Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you read contact patch tests on removal at 48 hours, and do those results matter if negative at 72 or 96 hours?
Great question, and one that comes up frequently in clinical practice. I remove patches at 48 hours, and at that point I do perform a quick read or, at a minimum, have the tested areas thoroughly photographed. While it is difficult to draw firm conclusions from a 48-hour read alone, it is genuinely ...
How soon after stopping oral steroids can patch testing be performed?
Dose strength and duration of oral steroid therapy should factor into the equation. I would say at least 2 weeks to be on the less cautious side and up to 1 month if there is no urgency to patch test.
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...
What is your approach to diagnosing insulin allergy in patients with diabetes?
Insulin allergy, though uncommon since the advent of recombinant human insulin (estimated prevalence ~2%), remains a serious clinical concern. It can manifest as type I (IgE-mediated), type III (immune complex-mediated), or type IV (T-cell-mediated) hypersensitivity, ranging from local cutaneous rea...
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.
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.
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...
Do allergy shots play a role in preventing recurrence of nasal polyps?
No
In a patient with selective IgM deficiency who is completely asymptomatic in terms of infections, what is your typical laboratory work up?
B cell phenotyping, lymphocyte subsets, IgG to diphtheria, tetanus and S pneumonia. Evaluate the humoral function, as it is important to know and possibly follow with time, but with an asymptomatic treatment is not warranted.