Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Should a biologic be started for prevention of asthma-related exacerbations and hospitalizations if these are infrequent and patient is well controlled outside of flares, but is also on prednisone that they cannot get off indefinitely due to adrenal insufficiency?
Biologics have transformed the management of severe asthma by reducing symptoms, decreasing exacerbation rates, improving lung function, and, in selected patients, reducing or eliminating the need for maintenance oral corticosteroids. In the scenario you describe, however, the patient is already rec...
Do you test adults for food allergies if they have non-IgE mediated symptoms to provide them reassurance?
I would like to say that I never get IgE food testing if the clinical history does not justify it. That's the easy answer, as it is almost always the correct one. And yet, I'm guessing we have all had patients who have debilitating anxiety, and have already undergone prolonged, extensive elimination...
What has been your experience using gene expression profiles (GEPs) to predict treatment response in atopic dermatitis?
Thanks for your request. I don't use GEPs to predict treatment response in AD. I advise against using similar tests in general, as they tend to add cost without improving treatment outcomes.
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...
How long do you try an inhaler before increasing the dose because it was inadequate/failed to control the patients asthma?
ICS inhalers should improve asthma control in weeks, not months, especially in steroid naive patients.
Do you routinely recommend epinephrine auto-injectors for patients with isolated oral allergy syndrome, or only when there are risk factors for progression to systemic reactions?
What are those risk factors?
What role do you feel topical steroids play in the management of atopic dermatitis with the growing availability of non-steroid topicals?
Corticosteroids remain my first-line topical treatment for atopic dermatitis due to their availability, cost, and efficacy. Obviously, topical corticosteroids are not an ideal long-term treatment for continuous use due to their cumulative local toxicity. Calcineurin inhibitors are more sustainable i...
Do you reflexively test for tree nut allergies when you diagnose a peanut allergy?
My decision to test tree nuts when a patient is diagnosed with a peanut allergy depends on multiple factors. In the past, children diagnosed with a peanut allergy were told to avoid all tree nuts due to the risk of co-existent allergy. That practice evolved over time as more research was conducted. ...
How do you time concurrent therapy with rituximab and IVIG?
Rituximab has about the same half-life as regular IgG. If the regular IVIG treatment can be delayed, it will be less likely to increase the catabolism of Rituximab. If the regular IgG is given at 3-4 week intervals, I would give the Rituxan halfway between IVIG doses. Complement is needed for optima...
How would you approach diagnosis of a patient with recurrent episodes of abdominal pain, severe myalgias, low grade fevers and urticaria?
Without the mEFV variant, from a rheumatologist viewpoint, the differential includes IBD, a periodic fever syndrome such as FMF or FCAS, and MCAS. Therefore, I would consider that workup with genetic testing (anyone can send!), fecal calprotectin, and MCAS eval with A/I. I don't think of urticarial ...