How Mount Sinai Queens Saved a Colleague’s Life

Updated on Sep 16, 2025 | Featured

Frank Parlatorre, center, Environmental Services, with a team of his colleagues who saved his life. From left: Mark Dela Cruz-Hunt, RN, RN, MHL, Clinical Nurse Manager; Francis Cortes, RN, BSN; Juliana Mariano, RN; Charmaine Escutin, RN; Jonathan Luke Murphy, MD; George Dangas, MD, PhD, Director, Cardiology; Kamran Babri, BLS, ACLS, RCIS, Cath Lab Lead Cardiovascular Tech; Anshika Rani, Physician Assistant; Michelle Hang, AGACNP-BC; Gian Florendo, Senior Physicians Associate; Sharri Keveson, RN; and Stefanie Pinto, RN

It started like any other day—until it wasn’t. On the morning of Thursday, February 20,  Frank Parlatore, Jr., a member of the Environmental Services team at Mount Sinai Queens, was preparing for his shift when he collapsed in the operating room locker room.

Frank had gone into sudden cardiac arrest, and his colleagues and friends, including nurses in the Post-Anesthesia Care Unit (PACU) and operating room, sprang into action and performed CPR right then and there. What happened next was a powerful reminder that at Mount Sinai, the commitment to care doesn’t stop with patients. Staff in the Mount Sinai community take care of each other, too.

“He had a cardiac arrest caused by severe coronary artery disease,” explains Georgios Syros, MD, Director of Cardiac Electrophysiology at Mount Sinai Queens. “He had multiple blockages—three-vessel coronary artery disease—and a weak heart, with only about one-third of normal function.” Lifestyle factors, including smoking and not seeing a doctor regularly, had contributed to his condition.

Following his initial stabilization, Frank was taken to the Emergency Department (ED), where the ED and ICU physicians performed resuscitation efforts for almost 40 minutes. After a normal rhythm was restored, he was taken for a coronary angiogram at the recently opened Mount Sinai Queens Cardiac Catheterization Laboratory. The angiogram confirmed the extent of his coronary blockages. Frank’s heart stopped again in the Cath Lab.  He was revived by Jonathan L. Murphy, MD, who used CPR and multiple defibrillation treatments.

Frank was placed on a respirator and fitted with a specialized device to support his circulation. Then, he was transferred to The Mount Sinai Hospital, where his heart function partially improved with medical therapy under the guidance of Ahmed El-Eshmawi, MD. In March 2025, Dr. Syros performed an electrophysiology study and implanted a defibrillator at Mount Sinai Morningside to help prevent life-threatening arrhythmias.

Over the next several weeks, Frank’s heart function continued to improve. By May, he was strong enough to undergo a double-vessel coronary artery bypass. The surgery was a success, and just months after that harrowing February morning, Frank was recovering exceptionally well.

“It’s not every day that the person on your OR table is also someone you know and work with,” Dr. Syros says. “That made it even more personal to me and the entire team to do everything we could to bring him back. This was Mount Sinai Queens at its best—quick thinking, teamwork, and compassion.”

How a Passion for Pharmacology and Addressing Substance Use Disorders Brought an Aspiring Researcher to Mount Sinai

Sep 9, 2025 | Featured, School

Ally Parpounas, MS

Ally Parpounas, MS, is a second-year student in the MD program at the Icahn School of Medicine at Mount Sinai. She previously completed the Master of Science in Biomedical Science (MSBS) at the Graduate School of Biomedical Sciences.

It was her decision to attend the MSBS program at Mount Sinai, along with her eventual participation in a number of different programs sparked by her desire to help people in need, that would lead to medical school, which in turn has opened a number of different career pathways.

Ms. Parpounas studied neuroscience at George Washington University in Washington, D.C. and studied abroad at the Danish Institute of Study in Copenhagen, Denmark. While at the Institute, she took a psychopharmacology course that sparked her interest in research. The course taught students how neural circuitry is implicated in various psychiatric conditions. She learned how to redirect it by developing a “pharmacological cocktail” that would minimize both side effects and symptoms.

“This experience unlocked my curiosity about the physiologic mechanisms that underlie disease, and so I  began to consider a career in medicine,” she says. She soon changed her major from psychology to neuroscience.

