Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?
While there are ongoing studies regarding the potential role of biologics in COPD care, to date, the data remains unclear. The whole issue of COPD/ asthma overlap syndrome remains controversial and I know of no clear data defining a role of biologics. However, I would suggest that the stronger the a...
What is your preferred prophylactic agent in idiopathic angioedema?
I start them on Zyrtec and titrate up to 4x daily dosing as I would in chronic urticaria.
How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as DMARDs and anti-TNF alpha therapy?
It is rarely necessary for any live virus vaccine to be mandatory as most employers will accept waiver letters, as will most countries requiring yellow fever vaccination to enter. The risk of disease exposure, illness must be balanced against disease flare holding therapy. Fortunately, with the adve...
How do you factor smoking history into biologic selection for asthma since the clinical trials generally excluded these patients?
This is very important clinical data depending upon the duration of smoking and whether the patient is still smoking. Confirming the underlying clinical diagnosis is the important first step. Even with a long history of documented asthma, the clinical question is whether the patient has progressed t...
Do you have to remove gold dental crowns if patch testing reveals a gold allergy?
Not all positive patch tests are relevant. I would only recommend removing the dental crowns if there was some evidence that the gold exposure was contributing to the patient's dermatitis or mucosal inflammation that does not have a better explanation.
Do you continue shots when a patient transfers under your care and has been receiving less than effective doses of AIT, but insist they have been effective?
Yes, I'd continue the shots. For some patients, even lower doses produce a meaningful desensitization and build tolerance. At some point, I would recommend retesting his allergies to objectively confirm the efficacy of the shots.
Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?
Familial HLH (fHLH) is a pediatric disease. Therefore, there is no place for genetic testing to establish a diagnosis of fHLH in adults, and treatment for HLH should not be delayed while waiting for genetic testing. However, there are hypomorphic polymorphisms in the fHLH genes that may be a contrib...
Do you routinely take a cancer history from patients being evaluated for atopy?
I do take a cancer history (not only in the patient's PMH but the family history as well). Given the evidence described above (which is even more robust in the literature than mentioned above), therapies that alter immune function (such as AIT) should have shared decision-making as part of the proce...
With regard to cat immunotherapy, if testing is positive for cat pelt and cat hair, do you include include 50% pelt and 50% hair if doing immunotherapy?
The answer will likely depend on which extracts you have available and potentially on whether you can do any additional component resolved diagnostic testing. The major allergen in cat hair is Fel d 1. The major allergens in cat pelt are Fel d 1 and albumin. You could consider doing component testin...
Should the RSV vaccine be administered to pregnant mothers even if it is not seasonally circulating but they are 32-36 weeks pregnant?
Here is the official CDC/ACIP recommendation (accessed 3/30/2025): "CDC recommends one dose of Pfizer’s Abrysvo for women who are 32 0/7 weeks’ through 36 6/7 weeks’ gestation. Pregnant women who are more than 36 weeks 6 days pregnant should not be vaccinated, as it is unlikely there will be enough ...