Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you recommend COVID vaccination in patients with antiphospholipid antibody positivity or other prothrombotic states not on anti-coagulation?
There are hypothetical reasons that the COVID-19 vaccine might increase thrombophilia in individuals with APS/APLAs. However, the only controlled study I could find, Absence of hypercoagulability after nCoV-19 vaccination: An observational pilot study by Campello et al., PMID 34246010 did not show a...
Do you avoid dupilumab (IL-4 inhibition) for severe asthma in patients already taking a biologic agent for RA?
Dupixent (dupilumab) is a humanized monoclonal IgG4 antibody that works by blocking the signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13). This is achieved by binding to the IL-4Rα subunit. When dupilumab occupies this subunit, it prevents IL-4 signaling via the Type I receptor and both I...
Would you have any hesitation to use belimumab in a patient with IgA deficiency?
For the most part, I would not have any hesitation as most patients with IgA deficiency are asymptomatic and do not experience recurrent infections. If they do have a history of recurrent sinopulmonary infections, they should be seeing an immunologist and may require IVIg depending on the severity. ...
With the approval of oral JAK inhibitors such as Upadacitinib for atopic dermatitis, how are you considering its safety profile in comparison to traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate?
In every treatment situation, we need to help the patient understand the potential benefits and potential risks of a medication. In my opinion, Upadacitinib is in a completely different category than traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate, si...
Is there any PFT criteria that you use in guiding decision making to offer transbronchial lung cryobiopsy to patients with interstitial lung disease?
We really don't have any specific PFT criteria to identify the need for cryobiopsy, but apply the same guidelines to determine the need for open lung biopsy in the decision-making process. Even with the risk of bleeding, cryobiopsy is safe. Unless someone is at high risk for ventilator dependence, o...
What is your threshold to start triple therapy in mild to moderate asthma/COPD overlap with minimal functional limitation?
The question is vague as it does not define functional limitations. If the patient has frequent exacerbations (not defined by the question), Triple therapy would be recommended. If she just has minimal SOB for instance an exercise induced type picture SABA/LAMA prn with LABA ICS (w/o LAMA) would be ...
What are the best labs to trend improvement in HLH?
Unfortunately, there is not one specific laboratory test to definitively trend responses to HLH directed therapy. In general, our approach is to obtain baseline inflammatory labs including CBC with differential, ferritin, soluble IL2 receptor (sIL2r), triglycerides, coagulation studies (PT/PTT) incl...
What is your approach to checking IgG levels post vaccination to detect common variable immunodeficiency in patients with systemic lupus?
I recommend that this type of workup for primary immunodeficiency disorders be done as soon as a diagnosis of systemic lupus erythematosus (SLE) is made. In other words, order quantitative immunoglobulins (IgA, IgM, IgG) plus IgG subclasses during your initial workup.Reasons being: Some primary immu...
Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?
I have checked M-M-R, Td, and pneumococcal titers in patients with hx of infection and low Ig levels to see if they are making an immunological response. If any of these immune titers are low or the immunization is “due” by routine schedules, I recommend immunization and repeat testing in 6 weeks. T...
How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?
Needs more information. Is the issue unresponsiveness or intolerance? Frequently, patients report GI intolerance and don't really take it. It's crucial to inquire about this and consider trying different preparations to find a suitable option. What was the nature of the iron sucrose allergy? Sometim...