Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Does food sensitivity testing for IgG subclasses help guide your management of food allergy?
No, it absolutely does not. For clinical concerns about an IgE mediated event, the food specific IgE testing is what we reach for. For other adverse food reactions including intolerances or sensitivities, food IgG or subclass testing doesn't correlate with symptoms either. The presence of food speci...
How are you diagnosing chronic FPIES in adults?
Primarily through patient history; delayed onset of GI symptoms, shellfish is a common culprit in adults with acute FPIES. It is hard to differentiate chronic FPIES from intolerance since there is limited pathophysiology on non-IgE mediated mechanisms. Limited role for challenge if history is convin...
Do you recommend patients try antihistamines such as oral ketotifen that are not approved in the US but are approved in the EU for MCAS if currently available formulations have not been effective?
Oral ketotifen is a mast cell stabilizer as well as an antihistamine that targets the H1 histamine receptor. In patients with mast cell activation syndrome that have not had complete symptom relief with second-generation H1 antihistamines at higher doses, including 4 tablets a day, I will consider o...
When would you consider initiating antibiotic sinus rinses for recurrent sinus infections, assuming no other underlying pathology and normal infunction?
Antibiotic sinus rinses are a great alternative to antibiotics by mouth. If indicated, I would favor the rinses after sinus surgery when there is better access to the sinuses. One commonly used preparation is Bactroban or bacitracin in a 45 ml Ocean nasal spray bottle.
When do you consider extending the dosing interval for patients on biologics with CRSwNP?
In patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) who are on biologics, I would wait four (4) symptom-free months before considering extending the dose interval. I can only cite personal experience and not evidence in the medical literature.
Does gastric bypass increase the risk of developing food allergies?
Not in the development of new/de novo food allergies. However, procedure can increase the sensitivity and/or severity of existing food allergies.
Should in-office oscillometry for lung function measurements be utilized in pediatric patients who are unable to reliably perform spirometry?
We don't use oscillometry right now in our office, but the current issue of Annals has several outstanding editorials and reviews looking at oscillometry and how to implement it in your practice. I highly recommend looking at these papers:Link to whole issueEditorials: Oscillometry-determined small ...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?
MMR titers are good correlates of protection. If any titer is undetectable it could be one of these situations: Primary failure. The components of the MMR have different efficacy. Two doses of appropriately given MMR will have 96+% against measles, but only 88% for mumps. Thus 1 in 10 appropriately...
How do you manage atopic dermatitis in pediatric patients who has failed dupilumab?
If dupilumab fails a preschool-aged patient, I consider UVB, methotrexate, or cyclosporine.