Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Can someone get sensitized to an allergen if they receive it in an AIT mix but they are not initially allergic to it?
Allergic sensitization occurs on a bell-shaped curve, meaning that the likelihood of sensitization increases with increasing exposure, but only to a point. At high enough concentrations, desensitization occurs, which is the principle of immunotherapy for environmental allergens. So, while it is poss...
Is addition of SLIT likely to provide additional benefit for isolated dust mite allergy that is not completely treated with SCIT?
I offer both and have patient decide.
Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?
I would not routinely perform genetic testing. Multicenter studies (Labrosse et al., PMID 33862010; and Otttaviano et al., PMID 35892275) show that genetic testing returns a low yield, <5%. Several authors suggest that the risk of persistent hypogammaglobulinemia due to PID is increased if there is ...
How are you selecting between oral therapies and parenteral treatments for managing hereditary angioedema attacks?
I use shared decision making by explaining the route of therapy, how often the medicine is given, the efficacy, and the side effects of the medications and allow the patient to decide what drug they would prefer.
In a patient with HAE and on prophylaxis for HIV, who has failed Tazhyro and Orladeyo and breakthrough on Cinryze, what do you recommend for prophylaxis?
First of all, the failure to respond to lanadelumab and berotralstat makes me think that the patient may not have hereditary Angioedema. If they did, I would suspect it would be a patient with the diagnosis of hereditary Angioedema with normal C1-inhibitor. The first thing I would ask is if the pati...
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...