Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How do you counsel patients with HAE to best ensure timely administration of on-demand treatments for attacks?
Use at the first symptoms or signs of an attack. The earlier the better.
How are you addressing accurate dissemination of information to patients with the increase in inaccurate information in the digital era?
There are some patients who have already “fallen down the rabbit hole” and are unlikely to be convinced of anything other than the inaccurate information. With these patients, I try to use diplomatic speech such as “we don’t have good evidence/data for this,” “that would be pretty atypical,” or “it ...
How do you address the discrepancy between traditional allergy skin testing and the Rinkel skin test results?
No one asks about the Rinkel skin test.
Do you utilize AIT for atopic dermatitis if there is no AR present?
Allergen Immunotherapy (AIT) was included as an adjunctive treatment option for patients with moderate to severe atopic dermatitis (AD) in the updated 2023 Guidelines for Atopic Dermatitis. The recommendation was made based on results from a systematic review and meta-analysis of 23 randomized contr...
What do you consider an appropriate observation period following resolution of anaphylaxis signs and symptoms given the risk of biphasic reactions?
4 hours.
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
Chronic urticaria (6 weeks or longer) is often a self-limited disorder seemingly idiopathic in etiology. There are certain autoimmune disease more prevalent in patients with chronic urticaria including systemic lupus erythematosus, Sjogren's syndrome, autoimmune thyroid disease, celiac sprue, and rh...
For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?
When deciding whether it is safe to re-challenge with rituximab after an infusion reaction, the most important consideration is the type of reaction that the patient experienced. This will help to risk stratify and determine whether same day or future infusions of RTX should be used. Importantly, th...
What were your top takeaways from ACAAI 2025?
I really liked the session titled "Practical approaches to mast cell concerns".My colleagues and I were discussing this recently seems like we are seeing more people concerned about mast cell activation syndrome, but their history and symptoms do not meet the criteria. What to do? Some interesting a...
What type of DES should you opt for if a patient has or is concerned about possible nickel allergy?
For a coronary stent, I would lean toward a Medtronic DES. There are published recommendations for nitinol with a durable polymer. That said, I cannot remember more than one case in 25 years where I thought that a metal allergy may have played a role in a patient receiving a stent and that was prior...
Can someone get sensitized to an allergen if they receive it in an AIT mix but they are not initially allergic to it?
Allergic sensitization occurs on a bell-shaped curve, meaning that the likelihood of sensitization increases with increasing exposure, but only to a point. At high enough concentrations, desensitization occurs, which is the principle of immunotherapy for environmental allergens. So, while it is poss...