Dr. Chitra Dinakar is a Clinical Professor of Medicine at Stanford University and the Clinical Chief of Allergy, Asthma and Immunodeficiency, Stanford Health Care. Prior to coming to Stanford she was a Professor of Pediatrics at the University of Missouri-Kansas City; and Director, Food Allergy Center at Children’s Mercy Hospital, Kansas City. She completed her fellowship in Allergy/Immunology (A/I) at the Cleveland Clinic Foundation, Ohio, and her residency in pediatrics at Case Western Reserve University/Metrohealth Medical Center, Ohio. She completed her medical school and pediatric residency training at JIPMER, a premier medical institution in India.

Having had the benefit of experiencing health care in diverse settings, Dr. Dinakar is empowered with the perspective, and driven by the passion, to improve health care across the globe. Her interests and expertise include food allergies, asthma, and health care disparities, delivery, and outcomes. She serves on the editorial boards of four reputed Allergy/Immunology journals and the World Allergy Organization Web Editorial Board. She has been involved in more than 50 multi-centered, clinical trials relating to asthma and food allergies, and has over 100 peer-reviewed publications and research abstracts in prestigious journals.

One of her current research interests is ASIAd (Allergy/Asthma Studies in Individuals of Asian Descent), that explores the Care, Cure and Prevention of Allergic conditions in individuals of Asian lineage. As part of the exploration she is collaborating with researchers from Northwestern University to study the unique food allergens prevalent in the South Asian population (please click on link: She hopes to address the significant knowledge gaps and unmet needs regarding diagnostic, treatment and preventive options available to this demographic group. Another current area of focus is development of tools to improve patient outcomes in food allergic disorders; she recently received a grant to support phase I of the project. Her other ongoing research interests include the health impact of e-cigarettes, clinical intervention trials and outcomes research in asthma, and use of e-health to improve patient outcomes.

She is an invited speaker at national and international allergy conferences, and serves on the Board of Directors at national A/I organizations [American Board of A/I; American Academy of A/I; Joint A/I Task Force on Practice Parameters; American Academy of Pediatrics Section of A/I]. Dr. Dinakar’s honors include the following national awards: ”Distinguished Fellow", "Woman in Allergy", “Acellus Teacher of the Year”, "Award of Excellence", and an honorary “Kentucky Colonel” awarded by the Governor of Kentucky, “Best Doctors in America”, and “Kansas City SuperDocs”.

Clinical Focus

  • Allergy and Immunology

Administrative Appointments

  • Clinical Chief, Allergy, Asthma and Immunodeficiency, Stanford Health Care (2017 - Present)

Honors & Awards

  • Distinguished Service Award, Executive Member of the Section of A/I, American Academy of Pediatrics, (2017)
  • Gies Foundation Endowed Faculty Scholar for Food Allergy, Asthma and Immunology Research, Child Health Research Institute, Stanford (2017)
  • Distinguished Fellow Award, American College of Allergy, Asthma and Immunology (ACAAI) (2016)
  • Excellence in Service, Missouri State Medical Association (2016)
  • Woman in Allergy Award, American College of Allergy, Asthma and Immunology (ACAAI) (2015)
  • Acellus Teacher of the Year, International Academy of Science (2015)
  • Service Recognition Award, American College of Allergy, Asthma and Immunology (ACAAI) (2014)
  • Golden Apple Mercy Mentor Award, Children's Mercy Hospital (2013)
  • Kentucky Colonel, Commonwealth of Kentucky (2013)
  • Award of Excellence, American Association of Allergists & Immunologists of Indian Origin (2009)
  • Outstanding Faculty Abstract Award, American Academy of Pediatrics Section on Allergy and Immunology (2005)
  • Fellow (FAAAAI), American Academy of Allergy, Asthma & Immunology (AAAAI) (2003)
  • Fellow (FACAAI), American College of Allergy, Asthma & Immunology (2003)
  • Clemens Von Pirquet Award For Best Research Abstract, American College of Allergy, Asthma & Immunology (ACAAI) (2000)
  • Fellow (FAAP), American Academy of Pediatrics (2000)
  • University Gold Medal, MD Pediatrics certifying examination, Pondicherry University, India (1993)
  • Gold Medal, MBBS certifying exam (MD equivalent), PFIZER, India (1991)