After completing her undergraduate program in 2020, she took a gap year working at an in-patient acute care psychiatric hospital in Washington D.C. She worked there for a year before deciding that she needed more basic research experience before medical school. A Master of Science in Biomedical Science seemed like a natural next step.

While looking at master’s programs, she noticed Mount Sinai’s MSBS program. She began looking into a few labs to determine what she wanted to study and focus on. She was drawn to the pharmacology research of the Daniel Wacker, PhD lab, where she would eventually be placed. She applied to a few other programs, but the MSBS program at Mount Sinai stood out because of the strong research component. She was also interested in living in New York City because it was close to where she grew up in Peekskill, New York, about an hour north of the city. She started the MSBS program in August 2021.

During her time in the program, she worked in a number of different areas that would eventually help shape her interest in a future career in medicine.

She volunteered and conducted clinical shadowing with the Mount Sinai Human Rights Program, which provides medical and psychological evaluations for people seeking asylum in the United States. The program helps people who are typically victims of human trafficking, political violence, and other difficult circumstances. They use these evaluations and affidavits to assist with asylum cases. She worked as one of the lead clinic managers.

“The program has shown me how we can leverage our roles as clinicians to protect the health and human rights of individuals, in addition to the traditional role providing direct medical care,” she says. “It’s incredible to see the impact you make on someone life beyond just their medical care.”

She also led the graduate school’s mentorship program. Mentors help first year students navigate decisions, such as determining what they want in a lab placement. Her positive experience doing this in her first year inspired her to act as a mentor for other students during her second year.

She was also a clinic manager at the East Harlem Outreach Partnership (EHHOP), the Icahn School of Medicine’s student-run, physician-supervised, free clinic. She has continued this work while in medical school as a part of the Access to Care Team, which helps patients gain access to medicines, healthy food, and legal assistance. She  is now on ACT team leadership as the ACT Resources Chair.

She believes that the opportunities she had to get clinical experience helped shape her drive towards medical school.

“My previous experiences helped inform my direction for medical school and the type of work I want to do when I become a physician,” she says. “My training in the MSBS program helped make me a more thoughtful and intentional applicant to medical school.”

“The program has shown me how we can leverage our roles as clinicians to protect the health and human rights of individuals, in addition to the traditional role providing direct medical care. It’s incredible to see the impact you make on someone life beyond just their medical care.”

The Graduate School provides support to help master’s students seeking to continue their education through PhD or MD programs. Ms. Parpounas  worked with a student advisor in the Medical Scientist Training Program (MSTP) that helped with her medical school application process. The student advisors provide services such as creating an MCAT study schedule and essay review and revision help. This support was available as needed, but it was up to Ally to schedule meetings and manage the process.

“When I was studying for the MCAT exam, my friends in the medical school and the MSAP advisors (the MSTP student advisors) recommended study plans and resources, like Anki flashcards, that were more similar to what people use in medical school vs undergrad. I think studying in this way helped me get an MCAT score that I was proud of and made me feel more ready for the academic rigor of medical school,” she says.

She completed the MSBS program in June 2023 and received the Award for Excellence in Biomedical Science Leadership and Service Award for her volunteering and mentorship. She then applied to a few MD programs and was accepted to the program at the Icahn School of Medicine. Ally appreciates being in the first class to experience the new ASCEND curriculum, which was introduced in the fall of 2024. The objective of this curriculum revamp is to provide a personalized and active-learning approach aimed at transforming the way knowledge and clinical experiences are acquired.

Upon completing her MD, Ally is interested in a few different paths in medicine. She is currently working with Leah Habersham, MD, Director of the Bridge Program at Mount Sinai. The Bridge Program is an integrated clinic providing women’s health care, including obstetrics and gynecology, along with care for substance use disorder.

These experiences at Mount Sinai have sparked an interest in a wide variety of areas, including specialties such as obstetrics and gynecology, pediatrics, and internal medicine. But she believes it’s important to keep an open mind and will explore more once she begins her clinical clerkships in February 2026.

Learn more about the MSBS Program
Learn more about the MD program

Stories Behind the Science: Preparing to Fight the Next Epidemic

Updated on Sep 9, 2025 | COVID-19, Featured, Research

Stories Behind the Science: Preparing to Fight the Next Epidemic

Kris White, PhD, Assistant Professor of Microbiology at the Icahn School of Medicine at Mount Sinai (right), and lab member Isidora Suazo, PhD, Postdoctoral Fellow (left), are part of a research network to discover new drugs for a viral epidemic preparedness initiative.

