The complexities and nuances for successfully treating chronic sinusitis usually involves two medical specialists, an otolaryngologist-head and neck surgeon (also called an ENT) and an allergist/immunologist.

Patients with this condition usually see these two specialists in separate appointments.

Now USF Health is offering a merged clinic for patients with chronic sinusitis and related conditions where they will have one appointment with both an ENT and an allergist at the same time.

Farnaz Tabatabaian, MD, associate professor in the Department of Allergy and Immunology in the USF Health Morsani College of Medicine, and Mark Tabor, MD, associate professor in the Department of Otolaryngology Head and Neck Surgery in the USF Health Morsani College of Medicine, have combined their expertise and their clinics to form this new merged clinic.

The aim is to more effectively treat patients by being more efficient with the treatment plan, Dr. Tabatabaian said.

“We’re an academic institution so we see more complex conditions,” Dr. Tabatabaian said. “Bringing these two specialties into one clinic, one visit for the patient, makes incredible sense, not just for convenience but also for continuity of care and better outcomes. An ENT and an immunologist both in the room will better help meet the needs of patients experiencing the most complex sinusitis cases.”

Those with chronic sinusitis need the expertise of both an ENT and an allergist because they may need surgery to address the physical and structural problems, which the ENT will provide, and then also need allergy shots, antibiotics and, perhaps, biologics from the allergist to address the underlying immune and inflammatory response. Most patients will need both approaches but, as typically happens, the time between appointments allows the condition to return, causing patients to need further care and starting the cycle of treatments and procedures over again.

“Done separately, the condition isn’t fully treated, meaning patients may go back and forth with ENT and allergist appointments,” Dr. Tabor said. “The structural fix only lasts until the immune system flares up again and sinusitis returns, or the immune system is calmed and the barriers in the structure continue to limit and sinusitis returns. By addressing both structural and immune response at once, treating the two root causes together, patients will fare better for beating the return of sinusitis.”

“The therapies are available, but the collaborative environment in one clinical setting means we are offering precision medicine at its core,” Dr. Tabatabaian said. “Combining our clinics into one collaborative setting means we are taking great care of patients and also learning from each other as colleagues.”

The USF Health combined clinic is also a great educational opportunity for medical students, resident physicians and fellows. And for patients, the merged clinic also means greater access to clinical trials for new therapies.

Chronic rhinosinusitis is inflammation of the nasal and sinus linings, nasal blockage, rhinorrhea, facial pressure/pain and loss of sense of smell, and may include nasal polyps.

Patients seeking appointments at this new USF Health combined clinic will need to have a diagnosis of chronic sinusitis and have tried but not benefited from traditional therapies. Ask your physician about a referral to the clinic to see if your condition qualifies.

Kimberly (Kim) Weeks has spent a lifetime with conditions doctors could never pinpoint causes for or new diagnoses added to her list of chronic conditions. Across her life she always had reoccurring asthma, bronchitis and ear and sinus infections, among other ailments.

“It seemed like every time we would go to the doctor they would say, “You have this’ and ‘Now this is going on,’” Kim said, an avid animal lover who works at a veterinarian clinic in Bradenton, Fla.,

In the spring of 2019, a sinus infection turned into double pneumonia, and she had to be placed on a ventilator for two days. Her doctors were considering removing part of the then-32-year-old’s lung. But they were hesitant to perform the surgery because they were still unsure what was making Kim so sick.

That led Kim to seek treatment from USF Health Jolan Walter, MD, PhD, division chief of the USF Health Pediatric Allergy and Immunology programs in the Morsani College of Medicine.

“I soon established that this is not the primary problem with the lung, but maybe her immune system is making her prone for the disease,” said Dr. Walter, who eventually diagnosed Kim with a version of severe combined immunodeficiency (SCID) referred to as leaky SCID.

Jolan Walter, MD,PhD

Leaky SCID is an atypical immune deficiency in the bone marrow that prevents white blood cells from maturing, which hampers their ability to fight infections. These cases may remain unnoticed for years before emerging with organ-damaging effects as the patient’s own immune system mistakenly attacks the body’s own tissue.

“Not only has Kim lost her immunity … she also acquired autoimmune complications,” Dr. Walter said.

The autoimmune complications included vitiligo, which causes the skin to lose color in blotches, and alopecia, or sudden hair loss. “Over time, it progressively got worse,” Kim said.

DNA samples

Dr. Walter determined that the only solution to restore Kim’s immune system was a bone marrow transplant, or hematopoietic stem cells. It came with risks.

“It was not an easy decision,” Dr. Walter said.

Treating leaky SCID with a bone marrow transplant is experimental, so Kim was sent to a National Institutes of Health (NIH) hospital in Maryland for the procedure.

“I don’t want to die, that’s my biggest fear,” Kim said.

In May 2021, Kim’s brother donated bone marrow for the transplant. She was the eighth person in the country to undergo the procedure for this condition. She was hospitalized for 45 days.

In the year since the transplant, Kim’s health has steadily improved, and she hasn’t seen a return of her symptoms.

“Overall, Kim being a year out of her transplant and the way she looks and feels is one of the biggest gifts that I can get from my career,” Dr. Walter said.

Now 35 years old, Kim can look forward to enjoying her life with family, friends and furry friends thanks to the excellent care provided by Dr. Walter and her team.

Dr. Jolan Walter with Kim Weeks during a follow-up appointment.

“She’s brilliant; she ensured that I’m going to be around to see my nieces and nephews graduate high school, college and be married,” Kim said.

