Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
Do patients with a PEG allergy have a contraindication to receiving mRNA vaccines?
While early anecdotal reports suspected that PEG allergy may be linked to allergic reactions to mRNA COVID vaccines, subsequent research disproved this. Therefore, even patients with true IgE-mediated allergy to PEG (which is extremely rare) do not have a contraindication to receiving mRNA vaccines....
Do you regularly check switched memory B cells in CVID?
Yes, about once a year, I get B cell subsets.
What specific comorbidities do you routinely screen for, beyond food allergy, in a child with moderate-to-severe atopic dermatitis?
I routinely screen for psychosocial dysfunction in all my patients, which is especially important for those with significant symptoms like pruritus or pain impacting quality of life, as in children with moderate-to-severe atopic dermatitis. This screening specifically includes quality of sleep (whic...
Should KIT D816V be checked in all patients with a stinging insect allergy, even with a normal tryptase, so that mastocytosis is not missed in patients with a normal tryptase?
Perhaps not in all patients but certainly in those with hypotensive, syncopal, or presyncopal symptoms regardless of tryptase levels, as well as in those with tryptase levels above 8 ng/ml.
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
When a patient with a known venom allergy reports a sting during immunotherapy but before reaching maintenance dose, do you accelerate the build-up schedule or restart from the beginning?
It usually would not change my approach. However, if close to maintenance and had a significant reaction, I would consider trying to achieve a higher maintenance dose. Not enough details here to fully answer.
Do you find that hydroxyzine worsens cognitive symptoms in patients who are already susceptible to cognitive impairment?
Hydroxyzine should not have a direct negative effect on cognition. For decades after its inception, it was lopped in with Benadryl in terms of its receptor binding affinity profile and is listed in several anticholinergic burden scales as being anticholinergic. Similar to the child’s game ‘telephone...
Is it necessary to test for all tree nuts when a patient presents with IgE mediated symptoms to an isolated tree nut?
Having an allergy to a specific tree nut does not mean a patient will be allergic to others, but there are some that are cross-reactive, and it may be worthwhile testing for the cross-reactive tree nut as opposed to testing for all. For example, if the patient had a reaction to cashew, testing for p...
Has anyone died from documented anaphylaxis due to alpha-gal allergy?
See: Platts-Mills et al., PMID 41222531