Boards, Advisory Committees, Professional Organizations

  • Board of Directors, American Academy of Allergy, Asthma and Immunology (AAAAI) (2017 - Present)
  • Board of Directors, American Board of Allergy and Immunology (ABAI) (2016 - Present)
  • Board Member, Joint Task Force on Allergy/Immunology Practice Parameters (2016 - Present)

Professional Education

  • Board Certification: Allergy and Immunology, American Board of Allergy and Immunology (1999)
  • Fellowship:The Cleveland Clinic Foundation Allergy and Immunology Fellowship (1999) OH
  • Board Certification: Pediatrics, American Board of Pediatrics (1996)
  • Residency:Metrohealth Medical Center Pediatric Residency (1996) OH
  • Medical Education:Jawaharlal Institute of Postgraduate Medical Education and Research (1993) India


All Publications

  • Biallelic mutations in DNA ligase 1 underlie a spectrum of immune deficiencies. The Journal of clinical investigation Maffucci, P., Chavez, J., Jurkiw, T. J., O'Brien, P. J., Abbott, J. K., Reynolds, P. R., Worth, A., Notarangelo, L. D., Felgentreff, K., Cortes, P., Boisson, B., Radigan, L., Cobat, A., Dinakar, C., Ehlayel, M., Ben-Omran, T., Gelfand, E. W., Casanova, J., Cunningham-Rundles, C. 2018


    We report the molecular, cellular, and clinical features of 5 patients from 3 kindreds with biallelic mutations in the autosomal LIG1 gene encoding DNA ligase 1. The patients exhibited hypogammaglobulinemia, lymphopenia, increased proportions of circulating gammadeltaT cells, and erythrocyte macrocytosis. Clinical severity ranged from a mild antibody deficiency to a combined immunodeficiency requiring hematopoietic stem cell transplantation. Using engineered LIG1-deficient cell lines, we demonstrated chemical and radiation defects associated with the mutant alleles, which variably impaired the DNA repair pathway. We further showed that these LIG1 mutant alleles are amorphic or hypomorphic, and exhibited variably decreased enzymatic activities, which lead to premature release of unligated adenylated DNA. The variability of the LIG1 genotypes in the patients was consistent with that of their immunological and clinical phenotypes. These data suggest that different forms of autosomal recessive, partial DNA ligase 1 deficiency underlie an immunodeficiency of variable severity.

    View details for DOI 10.1172/JCI99629

    View details for PubMedID 30395541

  • Penicillin allergy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Lang, D., Dinakar, C., Oppenheimer, J. J., Hernandez-Trujillio, V. 2018; 121 (5): 637–39

    View details for DOI 10.1016/j.anai.2018.08.011

    View details for PubMedID 30389083

  • AAAAI Response to the EAACI/GALEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria 2017 Revision. Allergy Wood, R. A., Khan, D. A., Lang, D. M., Fasano, M. B., Peden, D. B., Busse, P. J., Carter, M. C., Demain, J. G., Dinakar, C., Grayson, M. H., Markovics, S. B., Sicherer, S. H., Stone, K. D., Sullivan, K. E., Williams, P. V., Fleisher, T. A., Casale, T. B. 2018

    View details for DOI 10.1111/all.13636

    View details for PubMedID 30338538

  • Needs Assessment Survey for a Food Allergy Control Tool. The journal of allergy and clinical immunology. In practice Lippner, E., Sicherer, S. H., Land, M. H., Schatz, M., Dinakar, C. 2018

    View details for DOI 10.1016/j.jaip.2018.09.035

    View details for PubMedID 30317004

  • Pharmacotherapy ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Fineman, S. M., Khan, D. A., Dinakar, C., Lang, D., Tilles, S. A. 2018; 121 (1): 22–23

    View details for DOI 10.1016/j.anai.2018.05.008

    View details for Web of Science ID 000436596100006

    View details for PubMedID 29777743

  • Recent advances in our understanding of the environment's role in allergy ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Dinakar, C., Fineman, S. M., Chipps, B. E., Khan, D. A., Tilles, S. A. 2018; 120 (5): 465–67

