Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?
Hypersensitivity with urticaria in someone on alendronate is quite rare. I am not aware of any publications showing another bisphosphonate safely used in this setting. Although there are significant chemical differences between the various oral and IV bisphosphonates, I personally would avoid the en...
Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?
This is an interesting question. Clearly, patients with autoimmune or immune-mediated diseases because of their immunosuppressed status are at an increased risk of H. zoster, regardless of age. Presently, the recommendations from the CDC, different professional societies, etc., are to immunize patie...
Which ANCA vasculitis patients are better candidates for cyclophosphamide rather than rituximab?
Both can be used for induction in GPA/MPA vasculitis. I would use rituximab (RTX) if the patient has previously been treated with cyclophosphamide (CYC) and developed a relapse/flare and in patients who are young and with fertility concerns. In GPA/MPA, I tend to use RTX most of the time for inducti...
What patients with food allergies do you screen for EoE?
If a patient has symptoms of esophageal dysfunction, they should be screened for EoE. Because symptoms can be ill-defined in children, this may be more challenging. Growth failure, unexplained abdominal pain, or vomiting are indications for GI referral with consideration for endoscopy. Indiscriminat...
What functional assays do you recommend to determine if MGRPRX2 receptor activation has led to a non-IgE mediated anaphylaxis?
At present, I’m not aware of any functional assays available to determine whether MGRPRX2 activation is taking place. This topic is being studied extensively in research labs internationally; Dr. Didier Ebo in Antwerp is one of the leading researchers in this area. At present, the best markers and m...
In a patient with anaphylaxis and loss of consciousness from stinging insect, suspected to be yellow jacket, the sIgE was significantly positive to all vespids, but honeybee and paper wasp were only 0.44, would you evaluate further with skin testing to wasp and decide on including wasp in treatment based on skin testing being positive or include it with just the low IgE level?
The wasp IgE may be cross-reactive with YJ, and if the YJ is more than 5 times higher than Polistes IgE then this is almost certainly the case, which would suggest that Polistes VIT is not necessary. However, there is no available test to prove the cross-reactivity, so given the severity of the reac...
How do you decide when to obtain genetic testing for suspected autoinflammatory conditions in adults?
We have identified an autoinflammatory disorder that occurs in people of the Southern Appalachian mountains known as "Melungeons." Several have been evaluated at NIH, and while they do not have any of the known markers the diagnosis of familial Mediterranean fever has been confirmed. Dr. Kastner tol...
Is AIT safe to use with an active malignancy such as CTCL?
I'm not aware of any evidence to suggest that AIT would not be safe in stable patients with CTCL, although there are no studies either. If the patient is immune compromised there is a possibility that allergen immunotherapy would be less effective. The main concern with safety would be having to com...
How often do you monitor the eosinophil count after initiating anti-IL5 therapy for HAE?
First, I monitor the eosinophil count to determine that the medication has reduced the numbers of eosinophils. Second, I do not have a regular (established) schedule for testing after that. I do usually obtain a CBC and diff at each clinic, namely about every six months. Third, I pay particular atte...
Would you favor treating HES manifesting with EoE with dupilumab or anti-IL5 therapy?
That depends, and I'd need more information. Is this someone who has elevated peripheral eos and their GI tract is the only organ system involved (sometimes called 'overlap HES')? In this case, I'd ask GI colleagues to perform a colonoscopy as well to look for a lower EGID. I'd also screen for paras...