Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Should thunderstorm asthma be incorporated into asthma action plans?
Thank you for the ongoing dialogue around thunderstorm-associated respiratory events. These episodes represent not just allergen exposure but a combined aeroallergen–irritant phenomenon involving pollen fragmentation, fungal spore surges, PM2.5 downdrafts, ozone shifts, and the priming effects of pr...
Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?
The landscape of FUO and IUO and our clinical approach to diagnosing its cause has changed significantly over the past several decades. More sensitive microbiologic screening for infectious etiologies, including syndromic molecular panels and next-generation sequencing are now clinically available a...
Do you routinely recommend peak flow meters for asthma in your practice?
Always helpful for engaging patient in their own care, and managing exacerbations or fluctuations. Even if patient does not "need" it at first, good to have one on hand, have been trained, and establish good habit.
Should a patient on medium-dose ICS/LABA with normal PFTs, but who shows a greater than 10% decrease in FEV1 if their PFTs are done after 24 hours off their inhaler, be started on a biologic?
A little more clinical information would be useful to better answer the question. How well controlled is the patient on the LABA/ICS? What is the ACT score? The FEV1 decreased by greater than 10% (with volume >200 ml?) when LABA/ICS was stopped for 24 hours - how quickly did it normalize when the in...
Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?
I would not routinely perform genetic testing. Multicenter studies (Labrosse et al., PMID 33862010; and Otttaviano et al., PMID 35892275) show that genetic testing returns a low yield, <5%. Several authors suggest that the risk of persistent hypogammaglobulinemia due to PID is increased if there is ...
How do you measure outcomes and track treatment response in patients with CSU?
We measure outcomes and track treatment response in patients with CSU using validated tools such as the UAS7 (Urticaria Activity Score over 7 days) and the UCT (Urticaria Control Test). UAS7 is a daily diary score for urticaria severity, with possible scores of 0-3 for 7 consecutive days, which are ...
Can someone get sensitized to an allergen if they receive it in an AIT mix but they are not initially allergic to it?
Allergic sensitization occurs on a bell-shaped curve, meaning that the likelihood of sensitization increases with increasing exposure, but only to a point. At high enough concentrations, desensitization occurs, which is the principle of immunotherapy for environmental allergens. So, while it is poss...
What is the lowest maintenance dose you will use if a patient continues to have anaphylaxis when trying to achieve maintenance dosing?
Probably 1:1 0.2 ml. Most of the lesser dose maintenance patients are ones I inherited and had to go way back in the shot record to see what the indication for reduction was whether systemic vs long-lasting LLR or something else like an intolerance. I have a hard time believing that patients will ac...
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...
How often are you performing CT screening in CVID patients to screen for ILD?
CT once every 1-2 years, depending on symptoms and PFTs. PFTs, including DLCO, are annually performed.