    View details for DOI 10.1016/j.anai.2018.03.025

    View details for Web of Science ID 000432457900005

    View details for PubMedID 29577979

  • Biologics ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Dinakar, C., Khan, D. A., Fineman, S. M., Lang, D., Tilles, S. A. 2018; 120 (4): 354–56

    View details for DOI 10.1016/j.anai.2018.02.030

    View details for Web of Science ID 000429274800005

    View details for PubMedID 29625663

  • Recent advances in asthma ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Chipps, B. E., Dinakar, C., Fineman, S. M., Tilles, S. A. 2018; 120 (2): 128–30

    View details for DOI 10.1016/j.anai.2017.12.015

    View details for Web of Science ID 000425131400008

    View details for PubMedID 29413335

  • The importance of reducing risk in peanut allergy: Current and future therapies ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Shreffler, W. G., Baumert, J. L., Remington, B. C., Koppelman, S. J., Dinakar, C., Fleischer, D. M., Kim, E., Tilles, S. A., Spergel, J. M. 2018; 120 (2): 124–27

    View details for DOI 10.1016/j.anai.2017.10.038

    View details for Web of Science ID 000425131400007

    View details for PubMedID 29289463

  • Recent advances in atopic dermatitis ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Dinakar, C., Fineman, S. M., Tilles, S. A. 2018; 120 (1): 8–9

    View details for DOI 10.1016/j.anai.2017.11.009

    View details for Web of Science ID 000418485100004

    View details for PubMedID 29273133

  • Treatment of seasonal allergic rhinitis An evidence-based focused 2017 guideline update ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Dykewicz, M. S., Wallace, D. V., Baroody, F., Bernstein, J., Craig, T., Finegold, I., Huang, F., Larenas-Linnemann, D., Meltzer, E., Steven, G., Bernstein, D. I., Blessing-Moore, J., Dinakar, C., Greenhawt, M., Horner, C. C., Khan, D. A., Lang, D., Oppenheimer, J., Portnoy, J. M., Randolph, C. R., Rank, M. A. 2017; 119 (6): 489-+

    View details for DOI 10.1016/j.anai.2017.08.012

    View details for Web of Science ID 000417481100006

    View details for PubMedID 29103802

  • American College of Allergy, Asthma & Immunology Position Paper on the Use of Telemedicine for Allergists ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Elliott, T., Shih, J., Dinakar, C., Portnoy, J., Fineman, S. 2017; 119 (6): 512–17


    The integration of telecommunications and information systems in health care first began 4 decades ago with 500 patient consultations performed via interactive television. The use of telemedicine services and technology to deliver health care at a distance is increasing exponentially. Concomitant with this rapid expansion is the exciting ability to provide enhancements in quality and safety of care. Telemedicine enables increased access to care, improvement in health outcomes, reduction in medical costs, better resource use, expanded educational opportunities, and enhanced collaboration between patients and physicians. These potential benefits should be weighed against the risks and challenges of using telemedicine. The American College of Allergy, Asthma, and Immunology advocates for incorporation of meaningful and sustained use of telemedicine in allergy and immunology practice. This article serves to offer policy and position statements of the use of telemedicine pertinent to the allergy and immunology subspecialty.

    View details for DOI 10.1016/j.anai.2017.09.052

    View details for Web of Science ID 000417481100007

    View details for PubMedID 29103799

  • Combining anti-IgE with oral immunotherapy PEDIATRIC ALLERGY AND IMMUNOLOGY Lin, C., Lee, I. T., Sampath, V., Dinakar, C., DeKruyff, R. H., Schneider, L. C., Nadeau, K. 2017; 28 (7): 619–27


