Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?
If a patient can be identified as low-risk by history they should be considered for either historical removal of the label of direct oral challenge. If the history is not compatible with allergy (e.g. they have a family history or have tolerated another drug like Augmentin), historical de-labeling i...
Is there a role for biologics to improve lung function in patients who have severe asthma with daily symptoms and reduced lung function but do not experience frequent exacerbations?
Biologic therapy in severe asthma not only reduce exacerbation but also improve lung function based on several RCT.
Are you using any molecular allergen diagnostics for predicting the long-term outcomes of venom-specific immunotherapy and as guidance to stop VIT?
At the moment, we are not. Component-resolved diagnostics (CRD) for venom have been widely available in Europe for some time and were approved by US Food and Drug Administration for venom allergy diagnosis in April 2020. The primary use for CRD will likely be in differentiating patients who are trul...
What methods have you found successful in getting young children to use nasal sprays?
Intranasal corticosteroid nasal sprays (INCS) are beneficial in controlling symptoms in children with allergic rhinitis but acceptance is often a barrier to use. I advise parents first start with a gentle nasal saline spray to help their child accept the sensation of liquid in the nose. Parents can ...
Are you initiating/discussing peanut OIT in most children less than age 2 due to the benefits of desensitization and remission?
The relative risks and benefits must be weighed as an alternative to omalizumab or in combination with omalizumab. Between 25-40% of patients who are allergic to peanuts are also allergic to at least one tree nut. Although omalizumab has the advantage of providing protection for multiple food allerg...
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
How do you reconcile differences between SPT and serum IgE testing for aeroallergens when preparing AIT?
The 2008 Allergy Diagnostic Testing Practice Parameters would note as follows:"The precise sensitivity of these immunoassays (serum IgE testing) compared with prick/puncture skin tests has been reported to range from less than 50% to greater than 90%, with the average being approximately 70% to 75% ...
Is there any role for immunosuppressive/immunomodulatory therapy used off label for mast cell activation syndrome besides omalizumab?
The overwhelming key here is to determine if this is truly mast cell activation syndrome, and, if so, what type. Multiple published studies have born out what many of us who see patients for concern for MCAS-- that only a very small percentage of those with the label or concern for the label actuall...
How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?
The lymphocyte variant hypereosinophilic syndrome (L-HES) is a rare form of reactive eosinophilic driven by clonal, phenotypically aberrant T-lymphocytes that secrete IL-5 and other eosinophilopoeitic cytokines. Diagnosis is based primarily on immunophenotyping (flow cytometry) of peripheral blood. ...
How do you utilize cytokine panels in your clinical practice?
It's become easier to order cytokine panels that get processed locally in my hospital. However, I think we're still far from knowing how to interpret these or make clinical changes as a result. While it's tempting to think, "If TNF is elevated, I will give the patient a TNF inhibitor, which will mak...