Tara F Carr

Interests

Research

Asthma, sinusitis, rhinitis (allergic and non-allergic), food allergy, environment-host interactions

Teaching

All facets of Allergy/Immunology- atopy, rhinitis, sinusitis, asthma, hypersensitivity, drug allergy, immunotherapy, stinging insect allergy, food allergy, eosinophilic disorders, primary immunodeficiency, secondary immunodeficiency, evaluation and diagnosis of allergic/immunologic disorders

Courses

Scholarly Contributions

Chapters

• Gaefke, C. L., & Carr, T. F. (2018). Chapter 6 – Blood and Sputum Eosinophils as a Biomarker for Selecting and Adjusting Asthma Medication. In Personalizing Asthma Management for the Clinician. Elsevier. doi:10.1016/B978-0-323-48552-4.00006-8
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  Asthma is a common and yet heterogeneous disorder characterized by chronic inflammation of the airways, bronchial hyperresponsiveness, and reversible airflow obstruction. Asthma is dichotomously classified as eosinophilic or noneosinophilic based on the inflammatory cellular patterns seen in sputum, blood, and tissue compartments, as well as studied within the emergent concept of type-2 inflammatory response. The presence of eosinophils in the blood or sputum of patients with asthma may help to guide the selection and adjustment of personalized treatments for maximal control of symptoms. This chapter will review clinically relevant eosinophil biology and practical aspects of eosinophil measurement. Finally, we will discuss the utility of eosinophil assessment when selecting or adjusting medications including inhaled corticosteroids and biologic therapies targeting type-2 inflammatory pathways.
• Tongchinsub, P., & Carr, T. F. (2018). Rhinitis and Structurally Related Problems. In Rhinitis and Related Upper Respiratory Conditions; A Clinical Guide. Springer, Cham. doi:10.1007/978-3-319-75370-6_10
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  Structural abnormalities of the nasal passage are important causes of rhinitis and should be considered in patients with chronic or progressively worsening nasal or paranasal sinus symptoms. While most other etiologies of rhinitis, such as from allergy or acute infection, cause bilateral symptoms, structurally related problems can present unilaterally or bilaterally, depending on the site of the physical irregularity. Structural abnormalities can be grouped into static anatomic abnormalities and space-occupying lesions. Common anatomic abnormalities include deviated nasal septum, nasal septal perforation, turbinate hypertrophy, and atrophic rhinitis. Space-occupying lesions include benign and malignant tumors, granulomatous diseases, nasal polyposis, and adenoidal hypertrophy. Diagnosis of structural causes of rhinitis can be made through direct visualization, utilizing imaging and tissue biopsies when necessary to confirm diagnoses. Treatment of structural causes of rhinitis includes medical interventions specific to the underlying disease, but usually requires surgical correction of the structural issue to restore normal nasal function.
• Carr, T. F., & Gerald, L. B. (2016). Patient education: How to use a peak flow meter (Beyond the Basics). In UpToDate.
• Carr, T. F., & Gerald, L. B. (2016). Peak expiratory flow rate monitoring in asthma. In UpToDate.
• Carr, T. F., & Patel, S. (2015). Corticosteroids in Treatment of Allergic Diseases.. In Patterson's Allergic Diseases, 8th Edition. Wolters Kluwer.
• Gaefke, C. L., & Carr, T. F. (2017). Eosinophils as biomarker in asthma. In Personalizing Asthma Management for the Clinician. Elsevier.
• Patel, S., & Carr, T. F. (2017). Corticosteroids in Treatment of Allergic Diseases. In In Patterson’s Allergic Diseases, 8th Ed. Wolters Kluwer.
• Tongchinsub, P., & Carr, T. F. (2017). Structural causes of Rhinitis. In Springer Science.