    Food allergy is a significant medical problem that affects up to 8% of children in developed countries. At present, there are no curative therapies available in routine practice and management of food allergy involves strict allergen avoidance, education, and prompt treatment upon accidental exposure. Oral immunotherapy (OIT) is an efficacious experimental approach to food allergy and has been shown to provide a substantial benefit in terms of allergen desensitization. However, OIT is associated with high rates of allergic reactions, and the period of protection offered by OIT appears to be limited and highly variable. Recurrence of allergen sensitivity after a period of treatment discontinuation is commonly observed. With the aim of overcoming these limitations of OIT, several trials have studied omalizumab (anti-IgE monoclonal antibody) as an adjuvant treatment for patients undergoing OIT. Results from these trials have shown that the addition of omalizumab to OIT leads to a significant decrease in the frequency and severity of reactions, which allows for an increase in the threshold of tolerance to food allergens. This review provides a summary of the current literature and addresses some of the key questions that remain regarding the use of omalizumab in conjunction with OIT.

    View details for DOI 10.1111/pai.12767

    View details for Web of Science ID 000418437400002

    View details for PubMedID 28782296

  • Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Kim, H., Dinakar, C., McInnis, P., Rudin, D., Benain, X., Daley, W., Platz, E. 2017; 118 (6): 719-725 e1


    Epinephrine injection represents the standard of care for anaphylaxis treatment. It is most effective if delivered intramuscularly, whereas inadvertent intraosseous injection may be harmful. The needle length in current pediatric epinephrine autoinjectors (EAIs) is 12.7 mm; however, the ideal needle length for infants and toddlers weighing less than 15 kg is unknown.To determine the skin-to-bone distance (STBD) and skin-to-muscle distance (STMD) at baseline and after simulated EAI application in infants and toddlers (weighing 7.5-15 kg).Study participants recruited from 2 North American allergy clinics underwent baseline and compression (10-lb pressure) ultrasonography of the anterolateral thigh with a modified ultrasound transducer mimicking the footprint and maximum pressure application of an EAI device. Ultrasound images, with clinical data masked, were analyzed offline for STBD and STMD in short-axis approach.Of 53 infants (mean age, 18.9 months; 54.7% male; 81.1% white; mean weight, 11.0 kg), 51 had adequate images for short-axis STBD measurements. In these infants, the mean (SD) baseline STBD was 22.4 (3.8 mm), and the mean (SD) STMD was 7.9 (1.7) mm. With 10-lb compression, the mean (SD) STBD was 13.3 (2.1) mm, and the mean (SD) STMD was 6.3 (1.2) mm. An EAI with a needle length of 12.7 mm applying 10-lb pressure could strike the bone in 43.1% of infants and toddlers in this cohort.Our data suggest that the optimal EAI needle length for infants and toddlers weighing 7.5 to 15 kg should be shorter than the needle length in currently available pediatric EAIs to avoid accidental intraosseous injections.

    View details for DOI 10.1016/j.anai.2017.03.017

    View details for PubMedID 28483294

  • Patient-Centered Outcomes in Food Allergy. Current allergy and asthma reports Polk, B. I., Dinakar, C. 2017; 17 (6): 39-?


    Food allergy prevalence is increasing very rapidly, causing a significant disease burden. The threat of severe allergic reactions occurring unexpectedly and in settings that are not equipped to recognize and treat anaphylaxis is a constant source of worry for individuals and families with food allergies. Inadequate knowledge and understanding in the community significantly impairs the overall quality of life of these individuals and families. Additionally, families face challenges in finding and affording appropriate allergen-free foods.Advancements have been made in understanding the impact of food allergies on patient-centered outcomes such as quality of life and economic impact, and attempts have been made to develop tools to assess patient-centered variables. Innovative national and regional initiatives are helping to spread awareness of the disease condition and to create resources, including access to allergen-free foods. While there is a growing momentum toward recognition of food allergic disorders as a condition that profoundly impacts activities of daily living, greater effort needs to be expounded to develop validated tools and interventions that can adequately address these issues.

