Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you feel high dose Symbicort or Dulera is appropriate to use for SMART despite these doses not being studied in clinical trials?
One of the primary purposes of SMART therapy is to provide extra doses of ICS to patients inadequately controlled enough to use rescue inhalers. The other major purpose is to do this with a single inhaler instead of 2 or 3. So if the patient's baseline asthma is severe enough to require high-dose Sy...
How do you approach treating patients who develop psoriasis while on Dupixent?
Stop the Dupixent. These patients likely had a non-Th2 driven type of dermatitis e.g. Malassezia yeast hypersensitivity, which is Th17 driven, or stasis dermatitis with autoeczematization, or eczematous drug reaction. Revisit the Diagnostic Checklist for Generalized Dermatitis.
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...
Is there an optimal number of aeroallergens to test for that captures cross-reactivity without having an extensive panel?
Answers will depend greatly on the location of the patient population which primarily determines relevant seasonal allergens.
Which patient factors drive you to pursue patch testing in the workup of chronic hand eczema?
Seasonal hand eczema occurring only during the cold season is usually irritant and best addressed by minimizing hand washing and using cotton under occlusive gloves with frequents changes for wet work. Careful examination for signs of psoriasis and anti-synthetase syndrome is important. Next step is...
Where in the current treatment algorithm for CHE do you feel delgocitinib best fits?
Given the cost of delgocitinib, I have difficulty justifying it unless there has been an inadequate response to high-potency topical steroids and calcineurin inhibitors. I expect there to be significant improvement with these, and consider an inadequate response to be the inability to decrease to a ...
How often do you rely on using the C1 inhibitor functional assay versus the quantitative level alone to diagnose HAE?
Should always use both since the functional assay distinguishes between Type 1 and Type 2 HAE.
What literature do you recommend for reviewing lymphocyte panels for the workup of immunodeficiency?
The literature I would recommend is the following: Bonilla et al., PMID 26371839 Bousfiha et al., PMID 36198931 Tangye et al., PMID 35748970 Puck et al., PMID 33551023
Do patients with low C4 and known hereditary angioedema need an immunodeficiency/complement deficiency evaluation even if there is no infection history?
In most cases of HAE, the C4 is depressed and not absent, and the CH50 would be normal. For this reason, the complement pathway can still generate C3a, C5a, and induce cell lysis.
How do you approach performing a food challenge in a patient with CSU who is dependent on their H1 blockers?
We will perform food challenges for patients with CSU using 2 approaches depending on the patient and clinical history. Stop H1 blocker and start prednisone at the same time, continue until the day of the oral challenge, use that as a bridge to block the hives, do the challenge, then resume H1 block...