Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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...
Is there a role for the use of biologics as steroid sparing agents in treating patients with ABPA who are intolerant to prednisone?
Treatment for ABPA is generally guided by IgE levels and corticosteroids remain the main drug therapy regardless of classification in both people with cystic fibrosis (CF) and without. Limited treatment with antifungal therapy (itraconazole or voriconazole) is considered usually first in individuals...
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...