Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What treatment options do you consider if eosinophilia with end organ dysfunction persists with q8 week dosing of benralizumab and you can't obtain approval for q4 week dosing?
Depending on the degree of eosinophilia and end-organ dysfunction, if the patient is not already on oral steroids, they probably should be pending a new plan for a steroid-sparing agent. Is the diagnosis more consistent with HES or EGPA? Has the patient failed mepolizumab 300 mg? There is good data ...
What parasites do you screen for in your workup of HES?
In my practice, if GI symptoms (particularly diarrhea), then culture for stool ova and parasites (broad screen). If there are no GI symptoms, then only screening for Strongyloides with a blood test for Strongyloides antibody. If there is a recent travel history or a patient immigrated from areas wi...
What is your approach to biologic selection in a patient with resistant/persistent ABPA?
Omalizumab has been shown to be helpful in reducing OCS use/exacerbations in refractory ABPA despite OCS and voriconazole. There are several case reports and reviews of patients who have been on anti-IL5s which have led to a reduction in eosinophilia but not necessarily exacerbations. There are seve...
Is methacholine challenge on its way out?
I have not needed to order the challenge test for a long time now. I see the need for this test is declining.
Would you still consider omalizumab for CSU with angioedema in a patient with Factor V Leiden deficiency?
Heterozygosity of this genetic mutation increases the lifetime risk of thrombosis by about 7-fold, while homozygosity (which is rare) increases the risk by approximately 20-fold. Despite the increase in the risk of VTE, there is no clinical evidence that heterozygosity of factor V Leiden increases o...
What are the implications of immunosuppressive therapy in a chronic asymptomatic T cell lymphopenic adult undergoing lung transplant evaluation?
The details of T cell lymphopenia are not mentioned for this patient. Idiopathic CD4 T cell lymphopenia is a recognized clinical syndrome which has been studied extensively (Lisco et al., PMID 37133586). The need for lung transplant is not detailed and raises the question if the two are related. It ...
What is your preferred biologic in children and adolescents with T2 high asthma?
It depends on patient age, biomarkers (IgE levels, eosinophil counts, FeNO, allergy testing results), comorbidities, what insurance will cover, and how frequently a patient can tolerate injections, adverse effects. Also, clinical outcomes such as wanting to improve FEV1 can play a role in the decisi...
Is there utility in doing a baked egg versus lightly cooked egg challenge for FPIES?
For patients that have reacted to concentrated egg and do not have experience with baked egg, baked egg challenges can be useful. The few papers that reported on this limited this to patients with non-severe FPIES reactions.
How do you manage introduction of other seeds when the patient has never been exposed and has a sesame allergy?
Since there is considerable cross-reactivity between other seeds, but also with nuts and other foods, one needs to do allergy testing in a sesame seed allergic patient before introducing other seeds. That can be either with prick skin testing or in-vitro testing. However, if one is negative with one...
Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?
The advice is limited by the fact that there are no randomized controlled trials in adults on daily antibiotic prophylaxis post-splenectomy. There are trials in children with sickle-cell disease that do show a benefit, but it is not clear that these can be extrapolated to splenectomized adults. Furt...