Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Are there specific conventional DMARDs and/or biologics that are contraindicated in patients with alpha-gal allergy?
Here is a Q&A from AAAAI (American Academy of Allergy, Asthma and Immunology) addressing this question for etanercept and other monoclonal antibodies that are manufactured in cell lines that glycosylate with alpha-gal. The author concludes, "The risk is not zero, but likely very low".
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...
Would you still restrict live viral vaccines in a pediatric patient with CD4 count <500 even though they had previously tolerated them and before CD4 testing was obtained?
No. Generally, I follow the guidelines of CD4>400, CD8>200, and look at the response of other vaccines like Tetanus.
Do you see GLP-1 receptor agonists as a potential adjunctive therapy in patients with T2-low asthma and obesity who remain symptomatic on ICS-LABA, prior to escalation to tezepelumab?
Initial research is promising but needs more data.
Are there best practices for integrating pollen, wildfire smoke, and AQI data into asthma/allergic rhinitis action plans?
Living in northern Calif, we frequently incorporate this topic into our patient discussions. We advise virtually all of our asthmatic pts to have a high-quality HEPA air purifier available because they frequently become hard to get when the air quality decreases.
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...
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?
It depends on the patient and their co-morbidities. For poor compliance, Trelegy can be a game-changer due to ease of administration.
Do you withhold performing skin testing for aeroallergens, foods or venoms based on poor lung function?
I do not. However, if a known severe trigger of asthma by history, such as a cat, I instruct staff to wipe off the allergen if a large skin wheal occurs. Additionally, if lung function is compromised, starting the patient on a short course of oral steroids prior to testing will not compromise skin t...
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...
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 i...