Tbx1 that is deleted in DiGeorge syndrome patients harboring the 1223delC mutation. Hum Mol Genet. Apr 1 2005;14(7):885-92. [Medline].

  71. Sulik KK, Johnston MC, Daft PA, Russell WE, Dehart DB. Fetal alcohol syndrome and DiGeorge anomaly: critical ethanol exposure periods for craniofacial malformations as illustrated in an animal model. Am J Med Genet Suppl. 1986;2:97-112. [Medline].

  72. van Amelsvoort T, Daly E, Henry J, et al. Brain anatomy in adults with velocardiofacial syndrome with and without schizophrenia: preliminary results of a structural magnetic resonance imaging study. Arch Gen Psychiatry. Nov 2004;61(11):1085-96.

  73. Wilson DI, Burn J, Scambler P, Goodship J. DiGeorge syndrome: part of CATCH 22. J Med Genet. Oct 1993;30(10):852-6. [Medline].

  74. Yamagishi H, Garg V, Matsuoka R, Thomas T, Srivastava D. A molecular pathway revealing a genetic basis for human cardiac and craniofacial defects. Science. Feb 19 1999;283(5405):1158-61. [Medline].

  75. Zinkstok J, van Amelsvoort T. Neuropsychological profile and neuroimaging in patients with 22Q11.2 Deletion Syndrome: a review. Child Neuropsychol. Feb 2005;11(1):21-37. [Medline].

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Further Reading

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Keywords

DiGeorge syndrome, DiGeorge anomaly, DGA, thymic hypoplasia, thymic aplasia, third and fourth pouch syndrome, third and fourth arch syndrome, cellular immunodeficiency, hypoparathyroidism, 22q11 deletion syndromes, 22q11.2 deletion syndromes, 22q11DS, CH22qD syndrome, velocardiofacial syndrome, VCFS, Shprintzen syndrome, conotruncal anomaly face syndrome, Cayler syndrome, Opitz-GBBB syndrome, CHARGE syndrome, coloboma, heart anomalies, atresia of choanae, choanal atresia, retardation, genital hypoplasia, ear anomalies, hypocalcemia, fetal alcohol syndrome, FAS, FISH, FISH technique, fluorescent in situ hybridization, multiplex ligation-dependent probe amplification, MLPA

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Contributor Information and Disclosures

Author

Patrick Htain Win, MD, President/Director, Allergy, Asthma and Immunology Center, SC
Patrick Htain Win, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, and Joint Council of Allergy, Asthma and Immunology
Disclosure: Nothing to disclose.

Coauthor(s)

Sridhar Guduri, MD, Consulting Staff, Allergy and Asthma Clinics of Ohio
Sridhar Guduri, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American College of Allergy, Asthma and Immunology
Disclosure: Nothing to disclose.

Iftikhar Hussain, MD, Director of Allergy, Asthma, and Immunology Center, PC
Iftikhar Hussain, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, American Thoracic Society, and Association of Clinical Research Professionals
Disclosure: Nothing to disclose.

Medical Editor

Charles H Kirkpatrick, MD, Professor of Medicine and Immunology, University of Colorado School of Medicine; Director of Adult Immune Deficiency Program, Department of Medicine, University of Colorado Health Sciences Center; Consulting Staff, Department of Medicine, National Jewish Medical and Research Center
Charles H Kirkpatrick, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Physicians, American Federation for Clinical Research, American Society for Clinical Investigation, and Clinical Immunology Society
Disclosure: Lev Pharmaceuticals Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Samuel R Marney, Jr, MD, Director, Associate Professor, Department of Internal Medicine, Division of Allergy and Immunology, Vanderbilt University School of Medicine
Samuel R Marney, Jr, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Physicians, and Tennessee Medical Association
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD, Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy
Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians
Disclosure: Abbott Consulting fee Consulting; Alcon Consulting fee Consulting; Glaxo Consulting fee Consulting; Greer Consulting fee Consulting; Sanofi Consulting fee Consulting; Schering Consulting fee Consulting; Teva  Consulting; Meda Honoraria Speaking and teaching

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