Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How does being on dupixent for eczema affect food allergy SPT and IgE testing?
Food-specific IgE levels and skin tests get significantly smaller on Dupixent. See Spekhorst et al., PMID 36420598.Despite this, many are still clinically reactive at these levels, whereas many others not on Dupixent might be passing the oral food challenge. That's my and my colleagues' experience. ...
Does switching arms enhance the efficacy of subcutaneous allergen immunotherapy?
I wish we knew. Many of us switch arms with immunotherapy doses routinely to try to minimize local reactions and "spread out allergen evenly," so to speak. It is the latter concept that is relevant to the question. I do not know of any data as it pertains to allergen immunotherapy. However, there is...
In a young patient who was vaccinated to chickenpox as a child (no previous varicella infection) should the patient receive a shingles vaccine prior to starting Rinvoq?
Yes. The vaccines are different and current vaccine is to prevent zoster for patients who have been previously exposed to varicella or vaccinated for varicella.
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
Why are total IgE levels often less than the summation of food allergy component testing?
I have a couple of thoughts, although the maker would know the best. It may be because the different allergenic proteins (components) are not represented in a perfectly similar concentration in the component test and the total peanut test. In addition, there may be some subtle interference in IgE bi...
Do allergy shots play a role in preventing recurrence of nasal polyps?
No
In a patient with selective IgM deficiency who is completely asymptomatic in terms of infections, what is your typical laboratory work up?
B cell phenotyping, lymphocyte subsets, IgG to diphtheria, tetanus and S pneumonia. Evaluate the humoral function, as it is important to know and possibly follow with time, but with an asymptomatic treatment is not warranted.
Do you perform genetic testing in all patients with CVID?
I perform genetic testing in almost all of my CVID patients, and in 100% of those with evidence of immune dysregulation (e.g., lung, liver, or gut involvement; autoimmunity; cytopenias; or lymphoproliferation).
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Do you read contact patch tests on removal at 48 hours, and do those results matter if negative at 72 or 96 hours?
Great question, and one that comes up frequently in clinical practice. I remove patches at 48 hours, and at that point I do perform a quick read or, at a minimum, have the tested areas thoroughly photographed. While it is difficult to draw firm conclusions from a 48-hour read alone, it is genuinely ...