Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
When a patient with a known venom allergy reports a sting during immunotherapy but before reaching maintenance dose, do you accelerate the build-up schedule or restart from the beginning?
It usually would not change my approach. However, if close to maintenance and had a significant reaction, I would consider trying to achieve a higher maintenance dose. Not enough details here to fully answer.
Do you find that hydroxyzine worsens cognitive symptoms in patients who are already susceptible to cognitive impairment?
Hydroxyzine should not have a direct negative effect on cognition. For decades after its inception, it was lopped in with Benadryl in terms of its receptor binding affinity profile and is listed in several anticholinergic burden scales as being anticholinergic. Similar to the child’s game ‘telephone...
Is it necessary to test for all tree nuts when a patient presents with IgE mediated symptoms to an isolated tree nut?
Having an allergy to a specific tree nut does not mean a patient will be allergic to others, but there are some that are cross-reactive, and it may be worthwhile testing for the cross-reactive tree nut as opposed to testing for all. For example, if the patient had a reaction to cashew, testing for p...
Has anyone died from documented anaphylaxis due to alpha-gal allergy?
Sensitivity to the galactose-alpha-1,3-galactose (alpha-gal) oligosaccharide was initially discovered when patients receiving cetuximab mAb to treat their cancer, particularly in those who resided in the southeastern USA, had IgE-mediated mild to severe anaphylaxis shortly after receiving their firs...
If a patient has chronic spontaneous urticaria refractory to Xolair and is already on plaquenil, do you stop plaquenil and then initiate cyclosporine, or do you co-administer and then gradually stop plaquenil over time?
I would first increase the dose of Xolair, actually, up to 600 mg every 2 weeks.
How does being on dupixent for eczema affect food allergy SPT and IgE testing?
I have multiple patients on Dupixent (atopic dermatitis, nasal polyps, asthma, and food allergies). Most recently, a patient in their 60s with an IgE of 7,000 and Class 5 to shellfish with well-controlled asthma, chronic sinusitis/nasal polyps, atopic dermatitis, and food allergy to shellfish passed...
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 recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?
I don't recommend desensitization for allopurinol-allergic patients. There was a time when this made sense due to the lack of a viable alternative therapy. The process is cumbersome in a private practice setting and not as simple as providing the patient with a prescription for febuxostat.Febuxostat...
Are there benefits to adding IL5/IL5 receptor blockade in patients with vasculitic manifestations of EGPA?
While IL-5/IL5 receptor blockade has been shown to be efficacious in treating "eosinophilic" manifestations of EGPA, including asthma and nasal polyps, there are real-world studies that demonstrate its effectiveness in what we consider "vasculitic" manifestations of the disease as well. I personally...
What therapies would be considered safe and effective in pregnant patients with EoE?
Management of EoE during pregnancy should be individualized using a shared decision-making model. Food elimination can lead to remission, but some patients have difficulty following the diet. Proton pump inhibitors, such as omeprazole and esomeprazole, and swallowed budesonide are safe during pregna...