Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What is your experience managing patients with chronic spontaneous urticaria occurring only at night?
When I have patients with Chronic Spontaneous Urticaria (CSU) that is not responding like CSU should to medications, the first thing I wonder is if this is really CSU. In these situations, I will order additional lab work-up for CSU and conditions mimicking CSU, as discussed in a recent review in JA...
How do you think about using Ropeginterferon Alfa 2B for polycythemia vera in patients with active autoimmune disease?
Great question. In general, I avoid interferons in patients who have an autoimmune disease. In the PROUD-PV/CONTI-PV study, a medical history of autoimmune disease was an exclusion criterion. There have been reported cases of interferon-induced autoimmune disease, most commonly autoimmune thyroiditi...
Are drug challenges after serum sickness-like reactions useful in delabeling the allergy?
Too unpredictable each time.
Do you use Xoliar as add-on treatment for hereditary alpha tryptasemia?
No. Alpha Tryptase is released without mast cell degranulation triggered by an IgE/antigen reaction; hence, neutralizing IgE would not have any beneficial effect.
How do you counsel parents of children with atopic dermatitis about preventing recurrent Staph infections?
For recurrent Staph infections, I recommend bathing daily, as well as giving a bleach bath 2-3 nights per week. If they are struggling with multiple or recurrent abscesses, and/or other family members are also having recurrent Staph infections, that is when I recommend intranasal mupirocin. I typica...
What is your surveillance protocol for patients with common variable immunodeficiency receiving chronic IVIG therapy?
No target IgG level per se- dose/interval should be titrated to clinical condition. In general, trough IgG on treatment should be higher than 500 mg/dL, or 500 mg/dL higher than baseline. Most patients will not be in optimal clinical condition (minimal fatigue, arthralgias, absence of chronic cough,...
Do you avoid use of inhalers with milk protein in patients with a milk allergy?
According to the Advair Diskus package insert, “Immediate hypersensitivity reactions may occur after administration of ADVAIR DISKUS, as demonstrated by cases of urticaria, angioedema, rash, and bronchospasm. There have been reports of anaphylactic reactions in patients with severe milk protein alle...
Do you prescribe fluocinolone in peanut oil in patients with peanut allergies?
Yes. Paller et al., PMID 12664021
Has anyone incidentally diagnosed IgA deficiency in a patient who does not present with any recurrent infections?
Selective IgA deficiency is the most common primary immunodeficiency disorder. The majority of IgA deficiency patients are asymptomatic (often identified upon blood donation). It is thought that the other serum immunoglobulins compensate to provide enough protection in these asymptomatic patients. T...
Can Dupixent (dupliumab) be safely used in patients who are taking other biologics for rheumatic disease?
This is a really broad question given how many biologics exist now, but the answer is likely yes, given its outstanding safety profile. I have used it concurrently with other biologics on many occasions without any issues so far. As concurrent use increases, we may find out more if there are any "tw...