Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you reflexively test for tree nut allergies when you diagnose a peanut allergy?
Approximately 23-68% of peanut allergic children have co-existent tree nut or seed allergies. At some point, the child may accidentally ingest a tree nut/seed, or the parents may be interested in introducing tree nuts into the diet. Because many tree nut and seed reactions can be as severe or more s...
Do you perform food challenges after starting Xolair for IgE-mediated food allergy to ensure efficacy?
I don't do food challenges after starting Xolair for multiple food allergy treatment. Way too cumbersome and I don't see the clinical need as the patient must still avoid the foods.
In which patients with CHE will you prioritize early use of delgocitinib?
I can't think of any that I'd prioritize specifically compared to other patients. Trial of high-potency topical steroids, then Anzupgo next visit if not doing great. Other key point is to stop the steroid when you start the Anzupgo - topical steroids have a very strong negative impact on barrier fun...
How do you counsel patients with chronic urticaria on the role of stress management strategies in their treatment plan?
There are certain situations or times of the year when increased aeroallergen exposure is expected. It follows that increased vigilance is a management technique for those who suffer with sensitivity to these aeroallergen-induced symptoms in the areas of environmental control, pharmacotherapy, and, ...
What data exist regarding treatment for conjunctivitis from dupilumab in children <5 years of age?
The long-term dupilumab study in young children (Paller et al., PMID 41926052) showed 19% conjunctivitis (n = 121), all are mild to moderate and did not require treatment. Median time of resolution was 8 days. Therefore, if a young child with more severe conjunctivitis due to dupilumab lasting longe...
Does food sensitivity testing for IgG subclasses help guide your management of food allergy?
No, it absolutely does not. For clinical concerns about an IgE mediated event, the food specific IgE testing is what we reach for. For other adverse food reactions including intolerances or sensitivities, food IgG or subclass testing doesn't correlate with symptoms either. The presence of food speci...
Which biologics for asthma have data regarding mucus plugging?
There have been multiple studies on biologics investigating the effects on mucus plugging (as measured by the CT mucus plug score of the number of pulmonary segments with a mucus plug, established by Dunican et al., PMID 29400693). In these studies, high mucus plug scores correlate with T2 high biom...
Would you perform a bone marrow biopsy in a patient who had systemic anaphylaxis with hypotension to a stinging insect?
I would start with checking a serum tryptase and D816V mutation. Also, apply a REMA score and do a good skin exam. With normal tryptase and copy number, still check for KIT mutation.
Does receiving IVIG confound the result of SPEP and/or UPEP?
IVIG being a product of polyclonal immunoglobulins may ‘produce’ a monoclonal spike if the AUC is falsely calculated by the reader. IFE usually shows polyclonal banding but every now and then a monoclonal band is picked up. Being an IgG molecule with a 21 day halflife; and with the assumption that i...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...