Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Are there benefits to adding IL5/IL5 receptor blockade in patients with vasculitic manifestations of EGPA?
While IL-5/IL5 receptor blockade has been shown to be efficacious in treating "eosinophilic" manifestations of EGPA, including asthma and nasal polyps, there are real-world studies that demonstrate its effectiveness in what we consider "vasculitic" manifestations of the disease as well. I personally...
Do you look for local IgE production in the nares with negative SPT and IgE testing if the clinical history suggests AR and the patient desires AIT?
I do not check for local IgE production or perform nasal allergen challenges for local allergic rhinitis. I just offer these patients the combination of a nasal steroid and nasal antihistamine.The 2020 Rhinitis Practice Parameter has a nice summary of local allergic rhinitis."While the literature su...
If a child 4 years of age or younger has respiratory symptoms consistent with asthma, are you diagnosing asthma or using different terminology such as bronchiolitis or reactive airway disease?
There is no younger age limit at which asthma cannot be diagnosed. As you mentioned, not only do we have guidelines for the classification and management of asthma in children under 4 years of age, the GINA 2025 Report outlines criteria for asthma diagnosis in this age group. Although diagnosing ast...
What outcome do you value as the most important measure of success when treating CHE?
Sustained symptom control that restores hand function is the priority. Pain, fissuring, and itch are what drive disability and quality of life impact, so meaningful improvement in these symptoms and return to daily activities define true success. Patient-reported symptoms and quality of life inform...
Would you ever use dupilumab for atopic dermatitis in a patient who also has EGPA?
I would consider it if AD was moderate to severe and not improving with TCS, TCI, or Opzelura. I would make sure the skin was biopsied to rule out a vasculitic component to the rash, as EGPA skin manifestations are varied.
What role do you feel topical steroids play in the management of atopic dermatitis with the growing availability of non-steroid topicals?
Corticosteroids remain my first-line topical treatment for atopic dermatitis due to their availability, cost, and efficacy. Obviously, topical corticosteroids are not an ideal long-term treatment for continuous use due to their cumulative local toxicity. Calcineurin inhibitors are more sustainable i...
How do you time concurrent therapy with rituximab and IVIG?
Rituximab has about the same half-life as regular IgG. If the regular IVIG treatment can be delayed, it will be less likely to increase the catabolism of Rituximab. If the regular IgG is given at 3-4 week intervals, I would give the Rituxan halfway between IVIG doses. Complement is needed for optima...
Does Dupixent interfere with patch testing?
Dupilumab suppresses Th2 skewed responses such as those associated with systemic contact dermatitis (e.g. propylene glycol, compositae mix, carmine, etc.) so testing while on dupilumab results in incomplete results. Responses to Th1 skewed allergens (e.g. epoxy or methylchloroisothiazolinone) may be...
How do you choose between delgocitinib & ruxolitinib for patients with CHE?
Delgocitinib has broader inhibition (JAKs 1, 2, 3, and TYK2 pathways) compared to ruxolitinib and costs twice as much wholesale price, so I prefer to start with ruxolitinib. I view all dermatitis as some combination of irritant, allergic (Th1 and Th2), and microbial (Th17) factors. CHE usually invol...
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...