Kim’s treatment was so new that Dr. Walter chronicled her case as the senior author in an article under review for the “Journal of Allergy and Clinical Immunology: In Practice”, with former USF Health Pediatrics chief fellow Maria Chitty Lopez, MD, who is currently affiliated with the Children’s Hospital of Philadelphia, serving as a first author. Kim’s case was also included in a study recently published by Nature Immunology.

Several USF Health team members of Dr. Walter’s laboratory have contributed to Kim’s case including David Evan Potts (MD & PhD student), Dr. Krisztian Csomos (research associate),  Melis Yilmaz (student intern), Boglarka Ujhazi  (biological scientist) and several past and current fellows in training in USF Health Allergy Immunology (Drs. Natalie Diaz-Cabrera, Tara Saco, Leah Ismael) and colleagues from our community (Dr. Roger Danziger).

Tampa, Fla (October 30, 2017) – Pregnant women who consume fish rather than fish oil supplements are just as likely to protect their offspring from developing asthma.

Researchers at the University of South Florida in Tampa, Fla, just published a scientific review of two studies that conclude children whose mothers consume high-dose omega-3 fatty acids daily during the third trimester are less likely to develop such breathing problems.

However, co-authors Richard Lockey, MD, and Chen Hsing Lin, MD suggest pregnant women receive the same benefit following the Food and Drug Administration and Environmental Protection Agency’s recommendation to consume 8-12 ounces (2-3 servings) of low mercury fish a week.

The review published in the Journal of Allergy and Clinical Immunology: In Practice examined two articles. The New England Journal of Medicine study included 346 pregnant women in their 3^d trimester who took omega-3 fatty acids daily and 349 who took a placebo. The investigators also divided the trial population into three groups based on their blood levels of omega-3 fatty acids. The population with the lowest blood levels benefited the most from fish oil supplementation.

The Journal of Allergy and Clinical Immunology randomized pregnant women in their 3^rd trimester into fish oil, placebo and “no oil” groups. The fish oil group took omega-3 fatty acids daily as did the placebo (olive oil) group. The “no oil” group was informed of the trial proposal and therefore could consume fish oil or fish during the 3^rd trimester if they chose to do so. Researchers found the fish oil and the “no oil” groups took less asthma medication as they aged to 24 years old, inferring both groups developed less asthma.

“Omega-3 fatty acids cannot be synthesized by humans and therefore are essential nutrients which are derived exclusively from marine sources,” said Lin. “It may be premature to recommend daily high dose fish oil supplementation during the 3^rd trimester.”

“With almost equal to slightly higher cost, consuming 8-12 ounces (2-3 servings) of fish a week not only may attain the same asthma protection, but strengthens the nutritional benefits to infant growth and development,” said Lockey.

Allergy sufferers are breathing a sigh of relief with the news that FDA-approved medications taken via a pill or drops under the tongue over the course of weeks – as opposed to a series of injections that might last years – are starting to hit the market.

The sublingual medication is as effective in some patients as injections, a standard course of treatment that has changed little in the past 100 years, said Richard F. Lockey MD, FACP, professor and director of the Division of Allergy and Immunology in the USF Health Morsani College of Medicine and holder of the Joy McCann Culverhouse Chair of Allergy and Immunology.

“Sublingual immunotherapy has been around for a long time but earlier concentrations were ineffective because they were in too small of doses to help patients build immunity,” Dr. Lockey said. “These new standardized pills and drops are now in larger doses and have proven to be as effective in double-blind, controlled studies. These properly balanced studies showed a statistically significant benefit to patients.”

The first pills and drops available this summer target certain grasses and ragweed. Formulas for cat, dust mite and other allergens should be available next, Dr. Lockey said, while those for oak, Bahia and Bermuda grasses, other trees, weeds and molds may take years.

On-going clinical studies play into the pace for when the new sublingual immunotherapies become available. USF Health is a clinical site for the study related to dust mite allergies and continues to seek people allergic to dust mites to participate in the study, Dr. Lockey said. For more information about the dust mite study, call (813) 631-4024.

The number one allergen for Floridians is oak, Dr. Lockey said, so local allergy sufferers will have to wait because it is not yet a standardized allergen and not available for sublingual immunotherapy.

Patients who might benefit from the new medications are those who are allergic to only one or two things, and only seasonally. Those allergic to multiple things, called polysensitized, would likely see bigger benefits from shots, Dr. Lockey said. That’s because the serum used for injections can include concentrations for multiple allergens, creating a medication that is tailored to match each patient’s allergies. The new sublingual immunotherapies target only single allergens, making them somewhat like “one-hit wonders.”

But it also depends on where the person lives, he said. For example, people allergic to ragweed might be a candidate for the sublingual medications if they live up north, where ragweed blooms only seasonally. If they live in Florida, where ragweed is a year-round bloomer, they would not be prescribed the sublingual option.

The advantages for the new sublingual pills and drops are significant for patients, Dr. Lockey said, with time savings being the greatest. Sublingual immunotherapies are taken for about 12 weeks before the season begins and during the season for a patient’s particular allergen, he said. Injections are typically given one or two times each week for three to five months and monthly thereafter for three to five years or more. In addition, sublingual medications can be self-administered once the patient has taken the first dose at a physician’s office to monitor for adverse reactions. Injections require a visit to the physician’s office.

One of the big hopes, Dr. Lockey said, is that the new easy-to-take medications might entice more people to find relief.

“Some patients cannot pursue shots because of time constraints,” he said. “Sublingual immunotherapies can be given at home.”

For more information about the new sublingual immunotherapies and to make an appointment with a USF Health allergist, call (813) 974-2201.

Photos by Eric Younghans, USF Health Office of Communications