It was June 2022, and Peter White, a lawyer from Point Lookout, Long Island, was in Florida attending a work event. As he was waiting for his flight home, he started to feel sick.

“By the time I landed, I was very sick with a heavy pressure in my chest,” said Mr. White, 67. “Any time I had previously felt like this, it had always, at a minimum, developed into bronchitis or pneumonia.”

Mr. White was worried it was COVID-19, which could spell poor outcomes given his underlying respiratory condition. “When I get a cold, it has a tendency to morph into bronchitis and, at times, pneumonia. I’ve had walking pneumonia several times, as well as regular pneumonia,” he said. “I can’t count the number of times I have had bronchitis.”

His doctor advised him to go to the emergency room to seek treatment for COVID-19. Thankfully, just months prior—in December 2021—the antiviral medication Paxlovid (nirmatrelvir/ritonavir) from Pfizer had become available via emergency use authorization for the treatment of COVID-19.

“I did not feel better right away,” Mr. White recalled. “However, I did not get worse, which was huge given my prior history, and it was a comfort for me that the drug was working.”

“Thankfully, his bout with COVID-19 ended up being uneventful, because he was able to take Paxlovid quickly and clear it out of his system,” said Kris White, PhD, Assistant Professor of Microbiology at the Icahn School of Medicine at Mount Sinai and Mr. White’s son.

“The COVID-19 pandemic really taught us the value of having treatments ready to test and deploy quickly when an epidemic hits,” said Dr. White.

Mount Sinai has been working toward that goal, in part through its involvement in the Antiviral Drug Discovery (AViDD) Centers for Pathogens of Pandemic Concern, established in 2022 by the National Institutes of Health (NIH). Dr. White’s lab is among several at Mount Sinai contributing research as part of the AViDD Centers, developing antiviral drugs to tackle future outbreaks.

Dr. White (second from right) with his father, Peter (second from left), with five of Dr. White’s children and two nieces. Peter caught COVID-19 in 2022, but with Paxlovid antiviral treatment, it did not develop into something severe, for which Mr. White was at high risk.

However, recent cuts to NIH funding have threatened to stall progress. “We were halfway to the finishing point,” said Dr. White. “With our funding cut, it is like we have half a drug—and that is of no good to anyone.”

Read about how antiviral research can help us navigate future epidemics, and challenges the AViDD Centers face.

‘It Could Have
Been A Very
Different Pandemic’

The issue with relying solely on pharmaceutical companies to develop drugs for an epidemic is that until the health crisis is at hand, there is no incentive for them to carry out such research, noted Dr. White.

That was the case with COVID-19—when it hit in early 2020, there were few if any drug candidates to test right away. Pharmaceutical companies and academic institutions scrambled to find new compounds, or repurpose old ones, that could treat the infection.

Pfizer had a lead, PF-07321332, which had potential for targeting SARS-CoV-2, the virus that causes COVID-19. It was developed in 2003 to address the severe acute respiratory syndrome (SARS) outbreak in 2002-2004. But before it could make it into human clinical trials, the outbreak was contained and development was discontinued.

Even promising compounds take time before they can be used on patients. It wasn’t until March 2021 that Pfizer announced it would test PF-07321332 in humans in a phase 1 trial. In June that year, a phase 2/3 trial was carried out to test its effectiveness, and in December, the compound, which had been named Paxlovid, received its emergency-use authorization.

“We’ve seen that given the will, we can quickly test the effectiveness and safety of treatments and make them available to the public,” said Dr. White. “Imagine if we had compounds ready to test right at the beginning, it could have been a very different pandemic.”

For Dr. White’s father, that difference was between life and death. “Paxlovid was a game changer for me,” said Mr. White. “Knowing that I was most likely going to suffer, but not die, from COVID-19 was good news. It would have been better if this drug was available sooner rather than later.”

Having treatments available early on not only reduces transmission, disease severity, and mortality rates, but also has an impact on health policy.

“Having such an antiviral could even have mitigated the need for severe lockdowns, or even vaccine mandates,” said Dr. White. For people who might be ineligible for vaccines, or were resistant to such mandates, having a treatment available would have provided options for health providers and policymakers, he explained.