Journals/Publications

• Carr, T., Thompson, A. L., Benjamin-Neelon, S. E., Wasser, H. M., & Ward, D. S. (2023). Confirmatory factor analysis of the infant feeding styles questionnaire in infant and toddler child care teachers. Appetite, 183, 106449.
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  Early childhood is a critical time of development. Caregiver feeding style, including of child care providers, has been implicated in influencing children's food preferences and obesity. A better understanding of the determinants of child care providers' feeding styles is important as children increasingly receive daily care and nutrition in child care centers. Valid instruments to measure provider feeding styles specifically for infants are needed. This study's objective was to validate, for use with child care providers, the Infant Feeding Styles Questionnaire (IFSQ), an instrument originally designed for parents of infants and toddlers. Study data came from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) study, a cluster randomized trial, designed to evaluate the efficacy of a six-month-long obesity prevention intervention in child care centers. The IFSQ was administered at baseline and follow-up to infant and toddler teacher participants (n = 244). Scores for baseline IFSQ teacher responses (n = 219) were calculated for the 13 sub-constructs across the five feeding styles. We tested reliability with Cronbach's alpha coefficients and performed confirmatory factor analysis to examine factor loadings and goodness of fit characteristics, modifying constructs to achieve best fit. Reliability coefficients ranged from 0.42 to 0.82 for all sub-constructs. Goodness of fit indices for the final model ranged from: root mean square error of approximation (RMSEA) 0.000-0.082; comparative fit index (CFI) 0.943-1.000; Tucker-Lewis index (TLI) 0.906-1.000; and standardized root mean squared error (SRMR) 0.006-0.130. In a sample of racially diverse infant and toddler child care teachers, final models of the laissez-faire, pressuring, and responsive constructs and the restrictive-diet quality sub-construct performed well. Overall model fit was poor for the indulgence construct, but good for solely its corresponding belief items.
• Carr, T. F., & Kraft, M. (2022). Gaining Insights into Asthma-related COVID-19 Risk. American journal of respiratory and critical care medicine, 205(1), 1-2.
• Carr, T. F., Dixon, A. E., & Que, L. G. (2022). Advances in Asthma. Seminars in Respiratory and Critical Care Medicine, 43(05), 593-594. doi:10.1055/s-0042-1753473
• Carr, T. F., Fajt, M. L., Kraft, M., Phipatanakul, W., Szefler, S. J., Zeki, A. A., Peden, D. B., White, S. R., & , P. I. (2022). Treating asthma in the time of COVID. The Journal of allergy and clinical immunology.
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  The Precision Interventions for Severe and/or Exacerbation-Prone Asthma clinical trials network is actively assessing novel treatments for severe asthma during the coronavirus disease (COVID-19) pandemic and has needed to adapt to various clinical dilemmas posed by the COVID-19 pandemic. Pharmacologic interactions between established asthma therapies and novel drug interventions for COVID-19 infection, including antivirals, biologics, and vaccines, have emerged as a critical and unanticipated issue in the clinical care of asthma. In particular, impaired metabolism of some long-acting beta-2 agonists by the cytochrome P4503A4 enzyme in the setting of antiviral treatment using ritonavir-boosted nirmatrelvir (NVM/r, brand name Paxlovid) may increase risk for adverse cardiovascular events. Although available data have documented the potential for such interactions, these issues are largely unappreciated by clinicians who treat asthma, or those dispensing COVID-19 interventions in patients who happen to have asthma. Because these drug-drug interactions have not previously been relevant to patient care, clinicians have had no guidance on management strategies to reduce potentially serious interactions between treatments for asthma and COVID-19. The Precision Interventions for Severe and/or Exacerbation-Prone Asthma network considered the available literature and product information, and herein share our considerations and plans for treating asthma within the context of these novel COVID-19-related therapies.
• Carr, T. F., Stern, D. A., Morgan, W., Guerra, S., & Martinez, F. D. (2022). Elevated Childhood Insulin-related Asthma Is Risk Factor for Reduced Lung Function. American Journal of Respiratory and Critical Care Medicine. doi:10.1164/rccm.202209-1654le
• Carr, T., Holly, M., Reed, K., Rabbani, R., Chandler, C., Cook, B., Howard, P., McPherson, M., Henry, B., & Ramaswamy, R. (2022). Developing capacity for learning community systems: Experiences from the 100 Million Healthier Lives SCALE Initiative. Learning health systems, 6(3), e10296.
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  This paper explores the capabilities that contribute to community transformation and the common pathways followed by communities in the 100 Million Healthier Lives SCALE (Spreading Community Accelerators through Learning and Evaluation) initiative in their transformation journeys towards a "Culture of Health".
• Dixon, A. E., Carr, T. F., & Que, L. G. (2022). Advances in Asthma. Seminars in respiratory and critical care medicine, 43(5), 593-594.
• Eremija, J., & Carr, T. F. (2022). Immunotherapy for Asthma. Seminars in respiratory and critical care medicine, 43(5), 709-719.
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  Asthma represents one of the biggest global health concerns with increasing prevalence and influence on global health. Several distinct asthma phenotypes have been identified with one of the most common, earliest recognized, and described being the allergic asthma phenotype, in which allergens trigger asthma through mechanisms involving allergen-specific immunoglobulin E (IgE). Allergen-specific immunotherapy (AIT), in the forms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), has been used for many decades as a tool for reducing IgE-mediated sensitization and controlling symptoms of allergic disease, most commonly for allergic rhinitis, and it remains the only currently available disease modifying therapy in atopic patients. AIT has been studied for use in mild to moderate allergic asthma. While the data are often inconsistent, and utilize a multitude of different methods, antigens, and outcome measures, in general, AIT may have several beneficial effects on asthma disease control, quality of life, and requirement for medication. These benefits are notable when immunotherapy is used as an adjunct to pharmacologic treatment in carefully selected and monitored patients with mild to moderate persistent asthma. Patients with severe asthma are excluded from these trials. Importantly, patients with asthma, and in particular severe asthma, may have a higher rate of systemic adverse reactions to SCIT, including anaphylaxis; however, these events are overall rare. Future research in the area is needed to definitively assess the benefit of SCIT and SLIT for patients with asthma, comparing outcomes with different methods, addressing the role of AIT in severe asthma, significance of multiallergen AIT in allergic asthma, and safety concerns in asthma.
• Georas, S. N., Wright, R. J., Ivanova, A., Israel, E., LaVange, L. M., Akuthota, P., Carr, T. F., Denlinger, L. C., Fajt, M. L., Kumar, R., O'Neal, W. K., Phipatanakul, W., Szefler, S. J., Aronica, M. A., Bacharier, L. B., Burbank, A. J., Castro, M., Crotty Alexander, L., Bamdad, J., , Cardet, J. C., et al. (2022). The Precision Interventions for Severe and/or Exacerbation-Prone (PrecISE) Asthma Network: An overview of Network organization, procedures, and interventions. The Journal of allergy and clinical immunology, 149(2), 488-516.e9.
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  Asthma is a heterogeneous disease, with multiple underlying inflammatory pathways and structural airway abnormalities that impact disease persistence and severity. Recent progress has been made in developing targeted asthma therapeutics, especially for subjects with eosinophilic asthma. However, there is an unmet need for new approaches to treat patients with severe and exacerbation-prone asthma, who contribute disproportionately to disease burden. Extensive deep phenotyping has revealed the heterogeneous nature of severe asthma and identified distinct disease subtypes. A current challenge in the field is to translate new and emerging knowledge about different pathobiologic mechanisms in asthma into patient-specific therapies, with the ultimate goal of modifying the natural history of disease. Here, we describe the Precision Interventions for Severe and/or Exacerbation-Prone Asthma (PrecISE) Network, a groundbreaking collaborative effort of asthma researchers and biostatisticians from around the United States. The PrecISE Network was designed to conduct phase II/proof-of-concept clinical trials of precision interventions in the population with severe asthma, and is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Using an innovative adaptive platform trial design, the PrecISE Network will evaluate up to 6 interventions simultaneously in biomarker-defined subgroups of subjects. We review the development and organizational structure of the PrecISE Network, and choice of interventions being studied. We hope that the PrecISE Network will enhance our understanding of asthma subtypes and accelerate the development of therapeutics for severe asthma.
• Halonen, M., Carr, T. F., & Cusanovich, D. A. (2022). Evaluation of Swab-Seq as a scalable, sensitive assay for community surveillance of SARS-CoV-2 Infection. Scientific Reports.
• Kang, H., Allison, S., Spangenberg, A., Carr, T., Sprissler, R., Halonen, M., & Cusanovich, D. A. (2022). Evaluation of Swab-Seq as a scalable, sensitive assay for community surveillance of SARS-CoV-2 infection. Scientific reports, 12(1), 3047.
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  The ongoing SARS-CoV-2 pandemic and subsequent demand for viral testing has led to issues in scaling diagnostic lab efforts and in securing basic supplies for collection and processing of samples. This has motivated efforts by the scientific community to establish improved protocols that are more scalable, less resource intensive, and less expensive. One such developmental effort has resulted in an assay called "Swab-Seq", so named because it was originally developed to work with dry nasal swab samples. The existing gold standard test consists of RNA extracted from a nasopharyngeal (NP) swab that is subjected to quantitative reverse transcription polymerase chain reaction (qRT-PCR). Swab-Seq adapts this method to a next-generation sequencing readout. By pairing this modification with extraction-free sampling techniques, Swab-Seq achieves high scalability, low cost per sample, and a reasonable turnaround time. We evaluated the effectiveness of this assay in a community surveillance setting by testing samples collected from both symptomatic and asymptomatic individuals using the traditional NP swab. In addition, we evaluated extraction-free sampling techniques (both saliva and saline mouth gargle samples). We found the assay to be as clinically sensitive as the qRT-PCR assay, adaptable to multiple sample types, and able to easily accommodate hundreds of samples at a time. We thus provide independent validation of Swab-Seq and extend its utility regarding sample type and sample stability. Assays of this type greatly expand the possibility of routine, noninvasive, repeated testing of asymptomatic individuals suitable for current and potential future needs.
• Carr, T. F. (2021). Treatment approaches for the patient with T2 low asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 127(5), 530-535.
