Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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 ...
In a patient with eosinophilic asthma that is controlled daily in between exacerbations, but has very symptomatic exacerbations which lead to ER visits and steroid bursts about 2 to 3 times per year, would you consider starting a biologic agent for prevention of exacerbations even though outside of flares patient is controlled?
A pragmatic approach to a patient like this is consideration of SMART (Single Maintenance And Reliever Therapy) with a single inhaler containing inhaled corticosteroid (ICS) and formoterol. Although controlled most of the time, the exacerbation profile suggests suboptimal control of inflammation at ...
Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?
There is no good-quality evidence supporting a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients. The efficacy of nitazoxanide in viral gastroenteritis is supported by a small manufacturer-sponsored randomized, double-blind trial in non-immunocompromised ...
In a patient with multiple organ abscesses, no known predisposing factors, negative genetic panel testing for CGD and normal oxidative burst, what other testing modalities should be considered?
I would work the patient up for CVID. Also, I would find all the culture and sensitivity results to ensure it’s not MRSA. Also, culture results may open the door to other etiologies.
Why do foods seem to not have a refractory period when performing testing as is often the case with venom testing?
This is one of 2 important misconceptions about food anaphylaxis. There is actually good evidence of a refractory (anergic) period after anaphylaxis to foods, drugs, and peri-operative agents, but it is only about 7-10 days (and variable among individuals) rather than 4-6 weeks, as widely stated. It...
Do you switch from 0.15 mg to 0.3 mg epinephrine at 55 lbs or 66 lbs?
Dr. @Dr. First Last, thank you for posting this question. I see variances in practice among both allergy and primary care practices on when a patient is prescribed the 0.3mg dose of epinephrine. Our practice is to switch patients to 0.3mg when they are 25 kg to prevent underdosing and inadequate res...
Given the various trials in the literature studying different target maintenance doses, particularly as it pertains to peanut allergy, how do you determine your target maintenance dose for each patient undergoing oral immunotherapy?
Indeed, many studies use different maintenance doses in OIT. Our practice uses 3 g of peanut protein (3 teaspoons of pure peanut powder like PB2), which is one approach. The goal is the same irrespective of the given patient. There are limited studies looking at the efficacy of the maintenance dose,...
Is dog immunotherapy effective in patients monosensitized to Can f 5?
Theoretically, yes, but I would not guarantee it. Can f 5 is found in most commercial extracts, but amount is variable. Can f 5 is only found in male dogs, so the variability in Can f 5 component could be related to how much of the allergen/extract is obtained from male vs female dogs.
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 ...
Why are total IgE levels often less than the summation of food allergy component testing?
I have a couple of thoughts, although the maker would know the best. It may be because the different allergenic proteins (components) are not represented in a perfectly similar concentration in the component test and the total peanut test. In addition, there may be some subtle interference in IgE bi...