Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
In patients with severe asthma who are candidates for biologics, do you put them on an ICS/LABA/LAMA rather than high dose ICS/LABA?
Similarly to Dr. @Dr. First Last, I usually trial them on ICS/LABA/LAMA if possible, rather than high dose ICS/LABA with the anticipation that biologic may be added next. My preference is for ICS/LABA/LAMA over high-dose ICS/LABA, but unfortunately, I have been running into insurance coverage issues...
What factors do you weigh most heavily when deciding on the duration of treatment with dupilumab in a patient with atopic dermatitis who is responding well and tolerating therapy?
If the atopic dermatitis was severe and longstanding, I would continue dupilumab indefinitely. If the patient wanted to cut back, they could try gradually spreading out the doses until the disease recurred.
How do you approach selection of systemic treatment in a patient with atopic dermatitis with severe itch?
The good news is we have 6 approved options here, 4 biologics and 2 small molecules, and all of these therapies have excellent itch data. Selecting a systemic therapy needs to take other comorbid conditions, medications, delivery preference (pill or injection), lifestyle, and other patient attribute...
How do you manage high-threshold food allergies beyond strict avoidance?
Thanks for the question Dr. @Dr. First Last.The field is moving beyond a strict avoidance-only option, and this is an evolving area in managing patients who have food allergies but react at higher thresholds.For patients with evidence of a higher reaction threshold, I still start from a foundation o...
Can you safely use a cephalosporin in a patient who previously developed acute interstitial nephritis to amoxicillin?
Amoxicillin-associated interstitial nephritis is most often a type IV hypersensitivity reaction. Cross-reactivity with other beta-lactams is possible but poorly studied. I would try hard to find an alternative.
How long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
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...
If a patient had a non-anaphylactic IgE mediated reaction to Augmentin but can tolerate amoxicillin, would you directly proceed with an oral challenge to augmentin?
It is difficult to respond to this question, as “non-anaphylactic IgE-mediated reaction” is a bit vague. I assume this was an immediate cutaneous reaction with respiratory or cardiovascular manifestations. The issue, from my perspective, is that mild systemic reactions that appear to be IgE-mediated...
How are you using SLIT if that is the method you use to treat allergic rhinitis?
In our practice, we only use the FDA-approved SLIT tablets Grastek, Ragwitek, and Odactra. That said, it is not something used often, as most patients are polysensitized. We give the first dose in the clinic and monitor for 30 minutes. Admin at home thereafter with Epinephrine accessible. Most studi...
How does being on dupixent for eczema affect food allergy SPT and IgE testing?
I have multiple patients on Dupixent (atopic dermatitis, nasal polyps, asthma, and food allergies). Most recently, a patient in their 60s with an IgE of 7,000 and Class 5 to shellfish with well-controlled asthma, chronic sinusitis/nasal polyps, atopic dermatitis, and food allergy to shellfish passed...