Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you recommend weekly SQ immunoglobulin replacement for an asplenic patient who only responded to 4/23 pneumococcal serotypes after the Prevnar 20 vaccine?
Immunoglobulin replacement therapy is indicated for those with evidence humoral immune dysfunction. This is typically evaluated in a T cell independent fashion using a pneumovax as a challenge mechanism (or possibly Salmonella typhi vaccine which is also polysaccharide). Poor response to prevnar is ...
How exhaustive (especially considering cost) should an immunological workup be for patients with extensive, recurrent, or deep seated Staph aureus infections without obvious immunocompromise (e.g. cancer, diabetes, steroids) or recurrent breaks in skin integrity?
Obviously, children with recurrent Staph aureus infections should be evaluated for both CGD (chronic granulomatous disease) and IgM deficiency. However, the majority of adults with recurrent SA infections do not have a known systemic immunodeficiency. We should keep in mind that Staph aureus is an a...
Do you perform a bone marrow biopsy in all patients with grade 5 anaphylaxis to stinging insects and negative workup for HAT, MCAS, c-KIT?
Before saying that bone marrow biopsy is the next step (which it is), we must be certain that we are correctly assessing the situation. Was there documented hypotensive shock (and not just subjective light-headedness or brief vasovagal syncope? Were there other objective signs like urticaria (althou...
Do you recommend food elimination diets for GI eosinophilic disorder not affecting the esophagus?
Yes, food elimination diets would be recommended for eosinophilic gastritis and duodenitis, as per clinical studies and experience (Gonsalves et al., PMID 37462600).
Do you plan to use benralizumab to treat acute exacerbations of asthma or COPD associated with eosinophilia?
Currently, I do not use benralizumab for acute exacerbations of asthma or COPD, even with eosinophilia. Its role is in long-term maintenance for severe eosinophilic asthma, not in the acute setting where rapid-acting therapies are required. I’ll reconsider if emerging data support the benefit in exa...
Do you still skin test for a penicillin allergy if the symptoms are consistent with an IgE mediated reaction (Grade 2 or less), even if the reaction was 30+ years ago?
Do an oral challenge.
Do you generally favor nebulizers, HFAs or other devices in children aged 5 and younger with asthma?
When used correctly, MDI used with a spacer has been shown to be clinically equivalent in terms of efficacy and safety (Dhuper et al., PMID 19081697; Cates et al., PMID 24037768). Treatment with MDIs also offers a broader range of controller medication options, offering maximum flexibility for treat...
Do you reflexively test for tree nut allergies when you diagnose a peanut allergy?
Approximately 23-68% of peanut allergic children have co-existent tree nut or seed allergies. At some point, the child may accidentally ingest a tree nut/seed, or the parents may be interested in introducing tree nuts into the diet. Because many tree nut and seed reactions can be as severe or more s...
What treatments do you consider for cholinergic urticaria refractory to high dose H1 blockers and omalizumab?
Generally, my initial approach to cholinergic urticaria (CholU) is the same for chronic spontaneous urticaria and other forms of chronic inducible urticaria [1]. Most patients with antihistamine-refractory cholinergic urticaria (CholU) will respond to omalizumab 300 mg monthly. Those individuals wit...
Would you consider prescribing NAC for a patient with OCD and a documented sulfa allergy?
I would consider using NAC if needed in a patient with a documented sulfa allergy because, although NAC is a sulfur-containing compound, it is chemically different from sulfonamides.However, as with any new medical trial on a patient, individual hypersensitivity is a possibility. Provided there is a...