Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Based upon recently published information in the journal Science, would you offer zileuton to a high-risk food allergy patient who declines oral immunotherapy and omalizumab?
The data suggests that zileuton was not effective in preventing anaphylaxis.
Which patient characteristics or scenarios drive you to choose tezepelumab over dupilumab for asthma?
I typically put adult patients with T2 high, and allergic phenotype on dupilumab whereas those that are T2 high only or T2 low are on tezepelumab. Additionally, if the patient has nasal polyps or AD, then I would prefer dupilumab over tezepelumab. I always have a discussion with the patient regardin...
Is there any genetic testing available for the CDHR3 receptor?
A common variant in CDHR3, Cys529Tyr, leads to susceptibility to a variety of respiratory symptoms, including symptomatic rhinovirus, asthma, chronic rhino sinusitis and more. Depending on the ethnic background, between 15%-35% of the population carries at least one copy. There are no clinical uses ...
Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?
The landscape of FUO and IUO and our clinical approach to diagnosing its cause has changed significantly over the past several decades. More sensitive microbiologic screening for infectious etiologies, including syndromic molecular panels and next-generation sequencing are now clinically available a...
How do you reassure families that no allergy testing is needed for urticaria?
I explain to them that it is an immunologic phenomenon (inside job) and not allergic (outside job).
When would you pursue genetic testing for severe recalcitrant atopic dermatitis?
Not an easy question to answer, but severe and treatment-refractory AD, especially if early onset, is concerning for immune dysregulation and should warrant immune evaluation early. By treatment-refractory, I do not just mean topical therapies, but attempts to control the Th2 pathway that fail repea...
What factors do you consider prior to offering a trial of ICS/LABA therapy versus a methacholine challenge test in patients with suspected asthma but normal pulmonary function testing?
If there is a high suspicion of asthma, have the patient obtain a portable electronic spirometer. If peak flows/FeV1 drops >15% correlate with symptoms, start Rx and follow spiro results. If low suspicion for asthma or very mild symptoms, do methacholine.
What are your recommendations for managing perivascular dermatitis with eosinophils unresponsive to high-dose antihistamines, a prednisone taper, and topical steroids?
I would check and treat for scabies.
When a patient has CVID and is then diagnosed with lymphoma receiving ongoing chemotherapy, how do you manage the trough levels?
Assuming the patient is already on replacement therapy, I would make sure that at trough (if on IVIG, or steady state if on SCIG), the patient has protective levels against pneumococcal polysaccharides. If not, I would increase the dose and/or shorten the interval to achieve that, and record the tot...
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...