The 2019 IUIS classification identified 403 distinct primary immunodeficiencies associated with mutations in more than 430 genes. No single flow cytometry panel can resolve this diagnostic space.
When a child with Crohn’s disease stops responding to a biologic, the next decision is rarely as simple as choosing a…
A positive vaccine titer does not necessarily mean that an immunocompromised child is protected. In children receiving…
The diagnostic utility of lymphocyte subset panels in pediatric recurrent infections depends on clinical distribution…
Every week in my clinic I see the same avoidable error: a child arrives at the rheumatology or oncology service ready…
Targeted gene panels produced a molecular diagnosis in 56% of 780 patients evaluated for suspected primary…
A delayed vaccine series is not automatically a failed vaccine series. For most children, CDC catch-up guidance is…
T-cell receptor excision circles (TRECs) are stable, non-replicative episomal DNA by-products generated during V(D)J…
The central safety problem is not that vaccines are inherently dangerous for children with immune disorders. It is that…
A child on a scheduled biologic wakes up with a fever, comes home from school with a productive cough, or develops a…
For many children with juvenile idiopathic arthritis, the decision between oral and subcutaneous methotrexate is not a…
The choice between a maternal RSV vaccine and infant nirsevimab is not a simple preference between two equivalent…
A pediatric pre-transplant vaccine schedule is not simply a matter of bringing routine immunizations up to date. The…
In pediatric rheumatology, one of the most undervalued pieces of clinical evidence is often not a lab panel or a…
Starting a biologic or intensive immunosuppressive treatment in a child creates a narrow clinical planning window: we…
A child may complete chemotherapy with an apparently adequate vaccination history and still have incomplete protection…
The diagnostic yield for next-generation sequencing panels in primary immunodeficiency sits between 15% and 46%…
JIA-associated uveitis develops in roughly 10% to 15% of children diagnosed with juvenile idiopathic arthritis. In the…
When a child has a primary immunodeficiency or another condition causing significant immune suppression, vaccination…
A variant of uncertain significance can be one of the most difficult results in pediatric genetic testing—not because…
In adolescents aged 12 years and older, an ICS/formoterol-based Track 1 approach was associated with a 30-day hospital…
Approximately 5% to 15% of vaccinated individuals do not reach the protective anti-HBs threshold after a primary…
An abnormal TREC screening result is a signal, not a diagnosis. It means that a newborn blood spot contains low or…
Measles post-exposure prophylaxis is time-dependent. The MMR vaccine is generally used within 72 hours of initial…
The clinical landscape for families carrying a known primary immunodeficiency in their lineage is sharper than most…
Food allergy oral immunotherapy is not a single procedure and it is not a promise of permanent tolerance. For children…
Historical trials in children with sickle cell disease found that daily penicillin prophylaxis reduced pneumococcal…
A substantial proportion of children with juvenile idiopathic arthritis remain uncontrolled after exposure to multiple…
Rotavirus is one of the few routine pediatric vaccines that uses a live-attenuated oral product. The vaccine replicates…
Infants with severe combined immunodeficiency (SCID) have the highest clinical value from diagnosis before…
When a child has an abnormal newborn screening result, recurrent or unusually severe infections, persistent…
Allogeneic hematopoietic stem cell transplantation achieves overall survival above 90% in children with Wiskott–Aldrich…
The routine pneumococcal conjugate vaccine pathway is a four-dose series at 2, 4, 6, and 12–15 months…
A positive newborn screen for Severe Combined Immunodeficiency triggers a chain of events most pediatricians will…
The data supporting home subcutaneous immunoglobulin therapy in pediatric primary immunodeficiency is no longer in…
After hematopoietic stem cell transplantation (HSCT), a child’s previous vaccine history cannot be treated as a…
A molecular diagnosis of pediatric immunodeficiency is rarely just a matter of ordering the broadest available test…
When we discuss the barriers to pediatric clinical trial enrollment, the conversation often centers on eligibility…
RSV prevention for high-risk infants is governed by two time-dependent constraints: maternal vaccination must occur at…
When a child has recurrent infections, unexpectedly severe illness, poor vaccine responses, persistent lymphopenia, or…
Adenosine deaminase deficiency accounts for approximately 10%–15% of severe combined immunodeficiency cases. The…
A titer drawn two weeks after a vaccine series can look non-reactive. In an immunocompromised child, that single result…
The question of live vaccine timing after pediatric IVIG is not answered by a single number. The interval depends on…
Peanut allergy affects approximately 2% of the general population and up to 8% of children in Western countries. For…
Hyper-IgE syndrome can begin with a skin problem that looks familiar: severe infantile eczema, a persistent neonatal…
Roughly a third of the pediatric patients referred to my trial coordination desk arrive at the immunosuppression…