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  To identify treatment approaches that can be used in the management of patients with asthma who lack significant type 2 inflammation, also called T2 low asthma.
• Carr, T. F., & Kraft, M. (2021). Asthma and Atopy in COVID-19: 2021 Updates. The Journal of allergy and clinical immunology.
• Carr, T. F., Granell, R., Stern, D. A., Guerra, S., Wright, A., Halonen, M., Henderson, J., & Martinez, F. D. (2021). High Insulin in Early Childhood Is Associated with Subsequent Asthma Risk Independent of Body Mass Index. The journal of allergy and clinical immunology. In practice.
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  Asthma and obesity are major, interconnected public health challenges that usually have their origins in childhood, and for which the relationship is strengthened among those with insulin resistance.
• Gevaert, P., Wong, K., Millette, L. A., & Carr, T. F. (2021). The Role of IgE in Upper and Lower Airway Disease: More Than Just Allergy!. Clinical reviews in allergy & immunology.
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  Immunoglobulin E (IgE) is a well-known key factor in allergic airway disease; however, its central role in non-allergic airway inflammation is often underestimated. In some airway diseases, IgE is produced as a result of allergic sensitization. However, in others, IgE production occurs despite the lack of a specific allergen. Although multiple pathways contribute to the production of IgE in airway disease, it is its activity in mediating the inflammatory response that is associated with disease. Therefore, an understanding of IgE as the unifying component of upper and lower airway diseases has important implications for both diagnosis and treatment. Understanding the role of IgE in each upper and lower airway disease highlights its potential utility as a diagnostic marker and therapeutic target. Further classification of these diseases by whether they are IgE mediated or non-IgE mediated, rather than by the existence of an underlying allergic component, accounts for both systemic and localized IgE activity. Improvements in diagnostic methodologies and standardization of clinical practices with this classification in mind can help identify patients with IgE-mediated diseases. In doing so, this group of patients can receive optimal care through targeted anti-IgE therapeutics, which have already demonstrated efficacy across numerous IgE-mediated upper and lower airway diseases.
• Jain, S., Bleecker, E. R., Zeki, A. A., Wright, R. J., White, S. R., Wenzel, S. E., Wechsler, M. E., Vijayanand, P., Tulchinsky, A. F., Teague, W. G., Szefler, S. J., Smith, L. J., Ross, K. R., Phipatanakul, W., Peters, M. C., Peden, D. B., Ortega, V. E., O'neal, W. K., Noel, P., , Moy, J. N., et al. (2021). PrecISE: Precision Medicine in Severe Asthma: An adaptive platform trial with biomarker ascertainment.. The Journal of allergy and clinical immunology, 147(5), 1594-1601. doi:10.1016/j.jaci.2021.01.037
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  Severe asthma accounts for almost half the cost associated with asthma. Severe asthma is driven by heterogeneous molecular mechanisms. Conventional clinical trial design often lacks the power and efficiency to target subgroups with specific pathobiological mechanisms. Furthermore, the validation and approval of new asthma therapies is a lengthy process. A large proportion of that time is taken by clinical trials to validate asthma interventions. The National Institutes of Health Precision Medicine in Severe and/or Exacerbation Prone Asthma (PrecISE) program was established with the goal of designing and executing a trial that uses adaptive design techniques to rapidly evaluate novel interventions in biomarker-defined subgroups of severe asthma, while seeking to refine these biomarker subgroups, and to identify early markers of response to therapy. The novel trial design is an adaptive platform trial conducted under a single master protocol that incorporates precision medicine components. Furthermore, it includes innovative applications of futility analysis, cross-over design with use of shared placebo groups, and early futility analysis to permit more rapid identification of effective interventions. The development and rationale behind the study design are described. The interventions chosen for the initial investigation and the criteria used to identify these interventions are enumerated. The biomarker-based adaptive design and analytic scheme are detailed as well as special considerations involved in the final trial design.
• Lipworth, B. J., Chan, R., & Carr, T. (2021). Corticosteroid Protection Against COVID-19: Begin with the Nose. The journal of allergy and clinical immunology. In practice, 9(11), 3941-3943.
• Snider, J. M., You, J. K., Wang, X., Snider, A. J., Hallmark, B., Zec, M. M., Seeds, M. C., Sergeant, S., Johnstone, L., Wang, Q., Sprissler, R., Carr, T. F., Lutrick, K., Parthasarathy, S., Bime, C., Zhang, H. H., Luberto, C., Kew, R. R., Hannun, Y. A., , Guerra, S., et al. (2021). Group IIA secreted phospholipase A2 is associated with the pathobiology leading to COVID-19 mortality. The Journal of clinical investigation, 131(19).
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  There is an urgent need to identify the cellular and molecular mechanisms responsible for severe COVID-19 that results in death. We initially performed both untargeted and targeted lipidomics as well as focused biochemical analyses of 127 plasma samples and found elevated metabolites associated with secreted phospholipase A2 (sPLA2) activity and mitochondrial dysfunction in patients with severe COVID-19. Deceased COVID-19 patients had higher levels of circulating, catalytically active sPLA2 group IIA (sPLA2-IIA), with a median value that was 9.6-fold higher than that for patients with mild disease and 5.0-fold higher than the median value for survivors of severe COVID-19. Elevated sPLA2-IIA levels paralleled several indices of COVID-19 disease severity (e.g., kidney dysfunction, hypoxia, multiple organ dysfunction). A decision tree generated by machine learning identified sPLA2-IIA levels as a central node in the stratification of patients who died from COVID-19. Random forest analysis and least absolute shrinkage and selection operator-based (LASSO-based) regression analysis additionally identified sPLA2-IIA and blood urea nitrogen (BUN) as the key variables among 80 clinical indices in predicting COVID-19 mortality. The combined PLA-BUN index performed significantly better than did either one alone. An independent cohort (n = 154) confirmed higher plasma sPLA2-IIA levels in deceased patients compared with levels in plasma from patients with severe or mild COVID-19, with the PLA-BUN index-based decision tree satisfactorily stratifying patients with mild, severe, or fatal COVID-19. With clinically tested inhibitors available, this study identifies sPLA2-IIA as a therapeutic target to reduce COVID-19 mortality.
• Vickery, B. P., Vereda, A., Nilsson, C., du Toit, G., Shreffler, W. G., Burks, A. W., Jones, S. M., Fernández-Rivas, M., Blümchen, K., O'B Hourihane, J., Beyer, K., Anagnostou, A., Assa'ad, A. H., Ben-Shoshan, M., Bird, J. A., Carr, T. F., Carr, W. W., Casale, T. B., Chong, H. J., , Ciaccio, C. E., et al. (2021). Continuous and Daily Oral Immunotherapy for Peanut Allergy: Results from a 2-Year Open-Label Follow-On Study. The journal of allergy and clinical immunology. In practice, 9(5), 1879-1889.e13.
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  The randomized, controlled PALISADE trial demonstrated the benefit of daily oral immunotherapy with Peanut (Arachis Hypogaea) allergen powder-dnfp (PTAH, formerly AR101) in peanut-allergic children and adolescents.
• Chupp, G. L., Bleecker, E. R., Yanez, A., Wong, G. W., Virchow, J. C., Tanno, L. K., Sublett, J. L., Sanchez-borges, M., Rouadi, P. W., Rosenwasser, L. J., Peden, D. B., Passalacqua, G., Park, H., Ortega-martell, J. A., Morais-almeida, M., Martin, B., Levin, M., Hanania, N. A., Gonzalez-diaz, S. N., , Fiocchi, A., et al. (2020). COVID-19, asthma, and biological therapies: What we need to know.. The World Allergy Organization journal, 13(5), 100126. doi:10.1016/j.waojou.2020.100126
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  Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.
• Guerra, S., Halonen, M., Wright, A. L., Wright, A. L., Stern, D. A., Martinez, F. D., Halonen, M., Guerra, S., & Carr, T. F. (2020). High Early Childhood Insulin Increases Asthma Risk Independent of Obesity. The Journal of Allergy and Clinical Immunology, 145(2), AB112. doi:10.1016/j.jaci.2019.12.554
• Polverino, F., Stern, D. A., Ruocco, G., Balestro, E., Bassetti, M., Candelli, M., Cirillo, B., Contoli, M., Corsico, A., D'Amico, F., D'Elia, E., Falco, G., Gasparini, S., Guerra, S., Harari, S., Kraft, M., Mennella, L., Papi, A., Parrella, R., , Pelosi, P., et al. (2020). Comorbidities, Cardiovascular Therapies, and COVID-19 Mortality: A Nationwide, Italian Observational Study (ItaliCO). Frontiers in cardiovascular medicine, 7, 585866.
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  Italy has one of the world's oldest populations, and suffered one the highest death tolls from Coronavirus disease 2019 (COVID-19) worldwide. Older people with cardiovascular diseases (CVDs), and in particular hypertension, are at higher risk of hospitalization and death for COVID-19. Whether hypertension medications may increase the risk for death in older COVID 19 inpatients at the highest risk for the disease is currently unknown. Data from 5,625 COVID-19 inpatients were manually extracted from medical charts from 61 hospitals across Italy. From the initial 5,625 patients, 3,179 were included in the study as they were either discharged or deceased at the time of the data analysis. Primary outcome was inpatient death or recovery. Mixed effects logistic regression models were adjusted for sex, age, and number of comorbidities, with a random effect for site. A large proportion of participating inpatients were ≥65 years old (58%), male (68%), non-smokers (93%) with comorbidities (66%). Each additional comorbidity increased the risk of death by 35% [OR = 1.35 (1.2, 1.5) < 0.001]. Use of ACE inhibitors, ARBs, beta-blockers or Ca-antagonists was not associated with significantly increased risk of death. There was a marginal negative association between ARB use and death, and a marginal positive association between diuretic use and death. This Italian nationwide observational study of COVID-19 inpatients, the majority of which ≥65 years old, indicates that there is a linear direct relationship between the number of comorbidities and the risk of death. Among CVDs, hypertension and pre-existing cardiomyopathy were significantly associated with risk of death. The use of hypertension medications reported to be safe in younger cohorts, do not contribute significantly to increased COVID-19 related deaths in an older population that suffered one of the highest death tolls worldwide.
• Aggarwal, A., Balogun, R., Carr, T. F., Desai, A. P., Jie, T., & Pan, J. J. (2019). Transfer of peanut allergy from donor to recipient after liver transplant. Annals of hepatology, 18(3), 508-513.