    View details for DOI 10.1007/s11882-017-0708-z

    View details for PubMedID 28516366

  • Ara h2 levels in dust from homes of individuals with peanut allergy and individuals with peanut tolerance ALLERGY AND ASTHMA PROCEEDINGS Shroba, J., Barnes, C., Nanda, M., Dinakar, C., Ciaccio, C. 2017; 38 (3): 192-196


    Approximately 1% of the U.S. population has a peanut allergy. Previous studies that measured peanut protein in house dust support the hypothesis that household peanut consumption may lead to clinical sensitization through transdermal exposure.The aim of this pilot study was to characterize Ara h2 levels in house dust from homes with and without individuals with peanut allergy.Household dust was obtained from homes with an individual with peanut allergy and from homes with no individual with peanut allergy. Ara h2 levels were determined by using a monoclonal antibody-based immunoassay with a level of determination of 150 ng per gram of dust. Peanut consumption information was obtained by questionnaire.A total of 85 dust samples were collected: 38 from homes with a individual with peanut allergy and 47 from control homes. The median Ara h2 level in homes with an individual with peanut allergy was 1236 ng/g (interquartile range [IQR], 256-1342 ng/g), whereas the median Ara h2 level in homes without an individual with peanut allergy was 650 ng/g (IQR, 163-2201 ng/g). Ara h2 levels in dust from homes of individuals with peanut allergy were not significantly lower than in dust from control homes. Of the homes with an individual with peanut allergy, 15 reported complete avoidance of peanut in the home (39%). Ara h2 levels in homes that completely avoided peanuts were not significantly lower than Ara h2 levels in homes that did not restrict peanuts (p = 0.531).Although families may restrict peanuts and peanut products in the home, there was still detectable Ara h2 levels found in homes. Each subject's definition of restriction may vary, there seemed to be peanut protein entering the home, although the protein origin is not known. Possibilities include cross-reactivity with another antigen or transport into the home on some vector. Further investigation of hypotheses regarding cross-reactivity and environmental exposure to Ara h2 is necessary.

    View details for DOI 10.2500/aap.2017.38.4049

    View details for Web of Science ID 000401128300011

    View details for PubMedID 28441989

  • Immunodeficiency-associated Lymphoid Hyperplasia as a Cause of Intussusception in a Case of activated PI3K-delta Syndrome FRONTIERS IN PEDIATRICS Mettman, D., Thiffault, I., Dinakar, C., Saunders, C. 2017; 5


    Activated PI3K-δ syndrome refers to a recently described primary immunodeficiency syndrome consisting of recurrent sinopulmonary infections, lymphadenopathy, mucosal lymphoid aggregates, increased susceptibility to Epstein-Barr virus and cytomegalovirus, and increased incidence of B-cell lymphomas. Variants in PIK3CD, which encodes the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta isoform, enhance membrane association and kinase activity, resulting in increased signal transduction through the PI3K-Akt pathway. Whole-exome sequencing revealed a pathogenic PIK3CD variant in a patient with history of immunologic impairment, recurrent sinopulmonary infections, and lymphoid hyperplasia presenting as intussusception. This case illustrates that while lymphoid hyperplasia secondary to immunodeficiency is most often unsurprising and non-threatening, it can present as an emergency-like intussusception.

    View details for DOI 10.3389/fped.2017.00071

    View details for Web of Science ID 000399620700001

    View details for PubMedID 28469999

  • Food Allergy-Related Risk-Taking and Management Behaviors Among Adolescents and Young Adults. journal of allergy and clinical immunology. In practice Warren, C. M., Dyer, A. A., Otto, A. K., Smith, B. M., Kauke, K., Dinakar, C., Gupta, R. S. 2017


    Food allergy (FA) affects 8% of children and adolescents in the United States. Nearly 40% of those affected have experienced severe reactions. Fatal food-induced anaphylaxis is most common among adolescents and young adults (AYA); however, FA-related risk behaviors persist in this population and factors associated with these behaviors remain unclear.To characterize FA-related risk-taking and self-management behaviors of AYA with FA.A cross-sectional survey was administered to 200 AYA with FA. Latent class analysis was used to identify distinct behavioral risk classes and predictors of risk class membership.Two distinct FA behavioral risk classes were identified, representing less (N = 120) and more (N = 80) risky subpopulations. After adjusting for age, sex, and anaphylaxis history, odds of more risky class membership were significantly reduced for AYA with peanut allergy (odds ratio [OR], 0.27; 95% CI, 0.11-0.65), supportive female friends (OR, 0.27; 95% CI, 0.07-0.99), overprotective mothers (OR, 0.42; 95% CI, 0.18-0.97), teachers who are aware of their FA (OR, 0.39; 95% CI, 0.17-0.91), a history of being bullied (OR, 0.22; 95% CI, 0.09-0.51), and an established 504 education plan (OR, 0.35; 95% CI, 0.15-0.81). AYA also reported numerous positive outcomes of their FA, such as greater responsibility, empathy, and improved diet, which was significantly associated with reduced odds of risky class membership (OR, 0.38; 95% CI, 0.18-0.80).Among AYA, increased FA-related risk-taking was associated with clinical, demographic, and social factors, including peanut allergy, greater age, as well as absence of social support and specific school FA policies. These associations may be used to inform future interventions designed to address FA-related risk and management behaviors.