March 2020

The World Health Organization declares COVID-19 a pandemic.
September 2020

Pfizer completes pharmacokinetic study of PF-07321332 in rats.
March 2021

PF-07321332 tested in a first-in-human phase 1 trial.
June 2021

Phase 2/3 trial for PF-07321332 begins.
December 2021

PF-07321332 receives emergency-use authorization from the FDA, is named Paxlovid.

Kickstarting the Process

Dr. White, seen dressed in protective clothing, works with Biosafety Level 2 and Biosafety Level 3 viruses as part of his work. His lab’s research includes drug discovery of new antivirals and building up animal models of viral infection.

Following the authorization of Paxlovid, the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, realized the benefits of having promising drug candidates ready to be tested at the onset of an outbreak.

“Academic institutions like Mount Sinai were perfectly suited for kickstarting that discovery work,” said Dr. White, whose lab studies viral-host interactions, develops cell culture and animal models of viral infection, and performs other antiviral drug discovery work.

Members of Dr. White’s lab, from left to right: Briana McGovern, BS, Senior Research Associate; Meg Gordon, BA, Research Associate; Dr. White; Dr. Suazo; Jared Benjamin, MS, Research Associate.

“Historically, drug discovery was a process that took billions of dollars, and was usually undertaken by pharmaceutical companies,” said Dr. White. “Now, with technological advances and artificial intelligence, the cost of that process has been brought down to millions of dollars, which is a realm that the federal government can provide funding for.”

NIAID awarded a total of $577 million in 2022 toward the creation of nine AViDD Centers, which collectively work to discover better treatments for SARS-CoV-2 and other coronaviruses, as well as six other pathogen families of concern, which include Ebola, Zika, and other cold-causing viruses. Mount Sinai researchers received a total of $16 million and are involved in four of the nine centers.

Progress
Cut Short

Dr. White handling cell cultures stored in a cold storage unit in his lab.

The AViDD Centers were conceived as a five-year project. However, in March 2025—three years into the Centers’ inception—the Centers for Disease Control and Prevention canceled more than $11 billion in funding earmarked for pandemic response.

This included funding for the AViDD Centers, where researchers had the remainder of their unspent budget terminated immediately, pulling out the rug from under several projects.

“I’ve had to let people go from my lab, and we’re currently working in an unfunded state for the AViDD project,” said Dr. White. “We’re only continuing because we had prepaid for certain things before the funding cutoff.”

The most advanced drug developed thus far was basically a better Paxlovid for targeting coronaviruses, but without the need for the ritonavir component, said Dr. White. This is critical because the ritonavir component severely limits the use of Paxlovid in some patients due to drug interactions with other drugs. That compound is more or less ready for a pharmaceutical company to take over for clinical trial testing, with its patents remaining open access, as directed by the NIH.

“We have an excellent coronavirus drug ready to go to clinical trials, but every other drug for the other viruses—paramyxovirus, filovirus, flavivirus, and more—none of them are even close,” he said.

At best, work on the other viruses are close to getting their animal model efficacy data, which is crucial for moving the drugs into human models, said Dr. White. “Getting animal model data is hard enough in five years. Without funding for the remaining two years, getting that data in just three years is almost impossible.”

The drug dispensing robotics system, operated by research associate Mr. Benjamin in this photo, is part of the workflow in which the lab tests new antiviral compounds, said Dr. White. The equipment functions similar to an inkjet printer, and is able to print drugs into a plate format.
Dr. White’s lab had been working on animal models of coronaviruses, flaviviruses, and enteroviruses, and with funding for AViDD Centers abrupted halted, cultures remain in cold storage, waiting for work to resume.
Mr. Benjamin is monitoring the high throughput liquid handler system, which increases the number of samples that can be tested. Throughput is what drives drug discovery, and the lab was able install the equipment thanks to AViDD Centers funding, said Dr. White.

Operating costs for AViDD projects are on a larger scale because they involve high-throughput structural biology and biochemistry that run millions of dollars per year, noted Dr. White. Researchers are reaching out for patchwork funding to keep operations going, including from the Department of Defense, NIH, not-for-profit organizations such as the Drugs for Neglected Diseases initiative, and philanthropy.