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  31 years old female with a history of contact dermatitis, eczema, allergic rhinitis, pernicious anemia, alopecia areata and latent tuberculosis was treated concurrently with methotrexate along with isoniazid and pyridoxine. Five months into the therapy she developed acute onset jaundice progressing into fulminant liver failure with altered mentation and worsening liver function tests. Extensive workup including serological and histopathological evaluation revealed drug-induced liver injury as the etiology of her liver failure and she underwent a successful orthotropic liver transplant. On post-transplant follow-up at four months, she was noted to have an allergic reaction consisting of a perioral rash and swelling (without anaphylaxis) after receiving a kiss from her significant other who had just eaten a peanut butter chocolate. She denied any history of allergic reaction to peanuts prior to the transplant. Percutaneous skin testing revealed immediate hypersensitivity to peanut, hazelnut, and pecan believed to be acquired newly post-transplant. Further investigation revealed that the organ donor had a documented history of systemic anaphylaxis from the peanut allergy and a positive peanut-specific IgE level. Also, another parallel solid organ recipient (lung transplant) from the same organ donor experienced a serious anaphylactic reaction after peanut exposure. This is a case of food (peanut) allergy transfer from the donor to the recipient after the liver transplant. This case highlights the importance of incorporating known donor allergies as a part of pre-transplant screening, given the potentially serious consequences from the transfer of allergies to a previously anergic recipient.
• Cardet, J. C., Codispoti, C. D., King, T. S., Bacharier, L., Carr, T., Castro, M., Chinchilli, V., Dunn, R., Holquing, F., Engle, L., Nelson, K., Ortega, V. E., Peters, M., Ramratnam, S., Krishnan, J. A., Wechsler, M. E., Israel, E., & , N. H. (2019). Predictors of inhaled corticosteroid taper failure in adults with asthma. The journal of allergy and clinical immunology. In practice, 7(4), 1335-1337.e3.
• Carr, T. F., Alkatib, R., & Kraft, M. (2019). Microbiome in Mechanisms of Asthma. Clinics in chest medicine, 40(1), 87-96.
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  The lung and gut microbiome are factors in asthma risk or protection. Relevant elements of the microbiome within both niches include the importance of the early life window for microbiome establishment, the diversity of bacteria, richness of bacteria, and effect of those bacteria on the local epithelium and immune system. Mechanisms of protection include direct anti-inflammatory action or induction of non-type 2 inflammation by certain bacterial colonies. The gut microbiome further impacts asthma risk through the contribution of metabolic products. This article reviews the mechanisms that connect the lung and gut microbiota to asthma development and severity.
• Carr, T., Turner, M. W., & Ramaswamy, R. (2019). Scoping review study to identify how communities in the USA, Australia, New Zealand and Canada use quality improvement (QI) approaches to address community health and well-being. BMJ open, 9(12), e034302.
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  Both US and global communities lag on key health indicators. There has been limited progress in building capacity to improve health beyond the healthcare field. Yet, communities also need to engage in health improvement initiatives. A substantial body of literature describes standards and core components for quality improvement (QI) approaches in clinical settings. This study aims to determine how communities in the USA, Australia, New Zealand and Canada use QI approaches for health and well-being improvement and how such approaches compare to those in clinical settings.
• Grossman, N. L., Ortega, V. E., King, T. S., Bleecker, E. R., Ampleford, E. A., Bacharier, L. B., Cabana, M. D., Cardet, J. C., Carr, T. F., Castro, M., Denlinger, L. C., Denson, J. L., Fandino, N., Fitzpatrick, A. M., Hawkins, G. A., Holguin, F., Krishnan, J. A., Lazarus, S. C., Nyenhuis, S. M., , Phipatanakul, W., et al. (2019). Exacerbation-prone asthma in the context of race and ancestry in Asthma Clinical Research Network trials. The Journal of allergy and clinical immunology.
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  Minority groups of African descent experience disproportionately greater asthma morbidity compared with other racial groups, suggesting that genetic variation from a common ancestry could influence exacerbation risk.
• Ortega, G., Tongchinsub, P., & Carr, T. (2019). Combination biologic therapy for severe persistent asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 123(3), 309-311.
• Zawadzki, R., Shreffler, W. G., Rosen, K., Matthews, J. G., Jones, S. M., Griffin, N. M., Carr, T. F., & Adelman, D. C. (2019). Longer-Term Safety and Efficacy Measures of AR101 Oral Immunotherapy for Peanut Allergy: Results from a Phase 3 Follow-On Study. The Journal of Allergy and Clinical Immunology, 143(2), AB256. doi:10.1016/j.jaci.2018.12.781
• , P. G., Vickery, B. P., Vereda, A., Casale, T. B., Beyer, K., du Toit, G., Hourihane, J. O., Jones, S. M., Shreffler, W. G., Marcantonio, A., Zawadzki, R., Sher, L., Carr, W. W., Fineman, S., Greos, L., Rachid, R., Ibáñez, M. D., Tilles, S., Assa’ad, A. H., , Nilsson, C., et al. (2018). AR101 Oral Immunotherapy for Peanut Allergy. The New England journal of medicine, 379(21), 1991-2001.
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  Peanut allergy, for which there are no approved treatment options, affects patients who are at risk for unpredictable and occasionally life-threatening allergic reactions.
• Carr, T. F. (2018). Predictors of inhaled corticosteroid taper failure in adults with asthma. Journal of Allergy and Clinical Immunology: In Practice.
• Carr, T. F., & Alkatib, R. (2018). TO THE HEART OF THE MATTER: LARGE PERICARDIAL EFFUSION CAUSING SEVERE FACIAL ANGIOEDEMA. Annals of Allergy Asthma & Immunology, 121(5), S86. doi:10.1016/j.anai.2018.09.278
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  Introduction Angioedema is triggered by deep dermal, subcutaneous and submucosal vascular leakage that results in visible, nonpitting swelling. Subacute or chronic facial edema may be due to histamine or bradykinin-mediated angioedema, but alternate causes should be considered when symptoms are atypical or unresponsive to therapy. Case Description We evaluated a 24-year-old male with history of severe aplastic anemia, status-post unrelated donor allo-transplant and chronic graft-versus-host disease. Thirteen months after transplant while taking chronic prednisone, valacyclovir, voriconazole, pentamadine and amoxicillin prophylaxis, he developed acute worsening of facial edema on a background of chronic, mild generalized anasarca. The facial edema was diffuse with prominent bilateral, symmetric, non-pitting periorbital edema and accompanied non-pruritic flushing. Treatments included intravenous steroids, antihistamines, trials of furosomide and albumin, however this provided minimal relief. The swelling persisted for 12 weeks and progressed in severity, thus all antibiotics were discontinued. The patient was referred to Allergy/Immunology for evaluation of possible drug allergy. On Allergy/Immunology evaluation, despite discontinuation of antibiotics, notable facial swelling persisted. The patient denied urticaria but reported new onset progressive exertional dyspnea and orthopnea. Physical exam demonstrated diffusely edematous face with significant bilateral periorbital swelling, scattered blisters bilateral forearms, 2+ pitting edema to mid-thighs bilaterally. Serum tryptase and complement levels were normal. CT chest revealed alarge pericardial effusion with echocardiographic confirmation of pericardial tamponade, requiring urgent pericardial drain. The patient's swelling and dyspnea resolved post procedure. Discussion In the setting of chronic atypical facial edema, cardiac and vascular dysfunction should be included in the differential diagnosis.
• Carr, T. F., & Kraft, M. (2018). Use of biomarkers to identify phenotypes and endotypes of severeasthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 121(4), 414-420.
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  Severe asthma can be classified into phenotypes and endotypes, which may inform clinicians about inflammatory pathways leading to disease and ultimately guide optimal therapeutic strategy. Biomarkers, objectively measurable characteristics of the disease, are of increasing interest to clinicians and researchers as powerful tools to distinguish among the severe asthma phenotypes and endotypes. The objective of this review is to highlight current knowledge of biomarker applications to identify phenotypes and endotypes of severe asthma.
• Carr, T. F., Natarajan, M., Hsu, A. P., Weinreich, M. A., Zhang, Y., Niemela, J. E., Butman, J. A., Pittaluga, S., Sugui, J., Collar, A. L., Lim, J. K., Zangeneh, T., Oler, A. J., Similuk, M., Rosen, L. B., Desai, J. V., Freeman, A. F., Holland, S. M., Kwon-Chung, K. J., , Milner, J. D., et al. (2018). Aspergillosis, eosinophilic esophagitis, and allergic rhinitis in signal transducer and activator of transcription 3 haploinsufficiency. The journal of allergy and clinical immunology: in practice.
• Carr, T. F., Zeki, A. A., & Kraft, M. (2018). Eosinophilic and Noneosinophilic Asthma. American journal of respiratory and critical care medicine, 197(1), 22-37.
• Gaefke, C. L., Carr, T. F., Borgstrom, M., & Bime, C. (2018). Disparities in Risk of Hospitalization for Food Anaphylaxis in the United States. The Journal of Allergy and Clinical Immunology, 141(2), AB89. doi:10.1016/j.jaci.2017.12.285
• Natarajan, M., Hsu, A. P., Weinreich, M. A., Zhang, Y., Niemela, J. E., Butman, J. A., Pittaluga, S., Sugui, J., Collar, A. L., Lim, J. K., Zangeneh, T., Carr, T., Oler, A. J., Similuk, M., Rosen, L. B., Desai, J. V., Freeman, A. F., Holland, S. M., Kwon-Chung, K. J., , Milner, J. D., et al. (2018). Aspergillosis, eosinophilic esophagitis, and allergic rhinitis in signal transducer and activator of transcription 3 haploinsufficiency. The Journal of allergy and clinical immunology, 142(3), 993-997.e3.
• Wright, A. L., Carr, T. F., Stern, D. A., Halonen, M., & Martinez, F. D. (2018). Non‐atopic rhinitis at age 6 is associated with subsequent development of asthma. Clinical & Experimental Allergy, 49(1), 35-43. doi:10.1111/cea.13276
• Buckley, R. D., & Carr, T. F. (2017). Association of aeroallergen sensitization and atopic disease in the Sonoran Desert. Allergy and asthma proceedings, 38(5), 370-375.
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  Numerous aeroallergens have been associated with the development of asthma, including Alternaria, house-dust mite, and pet dander. Tucson, Arizona, is located in the Sonoran Desert, which has the highest diversity of vegetation of any desert in the world. Given the unique pollen profile in this region, we sought to identify the most common aeroallergens associated with rhinitis and asthma diagnosis in the local adult population.
• Buckley, R., & Carr, T. F. (2017). Association of aeroallergen sensitivity and airway disease in Tucson, AZ. Allergy Asthma Proc, 370-375. doi:10.2500/aap.2017.38.4077
• Carr, T. F., & Kraft, M. (2017). Management of Severe Asthma before Referral to the Severe Asthma Specialist. The journal of allergy and clinical immunology. In practice, 5(4), 877-886.
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  Severe asthma is associated with significant morbidity and can be challenging to assess and control, due to heterogeneity of disease, complexity of diagnosis, and impact of comorbidities. A structured approach to the assessment and management of severe asthma may be helpful to the practicing clinician. First, it is important to confirm a diagnosis of asthma. In patients who are either not responding to treatment, or who require high doses of medication to control symptoms, it is highly possible that disease mimickers or comorbidities are present and can inhibit therapeutic responsiveness. The assessment and management of common comorbidities of asthma may dramatically impact disease control and thus medication requirement. Determining medication adherence and optimizing drug dose and delivery may separate out truly severe asthmatics from those not using medications regularly or properly. Next, although true personalized medicine for severe asthma is not yet realized, for those individuals with severe asthma, phenotypic characteristics of each patient may guide which therapeutic options may be most effective for that patient. Finally, evaluation and management of severe asthma at a referral center can add additional phenotyping, therapeutic, and diagnostic strategies.
