Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Is there any non-invasive validated testing for Annatto (E-160b), also known as norbixin?
There is an approved test through ARUP laboratories for annatto/annatto seed. I have used this test when I have had a high index of suspicion and have received positive results that were clinically relevant in the few cases I needed it. I am not aware of data on negative and positive predictive valu...
In those patients who are initiated on omalizumab for multiple food allergies, once baked egg and baked milk are introduced into the diet, do you rely upon skin prick testing and/or ImmunoCAP testing in order to make the decision to introduce prepared egg or whole milk into the diet?
When the patient is on omalizumab, neither skin prick testing or serum IgE testing would be reliable biomarkers to follow.Omalizumab is known to reduce (not necessarily eliminate) skin prick responses. Ledford, PMID 30819523In the short term, serum-specific IgE may even increase prior to a possible ...
Is there a role for use of dupilumab for hypereosinophilic GI disorders distal to the esophagus?
No definitive studies performed yet and no FDA approval regarding using Dupilumab for EoG; however, in my opinion, I do believe that Dupilumab may be an effective treatment for some eosinophilic disorders beyond the esophagus.
Is there a role for anti-IL5 therapy in the treatment of EoE?
When looking at the use of IL-5 pathway drugs such as mepolizumab, reslizumab, and benralizumab in the treatment of eosinophilic esophagitis (EoE) studies to date have not demonstrated efficacy in terms of symptomatic improvement as related to the use of these series of medications. Each of these me...
Are there any contraindications to starting a patient on Dupixent for prurigo nodularis if the patient is already on Xolair for asthma?
No, and in fact, I have this combination in several patients.
Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?
We have a fairly large number of ABPA patients on Omalizumab. It works great. One of the issues we frequently encounter is that ABPA patients sometimes have too high of IGE counts for the approved highest Omalizumab dosage. In these patients, we initially treat them with standard prednisone therap...
In those patients who are initiated on omalizumab for multiple food allergies, how long should you wait before performing baked egg and baked milk challenges?
In the OuTMATCH trial, patients were on omalizumab for 16-20 weeks before undergoing food challenges. However, the primary outcome of the study was consumption of certain amounts of a food allergen without developing anaphylaxis. In Fiocchi's study entitled, Impact of Omalizumab on Food Allergy in P...
When do you refer pediatric patients with eczema to an allergist?
I refer concerns about immediate-type hypersensitivity symptoms (e.g. anaphylaxis, rhinitis, or asthma) to an allergist. Eczema is delayed-type hypersensitivity from contact with an inorganic or a protein allergen. Many dermatologists and allergists perform extended patch testing for these contribut...
How do you approach patients that develop atopic dermatitis while on biologics for psoriasis?
We have a few patients on dual-biologic therapy who have features of both psoriasis and atopic dermatitis, where each is severe enough to merit systemic therapy on their own. Probably a little less now with more JAK inhibitors available, but we still have some patients maintaining on these regimens....
Is the efficacy and dose same for subcutaneous vs intravenous IVIGs being used for dermatomyositis?
Thank you for the very interesting question:When considering the best answer, there is a bit of background I think is important to keep in mind. (I'll put my final thoughts about dosing at the end of this background) First and foremost, although IVIG has been used as a de facto treatment for multipl...