Getting continued funding is crucial because viral outbreaks do not take breaks.

“At our labs, we’ve been focusing on Zika virus disease and dengue fever, and these are viral infections we’ve already seen on our shores but still have no treatments for,” said Dr. White.

“At the end of the day, I want to be able to keep my dad and many other people like him safe when—and not if—the next viral outbreak occurs,” said Dr. White. “We were already caught by surprise once with COVID-19. Let’s not have history repeat itself again.”

Advancing Our Understanding of MS: One Researcher’s Quest to Uncover Hidden Brain Changes

Updated on Aug 28, 2025 | Featured, Research

Caption: An image from a standard clinical MRI, left, compared with an image from the same person using advanced methods on a stronger, 7T MRI. Compared to the standard clinical MRI, the research MRI is much clearer and multiple sclerosis lesions (dark spots) are more clearly seen.

How can clinicians better predict who will transition from relapsing to progressive Multiple Sclerosis (MS)? And can we use imaging techniques to diagnose MS more accurately and to select the right treatments for individual patients?

“These are questions people with MS and their doctors struggle with frequently, and so we hope to at least begin to answer them through our research,” says Erin S. Beck, MD, PhD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and a neurologist at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis.

Erin S. Beck, MD, PhD

Dr. Beck, whose research program explores the intersection of neuroimaging, immunology, and clinical  care, is seeking answers using advanced magnetic resonance imaging (MRI).

“At the heart of our work is a commitment to advancing both science and patient care,” says Dr. Beck. “By deepening our understanding of cortical lesions and the inflammatory processes that drive them, we are helping to shape a more precise and informed future for MS diagnosis, treatment, and care.”

For MS patients, the implications of this work are significant. If these imaging methods are validated, cortical lesion detection could become part of routine MRI protocols within the next several years. This could enable earlier and more accurate diagnosis, improve predictions of how a patient’s disease will unfold, and support more personalized treatment decisions.

Dr. Beck’s lab studies how lesions in the brain and spinal cord form, evolve, and repair in MS and other related diseases. A central focus of her lab’s research is understanding MS lesions in the cortex, the outer layer of the brain, which helps to control most of the brain’s functions. While white matter lesions are well-established markers of MS activity, they explain only part of the disease.

Cortical lesions, though harder to detect with standard imaging, are increasingly recognized as widespread in MS and closely tied to physical disability and cognitive impairment, particularly in progressive forms of the disease. It is unclear whether current MS treatments, which work by stopping new lesions from forming in the rest of the brain, are also effective at stopping cortical lesion formation.

Using state-of-the-art imaging technologies—including more powerful, 7 tesla (T) MRI scanners—Dr. Beck combines MRI with cerebrospinal fluid (CSF) and blood analysis to investigate the formation, repair, and clinical significance of cortical lesions. Her research integrates imaging with measures of inflammation, aiming to discover how immune processes contribute to lesion development and disease progression.

One of her lab’s key contributions is the development of MRI methods to improve cortical lesion detection using widely available 3T MRI scanners. These include IR-SWIET, a novel MRI method specifically optimized for visualizing cortical lesions. The lab is currently testing whether IR-SWIET could be useful for MS diagnosis and for monitoring response to treatment.

Her investigations also extend to patients with Radiologically Isolated Syndrome (RIS)—those whose MRI scans show MS-like lesions despite having no symptoms. Through advanced imaging and CSF studies, she hopes to identify biomarkers that distinguish individuals likely to develop clinical MS from those who will remain symptom-free.

Dr. Beck earned her MD/PhD from Columbia University. Following her neurology residency at New York–Presbyterian/Columbia and a neuroimmunology fellowship at the National Institutes of Health, she joined Mount Sinai’s faculty in 2021. Since then, she has been building her research program at the intersection of neuroimaging, immunology, and clinical MS care.

Dr. Beck’s research has been recognized with awards such as a Clinician Scientist Development Award and a Career Transition Fellowship from the National MS Society. Her findings have been published in leading journals, including Brain Communications, Investigative Radiology, and Human Brain Mapping.

By Julia Bonem, a volunteer at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis

Learn more about the Corinne Goldsmith Dickinson Center for Multiple Sclerosis

Why Are Vaccines Important?

