Allergy & Immunology Specialist, Internist
10 years of experience

Stone Oak
903 La Garganta
San Antonio, TX 78258
210-292-5042
Locations and availability (2)

Education ?

Medical School Score
Uniformed Services University (2000)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Board of Allergy and Immunology
American Board of Internal Medicine

Publications & Research

Dr. Coop has contributed to 6 publications.
Title Patient Perceptions Regarding Local Reactions from Allergen Immunotherapy Injections.
Date August 2008
Journal Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
Excerpt

BACKGROUND: Although most allergists agree that local reactions to immunotherapy are not predictive of future systemic reactions, the 2 main reasons for dose adjustments are the concern that local reactions cause discomfort that may lead to patient noncompliance and the concern that local reactions are predictive of future local reactions. OBJECTIVES: To determine patient perceptions regarding local reactions from immunotherapy. METHODS: A survey on allergen immunotherapy was provided to patients. Participants were asked about the presence of local reactions, the size of their local reactions, and how bothersome these local reactions were. Patients were also asked if they had considered stopping immunotherapy because of these local reactions. RESULTS: All 249 patients undergoing immunotherapy completed the survey. Seventy-one percent of the patients reported that they had experienced a local reaction during allergen immunotherapy. Of those patients who reported local reactions, 84.7% reported local reactions smaller than the palm of the hand and 81.9% deemed local reactions not to be bothersome at all or only slightly bothersome. Of those who experienced local reactions, 96.0% stated they would not stop immunotherapy because of these local reactions. CONCLUSIONS: Although most patients reported local reactions, these local reactions were usually small and not very bothersome. Most patients would not stop allergen immunotherapy because of local reactions.

Title Anaphylaxis from the Influenza Virus Vaccine.
Date May 2008
Journal International Archives of Allergy and Immunology
Excerpt

BACKGROUND: Allergic reactions to the influenza vaccine are uncommon and usually associated with sensitivity to egg or gelatin. The aim of this study was to report the case of anaphylaxis to the influenza vaccine. METHODS: Allergy percutaneous skin testing, serum specific IgE testing and IgE immunoblotting were performed to the influenza vaccine, egg, and gelatin. RESULTS: Percutaneous skin testing to the influenza vaccine and gelatin were positive and egg (white, whole, and yolk) was negative. Immunocap serum-specific IgE testing to egg (white, whole, and yolk) and gelatin were negative (<0.35 kU/l). IgE immunoblots were performed with 2 cord blood serums and the patient's serum at a 1:20 dilution against 10 microg of the Fluzone influenza vaccine. The patient's IgE immunoblot showed a protein band at 100 kDa which is similar to the molecular weight of gelatin protein, a 68-kDa protein which is similar to the molecular weight of hemagglutinin protein from the influenza vaccine, and a 45-kDa protein band that is similar to the molecular weight of ovalbumin protein from chicken embryo/egg. CONCLUSION: Based on clinical symptoms, skin testing, Immunocap testing and immunoblot evaluation, we feel that our patient is allergic to the infectious agent in the influenza vaccine as well as gelatin and ovalbumin in egg.

Title The Gill Study: Glycerin-induced Local Reactions in Immunotherapy.
Date February 2008
Journal The Journal of Allergy and Clinical Immunology
Excerpt

BACKGROUND: The mechanism of local reactions is not well defined. Glycerin, an excellent preservative used commonly in immunotherapy extracts, is a recognized irritant. OBJECTIVE: This study was undertaken to examine whether higher glycerin concentration in immunotherapy extracts is associated with an increase in local reaction rates during immunotherapy. METHODS: A retrospective analysis of electronic immunotherapy records over a 12-month period was performed from a single site. A small local reaction was defined as induration and/or erythema at the injection site smaller than or equal to the size of the patient's palm. A large local reaction was defined as a reaction larger than the patient's palm. RESULTS: Over the 12-month period, 360 patients received a total of 9678 immunotherapy injections. For all injections, the total local reaction rate was 16.3% (1574/9678), the small local reaction rate was 15.9% (1536/9678), and the large local reaction rate was 0.4% (38/9678). For aeroallergens, small local reaction rates increased significantly with increasing allergen concentrations, from 7.3% (1:1000 vol/vol) to 23.0% (1:1 vol/vol; P < .001). The small local reaction rate was higher with increasing allergen content but not higher glycerin concentration. Large local reactions were infrequent and did not significantly increase with allergen or glycerin concentration. CONCLUSIONS: Small local, but not large local, reaction rates increase with higher allergen concentration, number, and volume. Higher glycerin concentrations (even 50%) are not associated with significantly higher small or large local reaction rates.

