Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What is your second line therapy for patients with EGPA with mainly pulmonary and sinonasal features who did not respond to mepolizumab 300 mg/month and still require high doses of steroid?
This is an important question. Benralizumab has recently been shown to have similar efficacy to mepolizumab with a suggestion of a greater number of patients being able to fully discontinue steroids when treated with benralizumab as compared to mepolizumab. On the basis of this study I would use ben...
Do you look for local IgE production in the nares with negative SPT and IgE testing if the clinical history suggests AR and the patient desires AIT?
I do not check for local IgE production or perform nasal allergen challenges for local allergic rhinitis. I just offer these patients the combination of a nasal steroid and nasal antihistamine.The 2020 Rhinitis Practice Parameter has a nice summary of local allergic rhinitis."While the literature su...
If a child 4 years of age or younger has respiratory symptoms consistent with asthma, are you diagnosing asthma or using different terminology such as bronchiolitis or reactive airway disease?
There is no younger age limit at which asthma cannot be diagnosed. As you mentioned, not only do we have guidelines for the classification and management of asthma in children under 4 years of age, the GINA 2025 Report outlines criteria for asthma diagnosis in this age group. Although diagnosing ast...
What outcome do you value as the most important measure of success when treating CHE?
Sustained symptom control that restores hand function is the priority. Pain, fissuring, and itch are what drive disability and quality of life impact, so meaningful improvement in these symptoms and return to daily activities define true success. Patient-reported symptoms and quality of life inform...
Would you ever use dupilumab for atopic dermatitis in a patient who also has EGPA?
I would consider it if AD was moderate to severe and not improving with TCS, TCI, or Opzelura. I would make sure the skin was biopsied to rule out a vasculitic component to the rash, as EGPA skin manifestations are varied.
Does Dupixent interfere with patch testing?
Dupilumab suppresses Th2 skewed responses such as those associated with systemic contact dermatitis (e.g. propylene glycol, compositae mix, carmine, etc.) so testing while on dupilumab results in incomplete results. Responses to Th1 skewed allergens (e.g. epoxy or methylchloroisothiazolinone) may be...
How do you choose between delgocitinib & ruxolitinib for patients with CHE?
Delgocitinib has broader inhibition (JAKs 1, 2, 3, and TYK2 pathways) compared to ruxolitinib and costs twice as much wholesale price, so I prefer to start with ruxolitinib. I view all dermatitis as some combination of irritant, allergic (Th1 and Th2), and microbial (Th17) factors. CHE usually invol...
How do you counsel patients on safety and toxicity of delgocitinib?
I request all eligible patients to complete the vaccines for herpes zoster prior to starting. Delgocitinib has been reported to cause neutropenia, suggesting there is systemic absorption, so I do not recommend it for patients with a history of VTE. I rarely see highly immunosuppressed patients with ...
Do you prescribe silvadene cream for patients with a sulfa allergy?
No. I will consider hydrogel wound dressings in those situations
Should thunderstorm asthma be incorporated into asthma action plans?
Thank you for the ongoing dialogue around thunderstorm-associated respiratory events. These episodes represent not just allergen exposure but a combined aeroallergen–irritant phenomenon involving pollen fragmentation, fungal spore surges, PM2.5 downdrafts, ozone shifts, and the priming effects of pr...