Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Is it safe to use one TNF inhibitor (e.g., infliximab) in a patient who has had a severe allergic reaction to a different TNF inhibitor (e.g., adalimumab)?
The short answer is yes - it is ok to proceed with a different TNFi. First, it is important to determine whether the reaction was truly allergic or a nonspecific infusion reaction instead. If possible, obtaining a serum tryptase level at the time of the reaction can help clarify. Realistically, this...
Is asymptomatic long QT syndrome a contraindication for starting AIT?
No.
What is the rationale/evidence to support doing 4 puffs of albuterol vs. 2 puffs for a reversibility study?
The rationale per ATS in 2005 is that 4 puffs of albuterol is higher on the dose-response curve and thus would potentially avoid getting a suboptimal (< 12%, < 200 mL) response from 2 puffs. Having said that, there was a study of this issue in 240 pediatric patients showing non-inferiority of 2 puff...
What is your second line therapy for patients with EGPA with mainly pulmonary and sinonasal features who did not respond to mepolizumab 300 mg/month and still require high doses of steroid?
This is an important question. Benralizumab has recently been shown to have similar efficacy to mepolizumab with a suggestion of a greater number of patients being able to fully discontinue steroids when treated with benralizumab as compared to mepolizumab. On the basis of this study I would use ben...
Are there benefits to adding IL5/IL5 receptor blockade in patients with vasculitic manifestations of EGPA?
While IL-5/IL5 receptor blockade has been shown to be efficacious in treating "eosinophilic" manifestations of EGPA, including asthma and nasal polyps, there are real-world studies that demonstrate its effectiveness in what we consider "vasculitic" manifestations of the disease as well. I personally...
Do you utilize cytokine panels to guide treatment of patients with EGPA?
Whether biomarkers can guide treatment decisions or predict disease relapse is a critical area of study in ANCA associated vasculitis. However, efforts to identify biomarkers that are predictive in EGPA are at an early stage currently. There have been multiple negative studies of biomarkers being ab...
Do you look for local IgE production in the nares with negative SPT and IgE testing if the clinical history suggests AR and the patient desires AIT?
I do not check for local IgE production or perform nasal allergen challenges for local allergic rhinitis. I just offer these patients the combination of a nasal steroid and nasal antihistamine.The 2020 Rhinitis Practice Parameter has a nice summary of local allergic rhinitis."While the literature su...
If a child 4 years of age or younger has respiratory symptoms consistent with asthma, are you diagnosing asthma or using different terminology such as bronchiolitis or reactive airway disease?
There is no younger age limit at which asthma cannot be diagnosed. As you mentioned, not only do we have guidelines for the classification and management of asthma in children under 4 years of age, the GINA 2025 Report outlines criteria for asthma diagnosis in this age group. Although diagnosing ast...
What outcome do you value as the most important measure of success when treating CHE?
Sustained symptom control that restores hand function is the priority. Pain, fissuring, and itch are what drive disability and quality of life impact, so meaningful improvement in these symptoms and return to daily activities define true success. Patient-reported symptoms and quality of life inform...
Would you ever use dupilumab for atopic dermatitis in a patient who also has EGPA?
I would consider it if AD was moderate to severe and not improving with TCS, TCI, or Opzelura. I would make sure the skin was biopsied to rule out a vasculitic component to the rash, as EGPA skin manifestations are varied.