Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Given the various trials in the literature studying different target maintenance doses, particularly as it pertains to peanut allergy, how do you determine your target maintenance dose for each patient undergoing oral immunotherapy?
Indeed, many studies use different maintenance doses in OIT. Our practice uses 3 g of peanut protein (3 teaspoons of pure peanut powder like PB2), which is one approach. The goal is the same irrespective of the given patient. There are limited studies looking at the efficacy of the maintenance dose,...
Is dog immunotherapy effective in patients monosensitized to Can f 5?
Theoretically, yes, but I would not guarantee it. Can f 5 is found in most commercial extracts, but amount is variable. Can f 5 is only found in male dogs, so the variability in Can f 5 component could be related to how much of the allergen/extract is obtained from male vs female dogs.
Is it necessary to test both english walnut and black walnut when evaluating for a walnut allergy?
English walnuts are the standard grocery store walnut, and are great for everyday baking and snacks. Compared to Black walnut, they are mild, sweet, and buttery. Black walnuts are used in some specialty desserts, but are less commonly used. The two walnuts are greatly cross-reactive, so testing for ...
Why are total IgE levels often less than the summation of food allergy component testing?
I have a couple of thoughts, although the maker would know the best. It may be because the different allergenic proteins (components) are not represented in a perfectly similar concentration in the component test and the total peanut test. In addition, there may be some subtle interference in IgE bi...
Do you perform food challenges after starting Xolair for IgE-mediated food allergy to ensure efficacy?
I don't do food challenges after starting Xolair for multiple food allergy treatment. Way too cumbersome and I don't see the clinical need as the patient must still avoid the foods.
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
Is there an optimal number of aeroallergens to test for that captures cross-reactivity without having an extensive panel?
Answers will depend greatly on the location of the patient population which primarily determines relevant seasonal allergens.
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...
Where in the current treatment algorithm for CHE do you feel delgocitinib best fits?
Given the cost of delgocitinib, I have difficulty justifying it unless there has been an inadequate response to high-potency topical steroids and calcineurin inhibitors. I expect there to be significant improvement with these, and consider an inadequate response to be the inability to decrease to a ...
How often do you rely on using the C1 inhibitor functional assay versus the quantitative level alone to diagnose HAE?
We have seen a significant increase in lab costs billed to well-insured patients for some of the more "esoteric", detailed testing associated with immune/inflammatory disorders such as HAE. The cheapest screen is a C4 level, which, if normal during an active angioedema episode, makes C1 inhibitor de...