• Carr, T. F., Altisheh, R., & Zitt, M. (2017). Small airways disease and severe asthma. The World Allergy Organization journal, 10(1), 20.
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  The small airways of the lungs are commonly affected in pediatric and adult asthma. Small airways disease has been related to asthma control, severity, and risk of exacerbation. Diagnosis of small airways disease can be best made through evaluation of surgical lung specimens. Noninvasive techniques including spirometry, plethysmography, nitrogen washout, impulse oscillometry, and cross-sectional imaging have been utilized to assess and infer the extent of small airways disease in asthma and can be used longitudinally to assess response to treatment. Patients with small airways disease seem to benefit from inhaled asthma medications that have improved capacity to reach the distal lung compartment. This is especially important for patients with severe asthma, who rely upon high doses of inhaled corticosteroid and bronchodilators for asthma control. This review will describe the techniques which may be utilized to assess small airways disease, discuss the prevalence and characteristics of small airways disease in severe asthma, and highlight how small airway disease may complicate severe asthma treatment.
• Carr, T. F., Beamer, P. I., Rothers, J., Stern, D. A., Gerald, L. B., Rosales, C. B., Van Horne, Y. O., Pivniouk, O. N., Vercelli, D., Halonen, M., Gameros, M., Martinez, F. D., & Wright, A. L. (2017). Prevalence of Asthma in School Children on the Arizona-Sonora Border. The journal of allergy and clinical immunology. In practice, 5(1), 114-120.e2.
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  Mexican-born children living in the United States have a lower prevalence of asthma than other US children. Although children of Mexican descent near the Arizona (AZ)-Sonora border are genetically similar, differences in environmental exposures might result in differences in asthma prevalence across this region.
• Daines, M. O., Patel, S., Daines, M. O., & Carr, T. F. (2017). ORAI1 Mutation in a Child with Primary Immunodeficiency-9. The Journal of Allergy and Clinical Immunology, 139(2), AB17. doi:10.1016/j.jaci.2016.12.010
• Yang, M., Rosen, K., Griffin, N. M., Casale, T. B., & Carr, T. F. (2017). P430 Clinically significant improvement in mini-RQLQ scores in patients with nasal polyps after omalizumab initiation. Annals of Allergy Asthma & Immunology, 119(5), S88-S89. doi:10.1016/j.anai.2017.09.026
• Zangeneh, T. T., Weinreich, M. A., Sugui, J. A., Similuk, M., Oler, A. J., Natarajan, M., Milner, J. D., Lionakis, M. S., Kwon-chung, K. J., Hsu, A. P., & Carr, T. F. (2017). De novo STAT3 Mutation in a Patient with Fatal, Treatment-Refractory Sino-orbital Aspergillosis. Open Forum Infectious Diseases, 4(suppl_1), S114-S115. doi:10.1093/ofid/ofx163.130
• Berry, C. E., Billheimer, D., Jenkins, I. C., Lu, Z. J., Stern, D. A., Gerald, L. B., Carr, T. F., Guerra, S., Morgan, W. J., Wright, A. L., & Martinez, F. D. (2016). A Distinct Low Lung Function Trajectory from Childhood to the Fourth Decade of Life. American journal of respiratory and critical care medicine, 194(5), 607-12.
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  Low maximally attained lung function increases the risk of chronic obstructive pulmonary disease irrespective of the subsequent rate of lung function decline.
• Bleecker, E. R., Carr, T. F., & Bleecker, E. R. (2016). Asthma heterogeneity and severity.. The World Allergy Organization journal, 9(1), 41. doi:10.1186/s40413-016-0131-2
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  Asthma is a common, chronic inflammatory airways disease characterized by a clinical syndrome of bronchial hyperresponsiveness, inflammation, and reversible airflow obstruction. Individuals with asthma can vary widely in clinical presentation, severity, and pathobiology. The incident factors, pathogenesis, prognosis, and treatment of asthma remain incompletely understood. Utilizing measurable characteristics of asthmatic patients, including demographic, physiologic, and biologic markers, can however identify meaningful phenotypic categories in asthma. Identification of these phenotypes may help improve precision therapeutics targeted toward an individual's' disease, and may identify strategies for preventing progression of disease severity.
• Carr, T. F. (2016). Complications of Sinusitis. American Journal of Rhinology & Allergy, 30(4), 241-245. doi:10.2500/ajra.2016.30.4322
• Carr, T. F. (2016). Complications of sinusitis. American journal of rhinology & allergy, 30(4), 241-5.
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  Sinusitis is a common disorder associated with significant patient symptomatology that adversely affects quality of life. Sinusitis can cause further morbidity and mortality through its impact on comorbid disorders, progression of inflammation, and extension of infection.
• Carr, T. F. (2016). Editorial: Innovative steps toward understanding sinonasal disease, improving diagnostics and optimizing patient care. American journal of rhinology & allergy, 28(5), 359-60.
• Carr, T. F. (2016). Pathophysiology of Immediate Reactions to Injectable Gadolinium-based Contrast Agents. Topics in magnetic resonance imaging : TMRI, 25(6), 265-268.
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  The aim of this paper was to review the classification of adverse drug reactions, highlight the known pathophysiology of immediate hypersensitivity reactions, and discuss the utility of diagnostic testing for immunologically mediated immediate reactions to gadolinium-based contrast agents (GBCAs).
• Carr, T. F., & Kraft, M. (2016). Chronic Infection and Severe Asthma. Immunology and allergy clinics of North America, 36(3), 483-502.
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  Chronic bacterial infection is implicated in both the development and severity of asthma. The atypical bacteria Mycoplasma pneumoniae and Chlamydophila pneumoniae have been identified in the airways of asthmatics and correlated with clinical features such as adult onset, exacerbation risks, steroid sensitivity, and symptom control. Asthmatic patients with evidence of bacterial infection may benefit from antibiotic treatment directed towards these atypical organisms. Examination of the airway microbiome may identify microbial communities that confer risk for or protection from severe asthma.
• Carr, T. F., & Peters, A. T. (2016). Chapter 12: Asthma: principles of treatment. Allergy and asthma proceedings : the official journal of regional and state allergy societies, 33 Suppl 1, S39-43.
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  The goals of treatment are prevention of fatalities, hospitalizations, and emergency department visits, along with achieving good long-term control of asthma, with reduction of symptoms, maintenance of normal activity level, prevention of exacerbations, and accelerated loss of pulmonary function (forced expiratory volume in 1 second [FEV(1)]) as well as avoiding harm from therapies. Treatment often is initiated based on severity of symptoms, physical examination findings, and, for some patients, the FEV(1) or peak expiratory flow rates. Comorbidities such as gastroesophageal reflux disease and laryngopharyngeal reflux, rhinitis or rhinosinusitis, sleep apnea, recurrent infections, smoking, and substance abuse should be addressed. Two treatment modalities are indicated only for individuals with allergic asthma: allergen-specific immunotherapy, commonly known as allergy shots, and omalizumab. Allergen immunotherapy is effective in decreasing symptoms and medication use in selected patients with mild-to-moderate allergic asthma. In addition, patients receiving allergen immunotherapy for allergic rhinitis may have a decreased risk of developing asthma. Omalizumab, a recombinant humanized monoclonal anti-IgE antibody indicated for persistent moderate-to-severe allergic asthma, has been shown to improve asthma-related quality of life, decrease clinically significant exacerbation rates, number of courses of oral corticosteroids, and reduce the severity of exacerbations. It is administered every 2-4 weeks subcutaneously, and improvement should be ascertained after 4-6 months.
• Carr, T. F., & Saltoun, C. A. (2016). Chapter 21: Urticaria and angioedema. Allergy and asthma proceedings : the official journal of regional and state allergy societies, 33 Suppl 1, S70-2.
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  Urticaria, also known as hives, may affect up to 20% of the population at some time in their lives. Urticaria is characterized by extreme pruritus and described as erythematous, raised, circumscribed lesions with central pallor that blanch with pressure. The pathogenesis of urticaria involves mast cell activation, with subsequent release of histamine and other vasoactive mediators, leading to increased vascular permeability of postcapillary venules and development of edema, erythema, and pruritus. Urticaria is closely associated with angioedema in 40% of individuals; ∼10% of patients experience angioedema without urticaria. Urticarial lesions often are generalized with multiple lesions in no specific distribution; angioedema tends to be localized, commonly affecting the face (periorbital and perioral regions), tongue, uvula, soft palate or larynx, extremities, and genitalia. Urticaria is subdivided into acute and chronic urticaria based on duration of symptoms. Acute urticaria lasts 6 weeks is designated as chronic urticaria, and an etiology is seldom identified and thus considered idiopathic. Chronic urticaria may have an autoimmune basis. There is a well-documented association between autoimmune hypothyroidism (Hashimoto's disease) and urticaria and angioedema with higher incidence of antithyroid (antithyroglobulin and antiperoxidase) antibodies in these usually euthyroid patients. Furthermore, studies have revealed a circulating IgG antibody directed against the IgE receptor (F(Cε)RIα) or IgE in 40-60% of patients with chronic urticaria. Histamine 1-receptor antagonists (antihistamines) are initial therapy.
• Carr, T. F., & Saltoun, C. A. (2016). Chapter 2: Skin testing in allergy. Allergy and asthma proceedings : the official journal of regional and state allergy societies, 33 Suppl 1, S6-8.
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  Skin tests are used in addition to a directed history and physical exam to exclude or confirm IgE-mediated diseases such as allergic rhinitis, asthma, and anaphylaxis to aeroallergens, foods, insect venoms, and certain drugs. There are two types of skin testing used in clinical practice. These include percutaneous testing (prick or puncture) and intracutaneous testing (intradermal). Prick testing involves introducing a needle into the upper layers of the skin through a drop of allergen extract and gently lifting the epidermis up. Other devices are available for prick testing. Intracutaneous (intradermal) testing involves injecting a small amount of allergen (0.01-0.02 mL) into the dermis. The release of preformed histamine from mast cells causes increased vascular permeability via smooth muscle contraction and development of a wheal; inflammatory mediators initiate a neural reflex causing vasodilatation, leading to erythema (the flare). Prick testing methods are the initial technique for detecting the presence of IgE. They may correlate better with clinical sensitivity and are more specific but less sensitive than intradermal testing. Sites of skin testing include the back and the volar aspect of the arm. Although the back is more reactive, the difference is minimal. By skin testing on the arm, the patient can witness the emergence and often sense the pruritus of the skin test reaction. Because more patients are sensitized (have IgE antibodies and positive skin test reactions) than have current symptoms, the diagnosis of allergy can be made only by correlating skin testing results with the presence of clinical symptoms.
