Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What is the shortest amount of time SCIT buildup for aeroallergens can be performed if you are not using a cluster or rush protocol?
We prefer to do a half day RUSH protocol. Patients prefer it and feel better sooner.
How often are you performing CT screening in CVID patients to screen for ILD?
CT once every 1-2 years, depending on symptoms and PFTs. PFTs, including DLCO, are annually performed.
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
How often, if at all, do you monitor a CBC with differential to assess peripheral eosinophilia in patients with type 2 inflammatory asthma who have been started on dupilumab?
For most patients, a baseline CBC with differential followed by a recheck at approximately 3 months aligns with the observed pharmacokinetics of eosinophil rebound. GINA 2026 notes transient blood eosinophilia occurs in 4–13% of patients, with rare EGPA cases potentially unmasked following OCS reduc...
When a patient does not have comorbid atopic dermatitis or nasal polyposis, how do you determine when to use the 200 mg vs 300 mg maintenance dosing for Dupixent for asthma?
One might consider the nonbiologic baseline therapy and severity of the asthma that is driving the potential initiation of a biologic like dupilumab to treat the asthma. Assuming I have decided to use dupilumab instead of a different biologic for improving management of the patient's asthma, I would...
Which biologics for asthma have data regarding mucus plugging?
There have been multiple studies on biologics investigating the effects on mucus plugging (as measured by the CT mucus plug score of the number of pulmonary segments with a mucus plug, established by Dunican et al., PMID 29400693). In these studies, high mucus plug scores correlate with T2 high biom...
If you perform skin testing for a penicillin allergy, do you find skin prick testing necessary or do you only perform intradermal testing?
It’s time to take a serious look at the relative value of prick puncture testing for penicillin. With the exception of patients who have a history of severe anaphylaxis, intradermal testing should become standard.
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...
What is your approach for female patients with severe atopic dermatitis well controlled on Dupixent planning to conceive or already pregnant?
Based on published data, I have a few concerns. However, the clinical trials of Dupixent failed to study effects on learning and memory.IL-4 and IL-13 are known to be important for learning and memory in mice. IL-4-producing T cells accumulate in the meningeal spaces, and acute depletion of these ce...
In a young patient who was vaccinated to chickenpox as a child (no previous varicella infection) should the patient receive a shingles vaccine prior to starting Rinvoq?
Yes. The vaccines are different and current vaccine is to prevent zoster for patients who have been previously exposed to varicella or vaccinated for varicella.