Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
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...
Is the timing of childhood eczema onset useful as a prognostic factor in predicting food allergy tolerance?
It is the case that eczema and food allergy are correlated comorbidities. Studies have demonstrated that the age of presentation of the eczema may affect the development of food allergy. The HealthNuts study in Australia was a prospective cohort study looking specifically at the development of the a...
Any thoughts on whether oral immunotherapy versus Xolair would provide a better chance of outgrowing a food allergy?
Because oral immunotherapy is only approved for peanut, the response to this question will be limited to peanut allergy. Any discussion about outgrowing peanut allergy should mention the natural course of peanut allergy. Although some studies suggested that peanut allergy was persistent, subsequent ...
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...
If you have a patient with EoE on Dupixent 300 mg weekly, and they have severe tree nut allergies, would it be safe to add Xolair for severe food allergy?
Yes, it would be safe to add Xolair if deemed absolutely necessary through shared decision making with the family. However, I generally do not recommend using more than one biologic medication at a time. Additionally, while Dupixent has not been approved for the treatment or mitigation of food aller...
For a positive anti-TPO and normal TSH in the workup of CSU, are you referring to endocrinology?
I typically do not refer these patients to endocrinology. I do provide the patient with these results and have them communicate this with their PCP and/or communicate with the PCP myself so they can monitor for any symptoms associated with thyroid dysfunction.
Is there any way to perform a baked egg challenge in an infant, or best to wait until developmentally able to consume baked egg?
We have had great success with using the Mt Sinai Baked Egg Muffin recipe for older infants and toddlers. The muffin can be mixed in with tolerated foods such as apple sauce. While the actual efficacy of baked egg ingestion vs OIT may be less for the resolution of egg allergy, I do find baked egg c...
What patients with food allergies do you screen for EoE?
If a patient has symptoms of esophageal dysfunction, they should be screened for EoE. Because symptoms can be ill-defined in children, this may be more challenging. Growth failure, unexplained abdominal pain, or vomiting are indications for GI referral with consideration for endoscopy. Indiscriminat...
Would you consider upfront, time-limited anti-IL-5 therapy for I-HES or L-HES to avoid steroid side effects?
There are two parts to this question: Are there better options than steroids for the treatment of iHES and L-HES? The answer is an emphatic yes. These are chronic diseases, and steroids are really not the optimal therapy. IL-5 inhibitors such as mepolizumab and benralizumab are effective in reducing...