Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How do you approach SMART therapy in adolescent asthma patients who run out of medication prior to the next insurance approved refill?
In a patient who is consistently running short of inhaler supply because of their increased use of SMART-based puffs, the clear implication of this is inadequate asthma control (usually reflected in the ACT score), so I immediately assess for diminished control and alter the medical regimen appropri...
How do you approach aeroallergen testing in preparation for SCIT to treat allergic rhinitis in a patient with CSU on antihistamines?
In such a case, I would rely solely on IgE testing. However, you need to consider the concept of IgE density by comparing the allergen-specific IgE level with the total IgE level. This relationship may help differentiate more substantial sensitization from mild-to-moderate sensitization. When allerg...
How do you approach the use of supplements in a patient with confirmed mast cell disease refractory to standard treatment?
Which disease? Mast cell activation or mastocytosis?What standard treatment?You can consider using liposomal luteolin (formulated in olive pomace oil to avoid histamine-rich saturated oils).Tsilioni & Theoharides, PMID 38588651
In a young patient who was vaccinated against chickenpox as a child (no previous varicella infection), should the patient receive a shingles vaccine prior to starting Rinvoq?
Yes. The vaccines are different and current vaccine is to prevent zoster for patients who have been previously exposed to varicella or vaccinated for varicella.
What data exist regarding treatment for facial erythema from dupilumab in children <5 years of age?
In AD patients >6 years, the incidence of facial erythema for dupilumab was 1% vs placebo 0.7% (Paller et al., PMID 41163262). The placebo-controlled LIBERTY AD PRESCHOOL trial (Paller et al., PMID 36116481) and the subsequent open-label trial up to 2 years (Paller et al., PMID 41926052) for 6-month...
Have you observed adverse mental health side effects in patients who start montelukast?
A female patient with anxiety but no history of depression or suicidal tendencies developed suicidal ideation with intrusive thoughts while taking montelukast. These were resolved within days of stopping the medication. I also treated a child brought in by his parents for extreme and sometimes viole...
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
What is your approach to evaluating patients with a history of self-reported metal allergy prior to an upcoming metal implant?
The large majority of the time, patients are referred to us by surgical subspecialists for the specific purpose of ruling out metal allergy before a procedure. If a surgical specialist makes such a referral, we will patch test no matter the history, if only for the comfort of the surgeon. But once t...
Do you instruct patients with non-EoE EGID treated with budesonide to modify the capsules based on the specific location of the GI tract that is being targeted?
We suggest different approaches depending on the diagnosis. For eosinophilic gastritis, we recommend liquid budesonide (respules), unmixed or mixed with only a small amount of Splenda for taste. For eosinophilic duodenitis, we recommend that enteric budesonide (Entocort) be crushed and swallowed. If...
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...