Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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...
Do you counsel a mother to avoid certain food in her diet if she is still breast feeding and her child has confirmed IgE mediated food allergies?
Wangberg et al., PMID 33636342 surveyed a total of 133 breastfeeding mothers with allergic children. A total of 47.4% of mothers reported their healthcare provider encouraged them to continue breastfeeding without dietary restrictions, 17.3% were advised to continue breastfeeding but avoid eating th...
Have you observed adverse mental health side effects in patients who start montelukast?
A female patient with anxiety but no history of depression or suicidal tendencies developed suicidal ideation with intrusive thoughts while taking montelukast. These were resolved within days of stopping the medication. I also treated a child brought in by his parents for extreme and sometimes viole...
Would you test/treat a middle aged adult male who was stung in his 30s and developed immediate lip swelling that resolved with antihistamines in 15 minutes?
This is not a description of anaphylaxis and therefore does not require testing or VIT according to published Practice Parameters. Resolution was rapid and spontaneous (antihistamines don't work in under 15 minutes), also suggesting a very mild reaction. This was either a normal local reaction (if h...
How often do you find a food allergy on a skin test in an EoE patient that when avoided will result in significant resolution of EoE?
I do not skin test for food allergies when seeing a pediatric patient with EoE unless they have symptoms consistent with IgE mediated food allergy. My approach is to discuss different treatment options including dupilumab, swallowed steroids, and diet therapy (assuming the patient has already been t...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.