    View details for DOI 10.1016/j.jaip.2016.12.012

    View details for PubMedID 28132799

  • Evaluating proteins for potential allergenicity using bioinformatic approaches. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Dinakarpandian, D., Dinakar, C. 2017; 119 (3): 197–98

    View details for DOI 10.1016/j.anai.2017.06.020

    View details for PubMedID 28890013

  • Stinging insect hypersensitivity A practice parameter update 2016 ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Golden, D. B., DeMain, J., Freeman, T., Graft, D., Tankersley, M., Tracy, J., Blessing-Moore, J., Bernstein, D., Dinakar, C., Greenhawt, M., Khan, D., Lang, D., Nicklas, R., Oppenheimer, J., Portnoy, J., Randolph, C., Schuller, D., Wallace, D. 2017; 118 (1): 28-54

    View details for DOI 10.1016/j.anai.2016.10.031

    View details for Web of Science ID 000396430600007

    View details for PubMedID 28007086

  • Comparison of allergens collected from furnace filters and vacuum floor dust. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Allenbrand, R., Barnes, C. S., Mohammed, M., Gard, L., Pacheco, F., Kennedy, K., DiDonna, A., Portnoy, J., Dinakar, C. 2017; 118 (1): 108-109

    View details for DOI 10.1016/j.anai.2016.10.001

    View details for PubMedID 27839669

  • Prevalence of food allergies in South Asia. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Arakali, S. R., Green, T. D., Dinakar, C. 2017; 118 (1): 16-20


    To evaluate the published medical literature on the prevalence and types of food allergies in South Asia.A PubMed search was performed using the keywords India and food allergy, Asia and food allergy, and South Asia and food allergy for any period. Articles cited in selected studies were reviewed for their appropriateness of inclusion into this review.Publications were included that were original research and fit the topic of food allergy and South Asia. South Asia is defined as region inclusive of India, Pakistan, Bangladesh, and Sri Lanka.A total of 169 articles were initially identified, and 47 were reviewed in detail for inclusion in this review. The primary focus was placed on 10 studies that consisted of case reports of newly reported or documented food allergy, survey studies that investigated food allergy prevalence in specific demographics, and prospective and cross-sectional studies with case controls, all of which investigated food allergy prevalence by allergy testing in a selected population.The medical literature on the prevalence and types of food allergy in South Asia indicates that there is a variety of unusual and unique allergens and an overall low incidence of food allergy. There is also an association of increased food allergy prevalence in individuals who live in metropolitan regions or who migrate to communities that have adopted westernization.

    View details for DOI 10.1016/j.anai.2016.09.441

    View details for PubMedID 27864090

  • Association of tree nut and coconut sensitizations. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Polk, B. I., Dinakarpandian, D., Nanda, M., Barnes, C., Dinakar, C. 2016; 117 (4): 412-416


