Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?
The evidence for this is not very clear and limited. I think a honest discussion about the risk of JAKs and IVIG with the patient will be the most important; but as long as there is no clotting history or high risk of DVTs/PEs, and this is documented, and if a patient needs both medications to attai...
Is there any way to perform a baked egg challenge in an infant, or best to wait until developmentally able to consume baked egg?
We have had great success with using the Mt Sinai Baked Egg Muffin recipe for older infants and toddlers. The muffin can be mixed in with tolerated foods such as apple sauce. While the actual efficacy of baked egg ingestion vs OIT may be less for the resolution of egg allergy, I do find baked egg c...
Can Xolair (omalizumab) be safely used in combination with biologics for patients with rheumatic disease?
Ghazanfar & Thomsen, PMID 30132352 The above article addresses combined Xolair and Enbrel. Keep in mind, if RA flares or worsens after starting Xolair, it could be SE as it is well known to have a polyarticular small joint pattern similar to RA. So, the timing of Xolair initiation to RA loss of cont...
How do you approach patients who develop eczema flare after food exposure?
It depends on the timing of the eczema flare; if there are other immediate symptoms, it could be an IgE-mediated reaction. But if it is an isolated, delayed flare of eczema, it is a rare association; management depends on how reproducible the association is and the severity of the eczema. The age of...
Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?
While there are ongoing studies regarding the potential role of biologics in COPD care, to date, the data remains unclear. The whole issue of COPD/ asthma overlap syndrome remains controversial and I know of no clear data defining a role of biologics. However, I would suggest that the stronger the a...
What is your preferred prophylactic agent in idiopathic angioedema?
I start them on Zyrtec and titrate up to 4x daily dosing as I would in chronic urticaria.
How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as DMARDs and anti-TNF alpha therapy?
It is rarely necessary for any live virus vaccine to be mandatory as most employers will accept waiver letters, as will most countries requiring yellow fever vaccination to enter. The risk of disease exposure, illness must be balanced against disease flare holding therapy. Fortunately, with the adve...
How do you factor smoking history into biologic selection for asthma since the clinical trials generally excluded these patients?
This is very important clinical data depending upon the duration of smoking and whether the patient is still smoking. Confirming the underlying clinical diagnosis is the important first step. Even with a long history of documented asthma, the clinical question is whether the patient has progressed t...
Do you have to remove gold dental crowns if patch testing reveals a gold allergy?
Not all positive patch tests are relevant. I would only recommend removing the dental crowns if there was some evidence that the gold exposure was contributing to the patient's dermatitis or mucosal inflammation that does not have a better explanation.
Do you continue shots when a patient transfers under your care and has been receiving less than effective doses of AIT, but insist they have been effective?
Yes, I'd continue the shots. For some patients, even lower doses produce a meaningful desensitization and build tolerance. At some point, I would recommend retesting his allergies to objectively confirm the efficacy of the shots.