California's newborn screening program pushed 3,252,156 infants through T-cell receptor excision circle (TREC) testing…
Oral methotrexate has approximately 11–15% lower bioavailability than subcutaneous methotrexate at identical doses in…
When a young boy presents with bruising, petechiae, nosebleeds, or an unexpectedly low platelet count, immune…
The minimum age for risk-based MenACWY vaccination can be 2 months. The minimum age for MenB and pentavalent MenABCWY…
When a child has recurrent pneumonia, deep bacterial or fungal infections, unusually persistent lymphadenitis, or…
In my experience running pediatric immunodeficiency cohorts, this is the single most common dosing question I get from…
Reported overall survival after hematopoietic stem cell transplantation in congenital athymia is approximately 41%…
For a child with anatomic or functional asplenia, vaccination is not simply a matter of completing the routine…
A positive TREC newborn screening result for severe combined immunodeficiency is a referral, not a verdict — and the…
For families considering a pediatric gene therapy clinical trial, the most difficult part is often not finding a study…
In my line of work, I see clinical protocols that are meticulously designed and then routinely weakened at the point of…
Severe congenital neutropenia (SCN) is defined by a persistent absolute neutrophil count (ANC) below 500 cells/µl…
A child may have received every routine vaccine on schedule before cancer treatment and still need a carefully planned…
When a child presents with recurrent sinopulmonary infections, failure to thrive, or unusual autoimmune phenomena, the…
The FDA reports an approval rate of approximately 99% for submitted Expanded Access Program applications, with more…
Pediatric systemic lupus erythematosus is rarely a condition that can be managed with one prescription or a short…
A child with a 22q11.2 deletion may be listed in the chart as having DiGeorge syndrome, but that label does not answer…
For children with asthma, annual influenza vaccination is not optional risk management. Influenza can trigger acute…
An abnormal newborn SCID screening result is urgent, but it is not, by itself, a diagnosis of severe combined…
A pediatric hematopoietic stem cell transplant (HSCT) rarely begins on the day the cells are infused. By the time the…
A single oral corticosteroid dose, typically prednisone or prednisolone at 1 mg/kg at flare onset, resolves fever…
For families living with an immunocompromised child, the rotavirus vaccine can create an uncomfortable contradiction…
Combined TREC/KREC newborn screening has identified severe T- and/or B-cell immunodeficiencies at a prevalence of 8.13…
A denial of pediatric biologic therapy is rarely a simple statement that a child is “not eligible” for treatment. More…
The 2025 STOP-JIA trial results confirmed what many of us in pediatric rheumatology had suspected for years: earlier…
A pneumococcal vaccine schedule for an immunocompromised child is defined by two variables: the child’s underlying risk…
The conversation I keep having with genetics counselors goes something like this: a couple arrives after losing a first…
Intravenous and subcutaneous immunoglobulin replacement constitute the two established administration routes for…
Approximately 50 to 60 percent of positive results on standard skin prick tests (SPT) and serum-specific IgE (sIgE)…
When I sit down with a family after a fresh CGD diagnosis, the most common opening question is not "what is this…
A single dose of a long-acting monoclonal antibody such as nirsevimab provides passive protection against severe…
When a child has recurrent, unusually severe, or difficult-to-explain infections, the clinical challenge is not simply…
The deferral question lands on my desk roughly once a week. A family has a child on monthly IVIG for a primary antibody…
For moderate-to-severe pediatric atopic dermatitis, the treatment distinction is no longer simply topical therapy…
When parents or clinicians consider separating combination vaccines into individual injections, the discussion often…
The 2017 FDA approval of tisagenlecleucel for pediatric and young adult relapsed/refractory B-cell ALL was supposed to…
For a child, stepping down asthma controller medication is usually considered only after at least six months of stable…
Wiskott–Aldrich syndrome has an estimated incidence of approximately 1 in 250,000 live male births. It is an X-linked…
Vaccine titer testing for immunocompromised children can answer an important clinical question: has the child produced…
In my experience running pediatric immunology cohorts, the difference between a clean flow cytometry readout and a…
The 2026 American College of Rheumatology guidelines materially change several juvenile idiopathic arthritis treatment…
Genetic testing can clarify a child’s immune disorder, change the management pathway, and sometimes prevent years of…
In July 2026, the BMJ published the SPIRIT-C 2026 and CONSORT-C 2026 extensions — a set of new reporting expectations…
An abnormal SCID newborn screen is an urgent finding, but it is not the same as a diagnosis of severe combined…
For children with persistent allergic rhinitis, antihistamines and nasal sprays can control symptoms, but they do not…
A 76.9% reduction in severe acute respiratory infection (SARI) among infants was reported in one study when household…