    Coconut (Cocos nucifera), despite being a drupe, was added to the US Food and Drug Administration list of tree nuts in 2006, causing potential confusion regarding the prevalence of coconut allergy among tree nut allergic patients.To determine whether sensitization to tree nuts is associated with increased odds of coconut sensitization.A single-center retrospective analysis of serum specific IgE levels to coconut, tree nuts (almond, Brazil nut, cashew, chestnut, hazelnut, macadamia, pecan, pistachio, and walnut), and controls (milk and peanut) was performed using deidentified data from January 2000 to August 2012. Spearman correlation (ρ) between coconut and each tree nut was determined, followed by hierarchical clustering. Sensitization was defined as a nut specific IgE level of 0.35 kU/L or higher. Unadjusted and adjusted associations between coconut and tree nut sensitization were tested by logistic regression.Of 298 coconut IgE values, 90 (30%) were considered positive results, with a mean (SD) of 1.70 (8.28) kU/L. Macadamia had the strongest correlation (ρ = 0.77), whereas most other tree nuts had significant (P < .05) but low correlation (ρ < 0.5) with coconut. The adjusted odds ratio between coconut and macadamia was 7.39 (95% confidence interval, 2.60-21.02; P < .001) and 5.32 (95% confidence interval, 2.18-12.95; P < .001) between coconut and almond, with other nuts not being statistically significant.Our findings suggest that although sensitization to most tree nuts appears to correlate with coconut, this is largely explained by sensitization to almond and macadamia. This finding has not previously been reported in the literature. Further study correlating these results with clinical symptoms is planned.

    View details for DOI 10.1016/j.anai.2016.07.023

    View details for PubMedID 27566863

  • Telemedicine is as effective as in-person visits for patients with asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Portnoy, J. M., Waller, M., De Lurgio, S., Dinakar, C. 2016; 117 (3): 241-245


    Access to asthma specialists is a problem, particularly in rural areas, thus presenting an opportunity for management using telemedicine.To compare asthma outcomes during 6 months in children managed by telemedicine vs in-person visits.Children with asthma residing in 2 remote locations were offered the choice of an in-person visit or a telemedicine session at a local clinic. The telemedicine process involved real-time use of a Remote Presence Solution (RPS) equipped with a digital stethoscope, otoscope, and high-resolution camera. A telefacilitator operated the RPS and performed diagnostic and educational procedures, such as spirometry and asthma education. Children in both groups were assessed initially, after 30 days, and at 6 months. Asthma outcome measures included asthma control using validated tools (Asthma Control Test, Childhood Asthma Control Test, and Test for Respiratory and Asthma Control in Kids) and patient satisfaction (telemedicine group only). Noninferiority analysis of asthma control was performed using the minimally important difference of an adjusted asthma control test that combined the 3 age groups.Of 169 children, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all 3 visits. All had a small, although statistically insignificant, improvement in asthma control over time. Telemedicine was noninferior to in-person visits. Most of the telemedicine group subjects were satisfied with their experience.Children with asthma seen by telemedicine or in-person visits can achieve comparable degrees of asthma control. Telemedicine can be a viable alternative to traditional in-person physician-based care for the treatment and management of asthma.

    View details for DOI 10.1016/j.anai.2016.07.012

    View details for PubMedID 27613456

  • The talking card: Randomized controlled trial of a novel audio-recording tool for asthma control ALLERGY AND ASTHMA PROCEEDINGS Cowden, J. D., Wilkerson-Amendell, S., Weathers, L., Gonzalez, E. D., Dinakar, C., Westbrook, D. H., Williams, A. R. 2015; 36 (5): E86-E91


    Asthma care plans typically include complicated written instructions. Customized, audio-recorded instructions may bridge health literacy gaps and improve treatment plan understanding.To measure the effects of a recordable greeting card-style tool (Talking Card) on asthma control and parental care of children with asthma.Multisite randomized trial in two primary care clinics, including children 4-11 years old with uncontrolled asthma and their parents. Parent-child dyads were randomized to usual care of asthma or usual care plus the Talking Card. Dyads completed three asthma-focused visits over 3 months. At the visit, card recipients received customized instructions recorded by the pediatrician onto an audio chip in the card. Asthma control was measured by using the Childhood Asthma Control Test. Card use and parental satisfaction were measured by parental survey (card arm only). Outcomes were analyzed by using generalized estimating equations and frequency distributions.Sixty-four dyads participated and attended 166 clinic visits. Card use was associated with a 1.6-point increase in Childhood Asthma Control Test score (p = 0.02) and a clinic visit regardless of card use with a three-point increase (p < 0.001). Satisfaction and self-efficacy were high among the card users. The mean satisfaction score was 8.9 of 10, with 96% agreeing or strongly agreeing that the card helped them take better care of asthma.The Talking Card, a novel audio communication tool, was associated with improved asthma control and deemed highly desirable by parents and children struggling to control asthma. This inexpensive portable tool may be useful in other chronic disorders and in locales with low literacy and poor access to digital technology.

