Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...
How soon after stopping oral steroids can patch testing be performed?
Dose strength and duration of oral steroid therapy should factor into the equation. I would say at least 2 weeks to be on the less cautious side and up to 1 month if there is no urgency to patch test.
Would rhapsido be beneficial in patients with MCAS who experience anaphylaxis?
Remibrutinib is the first FDA-approved BTK inhibitor (BTKi). The efficacy data shared were specifically in patients with CSU who failed 4x antihistamine therapy. This class of medication holds promise and may be applicable to other conditions we treat, including anaphylaxis. I refer you to an intere...
Are your performing food challenges prior to starting OIT or omalizumab to determine if these patients have a threshold dose that would actually benefit from the intervention?
This is a great question! I’m curious about other allergists' practices as well. My response to this question is that it depends. I have patients who undergo a food challenge but do not pass. They then decide they would like to pursue OIT or omalizumab. We are then able to track their response to th...
Is it necessary to test for all tree nuts when a patient presents with IgE mediated symptoms to an isolated tree nut?
Having an allergy to a specific tree nut does not mean a patient will be allergic to others, but there are some that are cross-reactive, and it may be worthwhile testing for the cross-reactive tree nut as opposed to testing for all. For example, if the patient had a reaction to cashew, testing for p...
Can you have an allergic reaction to paprika if you have tree nut allergy?
Patients with tree nut allergies do not typically react to paprika. Paprika allergy is primarily associated with the celery-birch-mugwort-spice syndrome, where cross-reactivity occurs through pathogenesis-related proteins (PR-10), and profilins shared with birch and mugwort pollen, rather than throu...
Is it necessary to test both english walnut and black walnut when evaluating for a walnut allergy?
English walnuts are the standard grocery store walnut, and are great for everyday baking and snacks. Compared to Black walnut, they are mild, sweet, and buttery. Black walnuts are used in some specialty desserts, but are less commonly used. The two walnuts are greatly cross-reactive, so testing for ...
Would you stop Dupixent in an asthma patient who has good asthma control and notes improvement in loss of smell, but shows notable eosinophil elevation after 4-5 doses of the medication?
Transient eosinophilia has been reported in patients treated with Dupixent, likely related to downregulation of eotaxin and adhesion molecules resulting in impaired eosinophil migration into the tissues (Castro et al., PMID 29782217, Olaguibel et al., PMID 35522053). This phenomenon is typically see...
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
When do you consider de-escalating therapy such as dupilumab in eosinophilic esophagitis?
It is first important to recognize that EoE is a chronic condition. In a patient whose EoE is successfully being treated (whether it be with PPI therapy, swallowed steroids, food elimination, or dupilumab), the disease will invariably become active again over time if therapy is stopped. This is why ...