Updated on Aug 13, 2025 | Featured, Your Health

Vaccines strengthen your body’s natural defenses. They are the safest and most effective way to protect yourself and your family from many preventable diseases, according to the U.S. Centers for Disease Control and Prevention (CDC).

Vaccines are one of the few ways we have to eliminate—or mostly eliminate—certain diseases. But often, for this approach to be effective, almost everyone needs to get vaccinated, according to Jennifer Duchon, MD, MPH, DrPH, a pediatrician and an expert in infectious diseases. In this Q&A, Dr. Duchon, who is Hospital Epidemiologist and Director of Antimicrobial Stewardship at the Mount Sinai Kravis Children’s Hospital and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, discusses why vaccines are important, especially for young children, and why you should talk with your doctor or health care provider if you have any questions about them.

Jennifer Duchon, MD, MPH, DrPH

Why are vaccines important? Vaccines help keep us healthy on several levels. On a personal level, getting vaccinated prevents you from getting sick or from developing the worst complications of a vaccine preventable disease, such as hospitalization or death. On a community level, getting vaccinated keeps your family and friends safe. Some people cannot get vaccines; they may be too young or may have a compromised immune system or some other health issue that makes them unable to receive a vaccine. But if you’re vaccinated, your risk of transmitting the disease is usually much lower. Which means you help others near you avoid getting the disease.

How does that work? In a particular population, we need a percentage of people vaccinated to prevent the spread of certain diseases. For example, for measles, which we consider to be eliminated in the United States due to an effective vaccine, we need about 95 percent of the local population to be vaccinated to prevent spread. Even a small outbreak can spread farther and faster than you’d think, and as fewer people are vaccinated, epidemic spread of a disease is possible. Remember, we’re all citizens of the world, and we have a responsibility to protect people who can’t protect themselves from vaccine-preventable diseases.

What vaccines do children need? We recommend several vaccines for children. Some start at birth; others we administer later. Some are single vaccines, while others require multiple doses to build up immunity, or yearly vaccination  to combat emerging disease mutations. For the exact vaccination schedule, check out the American Academy of Pediatrics (AAP) vaccine schedule and the CDC website. These vaccines include:

  • During a child’s first year, we administer vaccines to protect against hepatitis, Streptococcus pneumoniae; Haemophilus influenzae (which are bacteria that cause meningitis, blood stream infections and ear infections); tetanus, diphtheria, and pertussis; and RSV (respiratory syncytial virus).
  • At one year of age of older, children receive one vaccine against measles, mumps, and rubella, known as the MMR vaccine, as well as for varicella (chickenpox) . When they reach 4 to 6 years of age (typically school age), they need a booster shot for some of these diseases, including the MMR and varicella vaccines.
  • Booster shots for tetanus, diphtheria, and pertussis are also needed after the primary series.
  • We also recommend certain vaccines for older school age kids, to protect against diseases such as Human Papillomavirus (HPV) and meningococcal disease.

There are also some vaccines available for people with certain medical conditions as well as boosters for pregnant and elderly people. In addition, there are vaccines adults and children need annually, such as flu and COVID-19.

If I have any questions or concerns about vaccines, what should I do?

If you have any questions, don’t hesitate to ask your doctor or your child’s doctor. It’s important to know that all the vaccines listed on the AAP and CDC schedules have been studied extensively for safety and efficacy. Even the newest vaccines have been researched very carefully. The CDC continues to collect information about the safety of all vaccines; there are mechanisms in place for anyone—the public, a health care provider, or a health department—to report adverse reactions. The CDC studies these results, looking for trends. I recommend speaking to your primary care pediatrician, your family doctor, your obstetrician, or whomever you see regularly, have a long-term relationship with, and trust. You know these doctors—and you know they have your and your child’s best interests at heart. I always recommend asking as many questions as you want.

Find a Mount Sinai doctor

Stories Behind the Science: A New Way Forward With Food Allergies

Updated on Aug 15, 2025 | Allergy, Featured, Research

Stories Behind the Science: A New Way Forward With Food Allergies

The Esteves family on vacation, from left to right: Craig, Violet, Holly, Jackson, and Sailor Esteves.

Eating out for Jackson Esteves, 10, from Bayville, Long Island, had always been a gamble for him and his parents. With severe food allergies of various kinds—peanuts, dairy, sesame seeds, to name a few—having a meal in a restaurant, or even at a friend’s house, came with challenges and stress.