    View details for DOI 10.2500/aap.2015.36.3881

    View details for Web of Science ID 000371873500002

    View details for PubMedID 26314809

  • Management of acute loss of asthma control in the yellow zone: a practice parameter ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Dinakar, C., Oppenheimer, J., Portnoy, J., Bacharier, L. B., Li, J., Kercsmar, C. M., Bernstein, D., Blessing-Moore, J., Khan, D., Lang, D., Nicklas, R., Randolph, C., Schuller, D., Spector, S., Tilles, S. A., Wallace, D. 2014; 113 (2): 143-159

    View details for DOI 10.1016/j.anai.2014.05.017

    View details for Web of Science ID 000341301000006

    View details for PubMedID 25065350

  • Simulation in pediatrics. Missouri medicine Sharma, J., Myers, D., Dinakar, C. 2013; 110 (2): 147-149

    View details for PubMedID 23724489

  • Social perceptions and preferences of youth with asthma. Missouri medicine Dinakar, C., Brimer, A. G., Adams, C. D., Malhi, K. 2006; 103 (5): 553-556


    Peers are a primary source of psychosocial support in youth. Chronic disease such as asthma can make youth feel different and impinge on their adherence to treatment. We investigated factors that make the asthmatic adolescent feel different from peers, and explore their willingness to belong to a peer social-group such as an asthma club. Sixty-six youth (ages 8-18 years) with asthma completed an anonymous questionnaire that included both multiple-choice and open-ended questions designed to explore the feelings of the respondents. Almost one-third of our sample reported negative feelings regarding their asthma. Nearly 27% reported that their diagnosis made them feel different from their healthy peers, while over 25% admitted feeling uncomfortable using their inhaler in front of their friends. Almost one-half of adolescents felt restricted or excluded from school activities, athletics, or social clubs. While most respondents (93.9%)

    View details for PubMedID 17133762

  • Effective management of home exacerbations (yellow zone) of asthma. Missouri medicine Dinakar, C. 2004; 101 (3): 212-217


    The NIH guidelines recommends hat practitioners give asthmatics written action plans with instructions on management of home (yellow zone) exacerbations. There is ambiguity regarding the definition of the yellow zone in patient-appropriate terms, and paucity of data on the efficacy of the different pharmacological interventions that can be used. This article reviews available data and attempts to incorporate these guidelines into clinical practice.

    View details for PubMedID 15311575

  • Allergen immunotherapy in the prevention of asthma. Current opinion in allergy and clinical immunology Dinakar, C., Portnoy, J. M. 2004; 4 (2): 131-136


    Asthma is a disease causing significant morbidity and mortality. In the recent past, there has been an explosion of pharmacotherapeutic options attempting to control the disease. Unfortunately, none of the current options offers the promise of prevention or a permanent cure. However, there appear to be exciting, new data emerging to support the hypothesis that the prevention or early treatment of allergic rhinitis, such as with the use of allergen immunotherapy, may help mitigate the severity of bronchial symptoms and even prevent the development of asthma. In this paper, we review recent research published proposing immunotherapy as a means of preventing the development of, or at least ameliorating, allergic asthma.There is evidence that the upper and lower airways may be considered a single unit, with the nasal and bronchial mucosa having features in common. Epidemiological, pathophysiological and clinical studies have shown that they can be affected by similar inflammatory triggers, with interconnected mechanisms amplifying the inflammatory cascade. Allergic rhinitis is interrelated to, and is a risk factor for, the development of asthma. An evidence-based review validates the successful use of allergen immunotherapy in treating allergic rhinitis and asthma. There is promising evidence advocating its use in the prevention of clinical asthma.This article explores current research pertaining to the use of immunomodulation, such as by using allergen immunotherapy, to ameliorate and prevent the development of allergic asthma.

    View details for PubMedID 15021067