• Carr, T. F., Berdnikovs, S., Simon, H. U., Bochner, B. S., & Rosenwasser, L. J. (2016). Eosinophilic bioactivities in severe asthma. The World Allergy Organization journal, 9, 21.
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  Asthma is clearly related to airway or blood eosinophilia, and asthmatics with significant eosinophilia are at higher risk for more severe disease. Eosinophils actively contribute to innate and adaptive immune responses and inflammatory cascades through the production and release of diverse chemokines, cytokines, lipid mediators and other growth factors. Eosinophils may persist in the blood and airways despite guidelines-based treatment. This review details eosinophil effector mechanisms, surface markers, and clinical outcomes associated with eosinophilia and asthma severity. There is interest in the potential of eosinophils or their products to predict treatment response with biotherapeutics and their usefulness as biomarkers. This is important as monoclonal antibodies are targeting cytokines and eosinophils in different lung environments for treating severe asthma. Identifying disease state-specific eosinophil biomarkers would help to refine these strategies and choose likely responders to biotherapeutics.
• Carr, T. F., Berdnikovs, S., Simon, H. U., Bochner, B. S., & Rosenwasser, L. J. (2016). Eosinophilic bioactivities in severe asthma.. World Allergy Organization Journal.
• Carr, T. F., Koterba, A. P., Chandra, R., Grammer, L. C., Conley, D. B., Harris, K. E., Kern, R., Schleimer, R. P., & Peters, A. T. (2016). Characterization of specific antibody deficiency in adults with medically refractory chronic rhinosinusitis. American journal of rhinology & allergy, 25(4), 241-4.
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  Specific antibody deficiency may predispose patients to recurrent respiratory tract infections. There is limited literature assessing specific antibody deficiency in chronic rhinosinusitis (CRS). This study evaluated the role of specific antibody deficiency in patients with CRS who have failed medical therapy.
• Chang, E. H., Hill, J. L., Chiu, A., Chang, E. H., & Carr, T. F. (2016). Alteration in Bacterial Culture After Treatment With Topical Mupirocin for Recalcitrant Chronic Rhinosinusitis.. JAMA otolaryngology-- head & neck surgery, 142(2), 138-42. doi:10.1001/jamaoto.2015.3059
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  Topical mupirocin therapy is used to treat symptomatic chronic sinusitis (CRS). However, the potential adverse impact of this therapy on the sinus microbiota has not been well quantified..To determine changes in microbiologic culture results before and after topical mupirocin therapy in patients with CRS with medically and surgically refractory disease..We performed a retrospective medical chart review for 22 consecutive adults evaluated and treated between January 1, 2012, and January 1, 2014, at an otolaryngology-rhinology clinic at a regional academic medical center. The patients were 14 men and 8 women, who had undergone functional endoscopic sinus surgery for CRS, and in whom sinus aspirate cultures were performed before and after topical mupirocin therapy for symptomatic disease. Analyses were performed in April 2014..Patients underwent treatment with saline sinus rinse, with the addition of mupirocin, for at least 1 week..Bacterial isolates from sinus aspirate culture..The patients included 14 men and 8 women, 18 to 75 years old, who underwent a mean of 1.9 functional endoscopic sinus surgical procedures. The mean (range) duration of mupirocin therapy was 6 (2-12) weeks. Before mupirocin therapy, cultures from symptomatic patients (14 men and 8 women, ages 18-75 years) revealed common bacteria implicated in CRS, which are characteristically gram-positive. After mupirocin therapy, cultures from symptomatic patients shifted significantly: 19 were gram-positive vs 3 gram-negative before treatment; 9 were gram-positive vs 13 gram-negative after treatment (P = .004), with increased growth of pathogenic gram-negative bacteria and Corynebacterium..These data present evidence supporting the distinct abrogation of culturable sinus bacteria after mupirocin rinses, identifying a shift toward increased pathogenic bacteria. Consideration of healthy host microbiome and immune dysfunction should guide future treatment considerations.
• Daines, M. O., Wright, A. L., Wright, A. L., Stern, D. A., Mathur, A. K., Martinez, F. D., Daines, M. O., & Carr, T. F. (2016). Sensitivity and Specificity of a Clinical Diagnosis of Allergic Rhinitis in Childhood. The Journal of Allergy and Clinical Immunology, 137(2), AB163. doi:10.1016/j.jaci.2015.12.664
• Gerald, J. K., Carr, T. F., Wei, C. Y., Holbrook, J. T., & Gerald, L. B. (2016). Albuterol Overuse: A Marker of Psychological Distress?. The journal of allergy and clinical immunology. In practice, 3(6), 957-62.
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  Albuterol overuse, 3 or more canisters per year, is associated with poor asthma control and frequent exacerbations.
• Hill, J. L., & Carr, T. F. (2016). Iatrogenic autoimmune progesterone dermatitis treated with a novel intramuscular progesterone desensitization protocol. The journal of allergy and clinical immunology. In practice, 1(5), 537-8.
• Kashani, S., Carr, T. F., Grammer, L. C., Schleimer, R. P., Hulse, K. E., Kato, A., Kern, R. C., Conley, D. B., Chandra, R. K., Tan, B. K., & Peters, A. T. (2016). Clinical characteristics of adults with chronic rhinosinusitis and specific antibody deficiency. The journal of allergy and clinical immunology. In practice, 3(2), 236-42.
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  Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD.
• Parsa, N. A., Carr, T. F., & Alkatib, R. (2016). Retrospective Analysis of Allergy Skin Testing Results and Relationship to Chronic Sinusitis in the Tucson Adult Population. The Journal of Allergy and Clinical Immunology, 137(2), AB163. doi:10.1016/j.jaci.2015.12.667
• Patel, S., Carr, T. F., & Buckley, R. D. (2016). Retrospective Analysis of Allergy Skin Testing Results and Relationship to Asthma in the Tucson Adult Population. The Journal of Allergy and Clinical Immunology, 137(2), AB4. doi:10.1016/j.jaci.2015.12.016
• Willis, A. L., Calton, J. B., Carr, T. F., Chiu, A. G., & Chang, E. H. (2016). Dead or alive: Deoxyribonuclease I sensitive bacteria and implications for the sinus microbiome. American journal of rhinology & allergy, 30(2), 94-8.
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  Recently, there has been tremendous interest in the sinus microbiome and how it relates to disease. However, a lack of a standardized sample collection and DNA extraction methods makes comparison of results across studies nearly impossible. Furthermore, current techniques fail to identify which components of the microbiome are actually alive within the host at the time of sampling.
• Willis, A. L., Calton, J. B., Carr, T. F., Chiu, A. G., & Chang, E. H. (2016). Differentiating live from dead: a novel profile of the sinus microbiome.. American Journal of Rhinology and Allergy.
• Carr, T. F., & Kraft, M. (2015). Update in Asthma 2014. American journal of respiratory and critical care medicine, 192(2), 157-63.
• Carr, T. F., Hill, J. L., Chiu, A., & Chang, E. H. (2015). Alteration in Bacterial Culture After Treatment With Topical Mupirocin for Recalcitrant Chronic Rhinosinusitis. JAMA otolaryngology-- head & neck surgery, 1-5.
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  Topical mupirocin therapy is used to treat symptomatic chronic sinusitis (CRS). However, the potential adverse impact of this therapy on the sinus microbiota has not been well quantified.
• Carr, T. F., Stern, D. A., Halonen, M., Wright, A. L., & Martinez, F. D. (2019). Non-atopic rhinitis at age 6 is associated with subsequent development of asthma. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 49(1), 35-43.
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  It has been postulated that the association between allergic rhinitis and asthma is attributable to the progressive clinical expression of respiratory inflammation during childhood. The role of non-allergic rhinitis in early life in relation to subsequent asthma has not been extensively explored.
• Carr, T., & Martinez, G. (2015). Credibility and (dis)use of feedback to inform teaching : a qualitative case study of physician-faculty perspectives. Southwest Journal of Pulmonary Critical Care, 10(6), 352-64. doi:http://dx.doi.org/10.13175/swjpcc076-15
• Halonen, M. J., Spangenberg, A., Martinez, F. D., Hill, J. L., Halonen, M. J., & Carr, T. F. (2015). Effect of Dithiothreitol on Sputum Interleukin-13 Protein Measurement. The Journal of Allergy and Clinical Immunology, 135(2), AB179. doi:10.1016/j.jaci.2014.12.1519
• Hill, J. L., Chiu, A. G., & Carr, T. F. (2015). Changes in Sinus Bacterial Culture Following Mupirocin Treatment in Surgically Recalcitrant Chronic Rhinosinusitis. The Journal of Allergy and Clinical Immunology, 135(2), AB54. doi:10.1016/j.jaci.2014.12.1108
• Kraft, M., & Carr, T. F. (2015). Update in Asthma 2014. American Journal of Respiratory and Critical Care Medicine, 192(2), 157-163. doi:10.1164/rccm.201503-0597up
• Marthur, A., & Carr, T. (2015). Medical image of the week: panlobular emphysema. Southwest Journal of Pulmonary Crit Care, 11(2), 86-7. doi:http://dx.doi.org/10.13175/swjpcc081-15
• Mathur, A. K., & Carr, T. F. (2015). A Novel Case of Idiopathic CD4 Lymphopenia Presenting with Disseminated Coccidioidomycosis. The Journal of Allergy and Clinical Immunology, 135(2), AB181. doi:10.1016/j.jaci.2014.12.1525
• Smith, L. J., Kalhan, R., Wise, R. A., Sugar, E. A., Lima, J. J., Irvin, C. G., Dozor, A. J., Holbrook, J. T., & , A. L. (2015). Effect of a soy isoflavone supplement on lung function and clinical outcomes in patients with poorly controlled asthma: a randomized clinical trial. JAMA, 313(20), 2033-43.
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  Soy isoflavone supplements are used to treat several chronic diseases, although the data supporting their use are limited. Some data suggest that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control.
• Peters, A. T., Kato, A., Zhang, N., Conley, D. B., Suh, L., Tancowny, B., Carter, D., Carr, T., Radtke, M., Hulse, K. E., Seshadri, S., Chandra, R., Grammer, L. C., Harris, K. E., Kern, R., & Schleimer, R. P. (2010). Evidence for altered activity of the IL-6 pathway in chronic rhinosinusitis with nasal polyps. The Journal of allergy and clinical immunology, 125(2), 397-403.e10.
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  IL-6 activates T(H)17 cells and regulates the response of B lymphocytes and regulatory T cells. The IL-6 receptor and the membrane protein, glycoprotein 130 (gp130), form an active signaling complex that signals through signal transducer and activator of transcription 3 (STAT3) and other signaling molecules. Both the IL-6 receptor (IL-6R) and gp130 can be found in soluble forms that regulate the pathway.
• Suh, L., Schleimer, R. P., Peters, A. T., Norton, J. E., Kern, R. C., Kato, A., Harris, K. E., Grammer, L. C., Conley, D. B., Chandra, R. K., & Carr, T. F. (2009). Analysis of the Th17 Pathway in Chronic Rhinosinusitis. The Journal of Allergy and Clinical Immunology, 123(2), S145-S145. doi:10.1016/j.jaci.2008.12.540

