Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
Do you use skin prick testing wheal size/grade or serum IgE levels when deciding what dose of allergen immunotherapy to start a patient on?
Generally, regardless of the degree of sensitization, I start my patients' immunotherapy with a 1:1000 dilution and build up to 1:1 over several months. However, I may consider the degree of sensitization when writing the extract prescription. I typically dose in the lower range for allergens with m...
For patients with chronic spontaneous urticaria who remain symptomatic despite maximally dosed second-generation H1 antihistamines, do you notice any meaningful difference in symptom response with add-on montelukast versus famotidine?
So, I am not impressed with the addition of H2 blockers, and the guidelines support my lack of enthusiasm. As for montelukast, a couple of articles suggest benefit, and it may be worth a 3-week trial, but if there is no benefit in a month, I would drop it off. There are a couple of manuscripts sugge...
Do you recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?
I don't recommend desensitization for allopurinol-allergic patients. There was a time when this made sense due to the lack of a viable alternative therapy. The process is cumbersome in a private practice setting and not as simple as providing the patient with a prescription for febuxostat.Febuxostat...
Would you stop Dupixent in an asthma patient who has good asthma control and notes improvement in loss of smell, but shows notable eosinophil elevation after 4-5 doses of the medication?
Transient eosinophilia has been reported in patients treated with Dupixent, likely related to downregulation of eotaxin and adhesion molecules resulting in impaired eosinophil migration into the tissues (Castro et al., PMID 29782217, Olaguibel et al., PMID 35522053). This phenomenon is typically see...
Is there a specific group of children that you start on AIT for prevention of asthma?
There are a few factors I consider in my decision to start allergy immunotherapy (AIT) in children with asthma. The age of the child, whether their asthma symptoms correlate with allergen trigger(s), the ability and willingness of the family to devote the time to build up and continue AIT. Asthma co...
Do you consider the efficacy of different nasal sprays when prescribing for allergic rhinitis or conjunctivitis?
When it comes to prescribing or recommending different nasal sprays for rhinitis, I tend to focus on the other considerations rather than efficacy, as for the most part all of the intranasal steroids are effective. The differences that I might highlight and/or consider include odor, drippiness, cost...
How are you using SLIT if that is the method you use to treat allergic rhinitis?
I don’t use SLIT.
How often are you performing CT screening in CVID patients to screen for ILD?
CT once every 1-2 years, depending on symptoms and PFTs. PFTs, including DLCO, are annually performed.
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...