Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
In patients with severe asthma who are candidates for biologics, do you put them on an ICS/LABA/LAMA rather than high dose ICS/LABA?
It depends on the patient and their co-morbidities. For poor compliance, Trelegy can be a game-changer due to ease of administration.
Do you withhold performing skin testing for aeroallergens, foods or venoms based on poor lung function?
I do not. However, if a known severe trigger of asthma by history, such as a cat, I instruct staff to wipe off the allergen if a large skin wheal occurs. Additionally, if lung function is compromised, starting the patient on a short course of oral steroids prior to testing will not compromise skin t...
What are your top takeaways from AAAAI 2026?
The presentations related to the treatment of systemic mastocytosis (SM) were the highlight of the AAAAI meeting. They demonstrated that patients with non-advanced SM (NonAdvSM) can achieve complete remission of SM where WHO diagnostic criteria are no longer met. The rate of remission (where WHO dia...
Are systemic effects from corticosteroid use greater with budesonide rinses compared to nasal sprays?
With the increased use of budesonide nasal rinses for chronic rhinosinusitis and nasal polyps, it seems appropriate to ask about the systemic effects of rinses versus nasal sprays. Two publications address this point, both of which are in the International Forum of Allergy and Rhinology. The first (...
What treatment approach do you suggests for a patient with nasal polyp disease and asthma who was improved on dupilumab, but over last 2 years has begun to have increased nasal symptoms and rising eosinophil counts?
Dr. @Dr. First Last's comments are quite valuable. It might be more expedient to consider simpler options first, then progress to the less common diagnoses as needed. I very much agree that unless we know what is meant by "increased nasal symptoms", it is difficult to provide precise alternative the...
In patients with moderate persistent asthma and elevated FeNO despite adequate symptom control on omalizumab and ICS-LABA, would you consider switching to another biologic such as dupilumab or tezepelumab?
If they have adequate symptom control, not sure I would switch. If I did switch, I would. Consider Dupiumab or an anti-IL5 or IL5R blocker given the Type 2 inflammation detected by elevated FeNO.
How do you manage a delayed cutaneous reaction to docetaxel after the first cycle of adjuvant TC in early-stage HR-positive, HER2-negative breast cancer?
There is excellent guidance in the literature on management of drug-induced rashes in these patients in Sibaud et al., PMID 27550571. Management generally involves topical and if necessary systemic steroids. I particularly like using lotion versions of topical steroids such as triamcinolone as they ...
Are you performing genetic testing on all patients that you suspect to have hereditary angioedema with normal C1 inhibitor?
Yes
What is the optimal duration of biologic therapy before assessing for non-response and initiating a switch in patients with uncontrolled asthma?
I generally wait 3-6 months before changing biologic class to allow for the medications to get to a steady state. I will monitor eNO and will not wean steroids prior to 3 months.
What is the best alternative oral therapy for treatment of non-severe pulmonary nocardiosis in an immunocompetent patient with sulfa allergy?
We have been using linezolid for this indication, based on a paper from ARUP Labs.Schlaberg et al., PMID 24247124