Proceedings Publications

• Carr, T., Williams, M., Ambrose, C., Lindsley, A., Ross, M., Collacott, H., Schulz, A., Chung, Y., Desai, P., Rane, P., & Gelhorn, H. (2022). Patient Preferences for Biologic Treatments for Severe Asthma: Pilot Results from a Discrete Choice Experiment. In American Thoracic Society.
• Wise, R., Kraft, M., Carr, T., Mammen, M., Criner, G., Dransfield, M., Halpin, D., Han, M., Hartley, B., Jain, R., Kaul, V., Kaye, M., Mapel, D., Midwinter, D., Scanlon, P., Singh, D., Wells, J., & Lipson, D. (2021). Risk of All-Cause Mortality During and After Severe Exacerbations in Patients with Chronic Obstructive Pulmonary Disease (COPD): Post Hoc Analysis of the IMPACT Trial. In American Thoracic Society 2021.
• Wright, A. L., Wright, A. L., Stern, D. A., Martinez, F. D., Honeker, L. K., Halonen, M. J., Guerra, S., & Carr, T. F. (2020). Association of Sputum Microbial Communities to Smoking in Adulthood and Respiratory Syncytial Virus Lower Respiratory Illness in Early Life: A Longitudinal Birth Cohort Study. In B28. HOST AND MICROBIAL CLINICAL STUDIES IN LUNG INFECTIONS AND LUNG DISEASES.
• Wright, A. L., Halonen, M. J., Wright, A. L., Stern, D. A., Spangenberg, A., Nenna, R., Martinez, F. D., Halonen, M. J., & Carr, T. F. (2019). Exposure to RSV in Late Pregnancy Increases RSV-Induced Cord Blood IFN-γ and Decreases Risk of Subsequent RSV-LRIs. In A27. PEDIATRIC LUNG INFECTION AND CRITICAL CARE AROUND THE WORLD.
• Carr, T. F. (2016, Spring). Complications of Sinusitis.. In North American Rhinology and Allergy Conference.

Presentations

• Carr, T. F. (2020, Fall 2020). Understanding Nasal Polyposis. ACAAI Virtual Meeting; CHEST Virtual Conference.
• Carr, T. F. (2020, Fall). Investigating TSLP: Part 3: Neutrophilic Inflammation and Non-T2 Effects in Asthma. Online WebcastAstraZeneca.

