Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
For a contact allergy, do you need to test for the metals individually or does it suffice to just test with a piece of metal from the device?
I asked Dr. Brandon Adler about this question and he said:Testing with metal discs or samples from a manufacturer is not recommended because irritant reactions, false negatives, and false positives are known to occur. Even if there were to be a true positive reaction, there would be no way to know w...
Is there a specific group of children that you start on AIT for prevention of asthma?
There are a few factors I consider in my decision to start allergy immunotherapy (AIT) in children with asthma. The age of the child, whether their asthma symptoms correlate with allergen trigger(s), the ability and willingness of the family to devote the time to build up and continue AIT. Asthma co...
Do you consider the efficacy of different nasal sprays when prescribing for allergic rhinitis or conjunctivitis?
When it comes to prescribing or recommending different nasal sprays for rhinitis, I tend to focus on the other considerations rather than efficacy, as for the most part all of the intranasal steroids are effective. The differences that I might highlight and/or consider include odor, drippiness, cost...
How are you choosing between Xolair, Dupixent or Rhapsido for patients with CSU?
Patient choice, many patients prefer a monthly shot as opposed to BOD meds every day or even q 2 weeks shot; also, co-morbidities--FA, eczema...
What are the implications of checking post-vaccine titers after administration of Prevnar 20 compared to PPSV23?
The landscape of pneumococcal vaccine choices has undergone considerable change in the past few years. Notably, the expanded pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) approved for a broad age range which provide almost overlapping coverage of the pure polysaccharide pneumococcal vaccine ...
Are there specific conventional DMARDs and/or biologics that are contraindicated in patients with alpha-gal allergy?
Here is a Q&A from AAAAI (American Academy of Allergy, Asthma and Immunology) addressing this question for etanercept and other monoclonal antibodies that are manufactured in cell lines that glycosylate with alpha-gal. The author concludes, "The risk is not zero, but likely very low".
Would you still restrict live viral vaccines in a pediatric patient with CD4 count <500 even though they had previously tolerated them and before CD4 testing was obtained?
No. Generally, I follow the guidelines of CD4>400, CD8>200, and look at the response of other vaccines like Tetanus.
Do you see GLP-1 receptor agonists as a potential adjunctive therapy in patients with T2-low asthma and obesity who remain symptomatic on ICS-LABA, prior to escalation to tezepelumab?
Initial research is promising but needs more data.
Are there best practices for integrating pollen, wildfire smoke, and AQI data into asthma/allergic rhinitis action plans?
Living in northern Calif, we frequently incorporate this topic into our patient discussions. We advise virtually all of our asthmatic pts to have a high-quality HEPA air purifier available because they frequently become hard to get when the air quality decreases.
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...