Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How do you manage atopic dermatitis in patients who have failed dupilumab?
The therapeutic landscape for atopic dermatitis is being updated every year, meaning that this question will have different answers in the next few years. In fact, new guidelines are being updated more frequently to capture new drug approvals. As always, medication selection should weigh risks and b...
Can venom immunotherapy cause ocular complications?
I know of no reported cases of ocular complications caused by VIT.This question has come to me before, after it was raised (by false association) in an AI search of VIT. It was traced to reported cases of intra-ocular stings in which the venom or an implanted stinger caused ocular complications (i.e...
Can a patient with mastocytosis be prescribed SCIT?
Yes, patients with systemic mastocytosis (SM) can be prescribed aeroallergen subcutaneous immunotherapy (SCIT) with caution in a practice that has the experience and resources needed to treat severe anaphylaxis. SM patients are at risk of severe anaphylaxis reactions to SCIT during buildup and maint...
How do you reassure families that no allergy testing is needed for urticaria?
I explain to them that it is an immunologic phenomenon (inside job) and not allergic (outside job).
With emerging therapies, what is your general treatment ladder for chronic spontaneous urticaria (CSU)?
Antihistamines remain the first-line therapy for chronic spontaneous urticaria (CSU), and doses should be optimized before turning to other therapies. If patients fail a trial of adequately dosed first- and second-generation antihistamines, montelukast is a reasonable adjunct. For patients with high...
Does receiving IVIG confound the result of SPEP and/or UPEP?
IVIG being a product of polyclonal immunoglobulins may ‘produce’ a monoclonal spike if the AUC is falsely calculated by the reader. IFE usually shows polyclonal banding but every now and then a monoclonal band is picked up. Being an IgG molecule with a 21 day halflife; and with the assumption that i...
Does switching arms enhance the efficacy of subcutaneous allergen immunotherapy?
I wish we knew. Many of us switch arms with immunotherapy doses routinely to try to minimize local reactions and "spread out allergen evenly," so to speak. It is the latter concept that is relevant to the question. I do not know of any data as it pertains to allergen immunotherapy. However, there is...
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...
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...
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...