Poster Presentations

• Carr, T. F., Odisho Domit, N., & Eremija, J. (2022). RARE CUTANEOUS ADVERSE REACTION TO ROUTINE IMMUNIZATIONS LEADING TO HYPER IGE SYNDROME (HIES) DIAGNOSIS. ACAAI Scientific Meeting 2022.
• Carr, T. F., Odisho Domit, N., & Eremija, J. (2022). SARS-COV-2 INFECTION ASSOCIATED WITH NEW SEVERE HYPEREOSINOPHILIA AND MULTIPLE ORGAN DAMAGE. ACAAI Scientific Meeting 2022.
• Martinez, F., Carr, T. F., Stern, D. A., Guerra, S., Wright, A. L., Halonen, M., Halonen, M., Wright, A. L., Stern, D. A., Guerra, S., Carr, T. F., & Martinez, F. (2020, February). High Early Childhood Insulin Increases Asthma Risk Independent of Obesity.. American Academy of Allergy, Asthma & Immunology 2020 Annual Meeting, Virtual Congress.
• Carr, T. F. (2019, March). Accidental Exposures to Peanut and Other Food Allergens: Results From a Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial (PALISADE).”. AAAAI National MeetingAimmune.
• Carr, T. F. (2019, March). Longer-Term Safety and Efficacy Measures of AR101 Oral Immunotherapy for Peanut Allergy: Results from a Phase 3 Follow-On Study.”. AAAAI National meetingAimmune.
• Carr, T. F. (2019, November). Identifying AR101-Eligible Patients Without an Oral Food Challenge: PALISADE Peanut-Specific IgE Versus Food Challenge Data. American College of Asthma Allergy and Immunology. Houston, TX: Aimmune.
• Carr, T. F., & Patel, S. B. (2019, November). MBL Deficiency Confirmed by Gene Sequencing. American College of Asthma Allergy and Immunology. Houston TX.
• Daines, M. O., Carr, T. F., & Patel, s. (2017, March). ORAI1 Mutation in a Child with Primary Immunodeficiency-9. AAAAI 2017 national meeting/Journal of Allergy and Clinical Immunology Supplement. Atlanta, GA: AAAAI.
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  Case presentation and discussion of pathology, diagnosis, and treatment of immune deficiency 9
• Carr, T. F., Alkatib, R., & Parsa, N. H. (2016, March). Retrospective Analysis of Allergy Skin Testing Results and Relationship to Chronic Sinusitis in the Tucson Adult Population.. American Academy of Allergy, Asthma, and Immunology Annual Scientific Meeting , Los Angeles.
• Carr, T. F., Buckley, R., & Patel, S. (2016, March). Retrospective Analysis of Allergy Skin Testing Results and Relationship to Asthma in the Tucson Adult Population. American Academy of Allergy, Asthma, and Immunology Annual Scientific Meeting , Los Angeles.
• Carr, T. F., Galvani, C. A., Patel, S., & Mathur, A. K. (2016, May). Reduction of Systemic Corticosteroid Requirement for Severe Asthma Following Minimally-Invasive Nissen Fundoplication for Severe GERD. American Thoracic Society Annual Meeting. San Francisco.
• Carr, T. F., Martinez, F., Wright, A. L., Daines, M. O., Stern, D., & Mathur, A. (2016, February). Sensitivity and Specificity of a Clinical Diagnosis of Allergic Rhinitis in Childhood. AAAAI 2016 annual meeting. Los Angeles, CA: AAAAI/Journal of Allergy and Clinical Immunology.
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  We sought to evaluate the sensitivity and specificity of a clinical diagnosis of allergic rhinitis, using history and physical, to identify skin test positive rhinitis.
• Carr, T. F., Mathur, A. K., Martinez, F., & Stern, D. A. (2016, March). Sensitivity and Specificity of a Clinical Diagnosis of Allergic Rhinitis in Childhood.. American Academy of Allergy, Asthma, and Immunology Annual Scientific Meeting , Los Angeles.
• Altisheh, R., & Carr, T. F. (2017, October). DRESS Secondary to Febuxostat in a Patient With Prior DRESS from Allopurinol. American College of Allergy, Asthma and Immunology National Meeting. Boston MA: American College of Allergy, Asthma and Immunology.
• Berry, C. E., Berry, C. E., Lu, Z. J., Lu, Z. J., Jenkins, I., Jenkins, I. C., Billheimer, D., Billheimer, D., Stern, D., Stern, D. A., Gerald, L. B., Gerald, L. B., Carr, T. F., Carr, T. F., Guerra, S., Guerra, S., Wright, A. L., Wright, A. L., Morgan, W. J., , Morgan, W. J., et al. (2015, May). Lung Function Trajectories in the Tucson Children's Respiratory Study. American Thoracic Society. Denver, CO: American Thoracic Society.
• Carr, T. F. (2018, March/Spring). Disparities in Risk of Hospitalization for Food Anaphylaxis in the United States. American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress. Orlando FL: American Academy of Allergy, Asthma and Immunology/World Allergy Organization.
• Carr, T. F. (2018, November/Fall). To the heart of the matter: Large pericardial effusion causing severe facial angioedema. American College of Allergy, Asthma and Immunology National Meeting. Seattle WA: American College of Allergy, Asthma and Immunology.
• Carr, T. F., Gonzalez-Reyes, E., Antonova, E., Trzaskoma, B., Iqbal, A., Limb, S. L., Griffin, N. M., & Lumry, W. (2017, May). Improvements in Asthma Symptom Control, Quality of Life, and Perception of Treatment Effectiveness After Omalizumab Initiation in Adolescents and Adults: Results from a 48-Week, Observational Study. American Thoracic Society International Conference. Washington DC: American Thoracic Society.
• Carr, T. F., Griffin, N. M., Yang, M., Rosen, K., & Casale, T. B. (2017, October). Clinically significant improvement in mini-RQLQ scores in patients with nasal polyps after omalizumab initiation. American College of Allergy, Asthma and Immunology National Meeting. Boston MA: American College of Allergy, Asthma and Immunology.
• Carr, T. F., Stern, D. A., Guerra, S., Wright, A. L., Morgan, W. J., Halonen, M., & Martinez, F. D. (2017, May). Lung Function Deficits to Age 32 Are Associated with History of Transient Wheeze. American Thoracic Society International Conference. Washington DC: American Thoracic Society.
• Carr, T. F., Stern, D., Halonen, M., Wright, A. L., & Martinez, F. (2015, May). Active Rhinitis at Age 6 Predicts Subsequent Development of Asthma Independent of Atopy. American Thoracic Society. Denver, CO.
• Mathur, A., Stern, D., Daines, M. O., Wright, A. L., Martinez, F., & Carr, T. F. (2016, February). Sensitivity and Specificity of a Clinical Diagnosis of Allergic Rhinitis in Childhood. AAAAI 2016 annual meeting. Los Angeles, CA: AAAAI/Journal of Allergy and Clinical Immunology.
  More info

  We sought to evaluate the sensitivity and specificity of a clinical diagnosis of allergic rhinitis, using history and physical, to identify skin test positive rhinitis.
• Patel, S., Dhanabalsamy, N., Galvani, C., & Carr, T. F. (2017, May). Reduction of Medication Use in Asthmatics Following Minimally Invasive Nissen Fundoplication for Severe GERD. American Thoracic Society International Conference. Washington DC: American Thoracic Society.
• Patel, s., Carr, T. F., & Daines, M. O. (2017, March). ORAI1 Mutation in a Child with Primary Immunodeficiency-9. AAAAI 2017 national meeting/Journal of Allergy and Clinical Immunology Supplement. Atlanta, GA: AAAAI.
  More info

  Case presentation and discussion of pathology, diagnosis, and treatment of immune deficiency 9
• Shareef, F., Carr, T. F., Billheimer, D., & Kraft, M. (2017, May). Inverse Relationship Between Leptin and Lung Function. American Thoracic Society International Conference, Washington DC, May 2017.. Washington DC: American Thoracic Society.
• Tongchinsub, P. P., & Carr, T. F. (2017, October). Combination Omalizumab and Mepolizumab Therapy for Poorly-Controlled Severe Persistent Asthma. American College of Allergy, Asthma and Immunology National Meeting. Boston MA: American College of Allergy, Asthma and Immunology.
• Tongchinsub, P., & Carr, T. F. (2017, March). Yellow Nail Syndome and Lymphopenia. American Academy of Allergy, Asthma and Immunology National Conference. Atlanta GA: American Academy of Allergy, Asthma and Immunology.

Reviews

• Ponda, P., Carr, T., Rank, M. A., & Bousquet, J. (2023. Nonallergic Rhinitis, Allergic Rhinitis, and Immunotherapy: Advances in the Last Decade(pp 35-42).
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  Chronic rhinitis encompassing both allergic and nonallergic rhinitis affects a significant portion of the population worldwide, having a great impact on patient quality of life, and associated comorbid conditions, with an important societal economic burden. Allergists are often the first to evaluate and treat allergic and nonallergic rhinitis, addressing the individual triggers of the disease as well as the patient-specific responses to these triggers. This review focuses on the advances that have been made in the diagnosis, management, and treatment of nonallergic and allergic rhinitis over the past 10 years, including specific allergen immunotherapy, care pathways, and digital health.
• Carr, T. F., Altisheh, R., & Zytt, M. (2017. Small Airways disease and Severe Asthma.
  More info

  doi: 10.1186/s40413-017-0153-4
• Carr, T. F., Carr, T. F., Kraft, M., & Kraft, M. (2017. Management of Severe Asthma before Referral to the Severe Asthma Specialist. J Allergy Clin Immunol Pract.
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  doi: 10.1016/j.jaip.2017.04.027
• Carr, T. F., & Bleecker, E. (2016. Asthma Heterogeneity and Severity: for the Collaboration on Severe Asthma on behalf of the World Allergy Organization Asthma Committee..
• Carr, T. F., & Bleecker, E. (2016. Asthma heterogeneity and severity(p. 41).
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  Asthma is a common, chronic inflammatory airways disease characterized by a clinical syndrome of bronchial hyperresponsiveness, inflammation, and reversible airflow obstruction. Individuals with asthma can vary widely in clinical presentation, severity, and pathobiology. The incident factors, pathogenesis, prognosis, and treatment of asthma remain incompletely understood. Utilizing measurable characteristics of asthmatic patients, including demographic, physiologic, and biologic markers, can however identify meaningful phenotypic categories in asthma. Identification of these phenotypes may help improve precision therapeutics targeted toward an individual's' disease, and may identify strategies for preventing progression of disease severity.
• Carr, T. F., Alkatib, R., & Kraft, M. (2017. Microbiome in Mechanisms of Asthma.
• Carr, T. F., Zeki, A., & Kraft, M. (2017. Eosinophilic and Non-eosinophilic asthma. Am J Respir Crit Care Med.

Other Teaching Materials

• Carr, T. F. (2020. 25. What is Causing my Chronic Cough?. Banner Health.
• Carr, T. F. (2019. Personalized Medicine for Improving Asthma Care: An Animated Video Series. France Foundation.
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  In this series of fast-paced animated videos, Dr. Tara Carr discusses the treatment of severe asthma, including how to choose targeted therapy based on patient endotypes and phenotypes. Video 1: Approved Medications For Treatment Of Severe Eosinophilic AsthmaVideo 2: Mechanisms Of Action Of Biologic Therapies For Severe AsthmaVideo 3: Endotypes And Phenotypes In AsthmaVideo 4: Who Should Be Targeted For Treatment With Biologic Therapy?Video 5: Discussions With Patients To Optimize Asthma Control
• Carr, T. F. (2017. Rhinitis Teaching Slide Deck. American Academy of Asthma Allergy and Immunology.
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  Create teaching slides
• Carr, T. F. (2019. AsthmaCon: Online Virtual Patient Convention. AstraZeneca.
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  1. Understanding types of medication and treatment for mild asthma2. What do your numbers mean? (PEF, FEV1, eosinophil counts, SPO2,…)

Others

• Carr, T. F. (2016, February). Asthma segment on “The Show”. KJZZ 91.5 FM. http://science.kjzz.org/content/478776/ua-study-looks-asthma-kids-both-sides-border
• Carr, T. F. (2017, April). Immune system health. Banner Health eConnect.
• Carr, T. F., Billheimer, D., & Kraft, M. (2017, December). Relationship of serum leptin to lung function across a national population. Original research paper.