When Jackson’s parents were told that it could be possible to address at least his peanut allergy and make it less severe, they were ecstatic. “When the opportunity to participate in this trial was presented to us, we jumped,” said Holly Esteves, Jackson’s mother.

Jackson was enrolled into a study, named CAFETERIA, which explored whether it is possible for people who are allergic to peanuts—but are able to take small amounts—to be desensitized to the allergen through a form of immunotherapy that gradually exposes the individuals to peanut butter.

The study, funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, found that participants who received allergist-supervised treatment with peanut butter were able to tolerate more peanut butter than before, without any allergic reactions.

“Our study results suggest a safe, inexpensive, and effective pathway for allergists to treat children with peanut allergy who can already tolerate the equivalent of at least half a peanut, considered a high-threshold peanut allergy,” said Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital.

The findings, published in NEJM Evidence, suggest multiple ways forward for the research team.

“There are still many things we need to know to really broaden the impact of this research,” said Dr. Sicherer, who is also Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute, and Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

“Can we apply this to other allergens? How do we know what the right threshold of tolerance should be? How do we identify whether patients are right for this kind of treatment? The road ahead is an exciting one,” said Dr. Sicherer.

Read below to learn more about how the CAFETERIA study helped Jackson live a fuller life, the next steps for researchers, and what it takes to get there.

A constant state
of hypervigilance

Jackson and Holly Esteves.

Jackson had lived with an allergy diagnosis pretty much since birth.

“It is a constant in our lives. I live with a seriousness that I used to be able to escape, but eventually, being in a perpetual state of high alert takes its toll,” said Ms. Esteves. Every day, several times a day, she worries that her son will encounter an allergic reaction. “I often feel worn down and tired from the worry, but I remember to slow down, breathe, and find gratitude in the little things.”

Over time, the Esteves family learned to adjust to a “never normal.”  “It’s not necessarily easier, it is just what we’re accustomed to,” said Ms. Esteves.

That means that when Jackson goes to school and camp, he carries his own lunch and safe snacks. Going to a friend’s birthday party? He has to bring his own meal and cupcake.

“When we travel, we also need a kitchen accommodation to prepare food,” said Ms. Esteves. “I’ve learned how to order in restaurants, how to engage in constructive conversations with school and camp staff, and really how to advocate for my son always.”

The CAFETERIA study kicked off in August 2019, and Jackson was one of 73 participants in the trial. Participants were randomly and equally assigned to either the ingestion group—starting with one-eighth of a teaspoon of peanut butter, and eventually increasing to one tablespoon—or avoiding peanut products entirely.

After 18 months, both groups were tested on how much peanut they could eat without an allergic reaction. Among those who completed the study, all 32 children in the ingestion group could tolerate two and a half tablespoons of peanut butter. Only 3 of 30 children in the avoidance group could tolerate that amount.

Jackson, who was in the ingestion group, had no issues with the escalation doses. He is currently working with Dr. Sicherer to address his other allergies.

“Today, Jackson is safely eating peanut butter. Not only were we able to open up his diet, but we forged a bond with the Mount Sinai community who deeply understand the need for innovation, treatment, and prevention of food allergy disease,” said Ms. Esteves.

Figure A of this diagram shows the percentage of each respective group that achieved desensitization to peanut product at the end of the trial. Figure B shows the percentage of each respective group that retained that desensitization after being subject to peanut product avoidance. Figure C shows the total dose of peanut product individuals in each respective group was able to tolerate from baseline to the end of the trial. Figure D shows the size of wheals of participants in each group when subject to a skin prick test, from baseline to the end of the trial.

“I am incredibly grateful for our trial experience, for the wonderful professionals who took care of us, and for the research that I hope will help thousands, if not millions, of people,” she said.

And the CAFETERIA study didn’t offer just Jackson a new lease on life—it took a weight off Ms. Esteves too. “I used to lead conversations with an apology for being a bother about Jackson’s allergies, but not anymore. Now I lead with compassionate command,” she said.

“I used to lead conversations with an apology for being a bother about Jackson’s allergies, but not anymore. Now I lead with compassionate command.” —Holly Esteves, Jackson’s mother.

