Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
When should we suspect ‘climate-amplified’ rhinitis/asthma versus poor control from other causes?
Before labeling rhinitis or asthma as “climate-amplified,” we must first exclude common causes of poor control: adherence issues, suboptimal controller dosing, inhaler technique, indoor allergen exposure, occupational triggers, and comorbidities (GERD, CRS, OSA, obesity). These remain far more commo...
Can autoimmune thyroiditis present with recurrent angioedema and bronchospasm?
There is an association between angioedema and autoimmune thyroid disease, although the incidence is not known. Activated CD4+ T lymphocytes, monocytes, and eosinophils. The incidence of thyroid autoimmunity in chronic urticaria is similar to the background population, but there is a cluster of angi...
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 ...
Does MCAS cause early closure of growth plates?
I am not aware of or encountered this complication in my mastocytosis patients some of whom also have mast cell activation episodes.
In patients with severe asthma who are candidates for biologics, do you put them on an ICS/LABA/LAMA rather than high dose ICS/LABA?
I have done both. Once I need to go to high-dose ICS/LABA or ICS/LABA/LAMA, I start looking at options for biologics. I work exclusively with children, so it depends on the age of the child and what is approved for their age. It is easier to add a LAMA under age than a biologic.
Is maternal asthma control associated with the baby developing atopic disease?
Maternal asthma control during pregnancy is associated with risk for childhood atopic disease, in particular atopic dermatitis (AD) and asthma. A longitudinal study of 100+ maternal-child dyads was studied for 5 years (2009-2014) using electronic health record (EHR) data. Children of mothers with a ...
Do you generally favor nebulizers, HFAs or other devices in children aged 5 and younger with asthma?
When used correctly, MDI used with a spacer has been shown to be clinically equivalent in terms of efficacy and safety (Dhuper et al., PMID 19081697; Cates et al., PMID 24037768). Treatment with MDIs also offers a broader range of controller medication options, offering maximum flexibility for treat...
How do you manage atopic dermatitis in patients who have failed dupilumab?
The therapeutic landscape for atopic dermatitis is being updated every year, meaning that this question will have different answers in the next few years. In fact, new guidelines are being updated more frequently to capture new drug approvals. As always, medication selection should weigh risks and b...
Can venom immunotherapy cause ocular complications?
I know of no reported cases of ocular complications caused by VIT.This question has come to me before, after it was raised (by false association) in an AI search of VIT. It was traced to reported cases of intra-ocular stings in which the venom or an implanted stinger caused ocular complications (i.e...
Can a patient with mastocytosis be prescribed SCIT?
Yes, patients with systemic mastocytosis (SM) can be prescribed aeroallergen subcutaneous immunotherapy (SCIT) with caution in a practice that has the experience and resources needed to treat severe anaphylaxis. SM patients are at risk of severe anaphylaxis reactions to SCIT during buildup and maint...