Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
For patients with progessive CKD with comorbid conditions, do you adjust IVIG or switch to SCIG to prevent further progession in GFR reduction?
SCIG would be preferred, but can also adjust IVIG.
Should IVIG dosing in patients with autoimmune disease (i.e., dermatomyositis) who become pregnant continue to be based on actual weight at the time of each infusion, or should it be limited to pre-pregnancy weight?
This is a very interesting and incredibly pragmatic question, but not one with an easy answer.By way of background:The treatment of pregnant DM patients is understandably complicated by the need to balance adequately treating disease activity against the maternal/fetal toxicity of medications. In ad...
How do you determine if a positive thimerosal patch test isn't a false positive?
Thimerosal is commonly positive on patch testing and frequently not relevant. In fact, it was voted (non) Allergen of the Year by the American Contact Dermatitis Society. While small amounts are used in some influenzae vaccines, there is not much else that contains this. At one time, it was a preser...
What treatments would you recommend for patients with chronic urticaria who have minimal improvement with anithistamines and Xolair?
Cyclosporine, no question about it. I start at about 3 mg/kg/d of modified cyclosporine if omalizumab been failed, then try to taper once it is well controlled. I also want to give glucosamine at about 25 mg/kg/d - which has been shown in a randomized double-blind placebo-controlled clinical trial t...
What is your approach to treating patients with dupilumab induced facial redness?
Literature is quite clear that the majority of these patients have Malassezia hypersensitivity as the etiology and the pathophysiology is essentially the same as seborrheic dermatitis. The IL-4 blockade allows upregulation of Th17 activity, which is the inflammatory pathway for seborrheic dermatitis...
Do you recommend weekly SQ immunoglobulin replacement for an asplenic patient who only responded to 4/23 pneumococcal serotypes after the Prevnar 20 vaccine?
Immunoglobulin replacement therapy is indicated for those with evidence humoral immune dysfunction. This is typically evaluated in a T cell independent fashion using a pneumovax as a challenge mechanism (or possibly Salmonella typhi vaccine which is also polysaccharide). Poor response to prevnar is ...
How exhaustive (especially considering cost) should an immunological workup be for patients with extensive, recurrent, or deep seated Staph aureus infections without obvious immunocompromise (e.g. cancer, diabetes, steroids) or recurrent breaks in skin integrity?
Obviously, children with recurrent Staph aureus infections should be evaluated for both CGD (chronic granulomatous disease) and IgM deficiency. However, the majority of adults with recurrent SA infections do not have a known systemic immunodeficiency. We should keep in mind that Staph aureus is an a...
Do you recommend food elimination diets for GI eosinophilic disorder not affecting the esophagus?
Yes, food elimination diets would be recommended for eosinophilic gastritis and duodenitis, as per clinical studies and experience (Gonsalves et al., PMID 37462600).
Do you plan to use benralizumab to treat acute exacerbations of asthma or COPD associated with eosinophilia?
Currently, I do not use benralizumab for acute exacerbations of asthma or COPD, even with eosinophilia. Its role is in long-term maintenance for severe eosinophilic asthma, not in the acute setting where rapid-acting therapies are required. I’ll reconsider if emerging data support the benefit in exa...
Do you still skin test for a penicillin allergy if the symptoms are consistent with an IgE mediated reaction (Grade 2 or less), even if the reaction was 30+ years ago?
Do an oral challenge.