What it takes
to get to the next stage

Dr. Sicherer at the the Elliot and Roslyn Jaffe Food Allergy Institute.

With the CAFETERIA study concluded, Dr. Sicherer and his team are already contemplating next steps. The biggest question: can this method of immunotherapy be replicated in other food allergies?

A clear, direct way to test that would be a formal multicenter study in different types of food, said Dr. Sicherer. “That would be a huge undertaking—a clinical trial like that would require, perhaps, in the ballpark of $15 million, and years to run.”

But should the team’s hypothesis prove right, it could change how allergists can treat and advise children with high-threshold food allergies.

“A decade ago, allergists used to tell patients to completely avoid a food they were allergic to, even if they had a threshold before getting a reaction,” said Dr. Sicherer. “With the findings from the CAFETERIA study, it could be a future where patients could work with their doctors to start small, and eventually overcome their allergy.”

Specialists in the field have indicated interest in this new possibility, noted Dr. Sicherer. In a survey his team did, many allergists said they were open to recommending that patients with high-threshold allergies attempt a food escalation challenge.

Basic science
matters too

Supinda Bunyavanich, MD, MPH, MPhil, Mount Sinai Professor in Allergy and Systems Biology, has a lab focused on studying systems biology in allergy and asthma.

Even as the team is applying for grants from the National Institutes of Health (NIH) to fund that trial, researchers at Mount Sinai are working on parallel questions that the CAFETERIA study couldn’t address.

“Pharmaceutical companies have long focused on developing options for people who have low-threshold food allergies—meaning they react even to the slightest amount,” said Dr. Sicherer. “But not all patients with allergies are the same. What if they have higher thresholds, then how do we know which strategy—be it our protocol from the CAFETERIA study, or the commercial drugs—is best suited for them?”

There are two Food and Drug Administration-approved treatments for food allergies: Palforzia, peanut allergen powder, used as ingested immunotherapy for children with confirmed peanut allergies, and Xolair® (omalizumab), an injected antibody therapy used to reduce the risk of allergic reactions in case of an accidental exposure.

“Furthermore, we need a better way of identifying allergy thresholds in patients other than by feeding patients increasing amounts of a food to see when symptoms start,” said Dr. Sicherer.

A key to answering those questions: biomarkers. Researchers at the Elliot and Roslyn Jaffe Food Allergy Institute and elsewhere in the Icahn School of Medicine at Mount Sinai are tackling biomarkers at all levels, from basic science to human models. Some ongoing allergy research at labs at Mount Sinai include:

  • Hugh Sampson, MD, Kurt Hirschhorn, M.D./The Children’s Center Foundation Chair in Pediatrics, focusing on the humoral immune system and the proteins it makes that cause allergic reactions.
  • Maria Curotto de Lafaille, PhD, working on B cells and food allergies.
  • Erik Wambre, PhD, Director of Technology and Business Development at the Human Immune Monitoring Center at Mount Sinai, working on T cell responses in food allergies.
  • Supinda Bunyavanich, MD, MPH, MPhil, Mount Sinai Professor in Allergy and Systems Biology, studying systems biology in allergy and asthma, including the microbiome.

Dr. Sicherer (left) with Hugh Sampson, MD (right), Kurt Hirschhorn, M.D./The Children’s Center Foundation Chair in Pediatrics, whose lab focuses on the humoral immune system and the proteins it makes that cause allergic reactions.

These teams are firing on all cylinders to gather support. “Even philanthropic support can lead to something greater,” said Dr. Sicherer. “After all, that’s how the CAFETERIA study got started.”

To get NIH funding, one needs preliminary data as part of the application. In 2015, the Elliot and Roslyn Jaffe Food Allergy Institute launched the Food Allergy Treatment and Research Center, which is supported by philanthropy. The research center had a high success rate with a pilot study that was the precursor of the CAFETERIA study. With those findings, Dr. Sicherer applied for NIH funding in 2017, and was awarded the grant in 2018.

In a way, the journey of this research has similarities with the treatment protocol, where patients escalate from one dose to the next, eventually getting their desired outcome, noted Dr. Sicherer.

“In this case, it began with small philanthropic support, leading to a small study and idea, which then led to the CAFETERIA study,” he said. “I can’t wait to see where it goes next.”

Pin It on Pinterest