Title Extensive Keloid Formation and Progression After Each Vaccination.
Date November 2007
Journal Human Vaccines
Excerpt

Keloids are scars that extend beyond the original wound boundaries. They typically occur in darker skinned individuals with a familial tendency. Keloid formation has occurred after vaccination with bacilli Calmette-Guerin (BCG), small pox and hepatitis B vaccinations. We report the case of a 45-year-old female patient who developed extensive keloidal scars on her bilateral upper arms beginning in childhood after routine vaccinations. These keloids progressed with additional vaccines given at the same sites. Keloidal scars develop in anatomic areas exposed to increased skin tension as was seen in this patient. Treatment of these keloids is difficult but typically involves surgical excision, cryotherapy, radiation and intralesional and topical corticosteroids.

Title Dose Adjustment Practices Among Allergists for Local Reactions to Immunotherapy.
Date September 2007
Journal Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
Excerpt

BACKGROUND: Dose adjustments for local reactions to immunotherapy have been previously proposed. Several studies have shown that systemic reactions from immunotherapy injections are not predicted by previous local reactions. However, no previous reports have evaluated the prevalence and rationale of dose adjustment protocols within allergists' practices. OBJECTIVE: To examine allergists' response after patients' local reaction to immunotherapy. METHODS: On behalf of the American College of Allergy, Asthma and Immunology (ACAAI) Immunotherapy and Diagnostics Committee, an electronic survey was sent to all practicing allergists of the ACAAI. Participants were asked whether they make dose adjustments for local reactions to immunotherapy and the rationale behind this decision. Strategies to prevent and minimize local reactions were also queried. RESULTS: A total of 2,797 electronic letters were successfully sent, and 761 allergists (27.2%) responded to the survey, with 94.7% of the participants having completed a fellowship in allergy and immunology. Common strategies used by allergists to prevent and minimize local reactions included a dose adjustment based on the local reaction from the previous injection (79.1%) and pretreatment with an antihistamine (70.1%). Most allergists (91.9%) dose adjusted for local reactions. Most of these dose adjustments were based on protocols that included criteria for both repeating and decreasing the dose of immunotherapy based on the size of the local reaction. Rationales used by allergists for local reaction dose adjustment protocols included beliefs that local reactions cause discomfort that leads to patient noncompliance (88.9%), local reactions are predictive of future local reactions (45.7%), and local reactions are predictive of future systemic reactions (29.2%). CONCLUSIONS: Our survey results indicate that most allergists dose adjust for local reactions to allergen immunotherapy. Although most allergists agree that local reactions are not predictive of future systemic reactions, the 2 main reasons for dose adjustments include the concern that local reactions cause discomfort that may lead to patient noncompliance with immunotherapy and the concern that local reactions are predictive of future local reactions.

Title Allergic Fungal Sinusitis Presenting with Proptosis and Diplopia: a Review of Ophthalmologic Complications and Treatment.
Date September 2006
Journal Allergy and Asthma Proceedings : the Official Journal of Regional and State Allergy Societies
Excerpt

Allergic fungal sinusitis is a noninvasive, but vigorous, inflammatory response to mold that occurs in immunocompetent patients with chronic sinusitis and nasal polyposis. It typically occurs in patients who have a history of atopic disease. Occasionally, the patients with allergic fungal sinusitis present with ophthalmic signs and symptoms--most commonly proptosis and diplopia. We report the case of a 23-year-old man with right-sided proptosis, diplopia, and nasal obstruction. He had a history of sinusitis in the past. On presentation, sinus computed tomography scan showed pansinusitis. Subsequent workup revealed elevated immunoglobulin E and positive skin testing to several molds including Bipolaris spicifera and Aspergillus fumigatus. Functional endoscopic sinus surgery was performed, and the surgical specimen revealed allergic mucin with eosinophils, Charcot-Leyden crystals, and a silver stain showing fungal elements. His symptoms, including proptosis and diplopia, improved after surgical debulking and use of systemic corticosteroids.


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