Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Should a patient with breakthrough urticaria, on maximal dosing of second generation H1 antihistamines with elevated CRP and anti-TPO antibodies, be treated with omalizumab to protect the thyroid from autoantibodies and improve urticaria control?
This patient likely has chronic autoimmune (Type IIB) urticaria. Would obtain a CU index. It is likely based on data that OMA would be less effective at the currently approved doses. There is data that increasing the dose or frequency of administration of OMA may be effective in those patients with ...
For a contact allergy, do you need to test for the metals individually or does it suffice to just test with a piece of metal from the device?
I asked Dr. Brandon Adler about this question and he said:Testing with metal discs or samples from a manufacturer is not recommended because irritant reactions, false negatives, and false positives are known to occur. Even if there were to be a true positive reaction, there would be no way to know w...
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 ...
Do you use skin prick testing wheal size/grade or serum IgE levels when deciding what dose of allergen immunotherapy to start a patient on?
Generally, regardless of the degree of sensitization, I start my patients' immunotherapy with a 1:1000 dilution and build up to 1:1 over several months. However, I may consider the degree of sensitization when writing the extract prescription. I typically dose in the lower range for allergens with m...
For patients with chronic spontaneous urticaria who remain symptomatic despite maximally dosed second-generation H1 antihistamines, do you notice any meaningful difference in symptom response with add-on montelukast versus famotidine?
So, I am not impressed with the addition of H2 blockers, and the guidelines support my lack of enthusiasm. As for montelukast, a couple of articles suggest benefit, and it may be worth a 3-week trial, but if there is no benefit in a month, I would drop it off. There are a couple of manuscripts sugge...
Is there a specific group of children that you start on AIT for prevention of asthma?
There are a few factors I consider in my decision to start allergy immunotherapy (AIT) in children with asthma. The age of the child, whether their asthma symptoms correlate with allergen trigger(s), the ability and willingness of the family to devote the time to build up and continue AIT. Asthma co...
Do you consider the efficacy of different nasal sprays when prescribing for allergic rhinitis or conjunctivitis?
When it comes to prescribing or recommending different nasal sprays for rhinitis, I tend to focus on the other considerations rather than efficacy, as for the most part all of the intranasal steroids are effective. The differences that I might highlight and/or consider include odor, drippiness, cost...
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
How are you choosing between Xolair, Dupixent or Rhapsido for patients with CSU?
Patient choice, many patients prefer a monthly shot as opposed to BOD meds every day or even q 2 weeks shot; also, co-morbidities--FA, eczema...
What are the implications of checking post-vaccine titers after administration of Prevnar 20 compared to PPSV23?
The landscape of pneumococcal vaccine choices has undergone considerable change in the past few years. Notably, the expanded pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) approved for a broad age range which provide almost overlapping coverage of the pure polysaccharide pneumococcal vaccine ...