Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What factors do you weigh most heavily when deciding on the duration of treatment with dupilumab in a patient with atopic dermatitis who is responding well and tolerating therapy?
If the atopic dermatitis was severe and longstanding, I would continue dupilumab indefinitely. If the patient wanted to cut back, they could try gradually spreading out the doses until the disease recurred.
Can you safely use a cephalosporin in a patient who previously developed acute interstitial nephritis to amoxicillin?
Amoxicillin-associated interstitial nephritis is most often a type IV hypersensitivity reaction. Cross-reactivity with other beta-lactams is possible but poorly studied. I would try hard to find an alternative.
If a patient had a non-anaphylactic IgE mediated reaction to Augmentin but can tolerate amoxicillin, would you directly proceed with an oral challenge to augmentin?
It is difficult to respond to this question, as “non-anaphylactic IgE-mediated reaction” is a bit vague. I assume this was an immediate cutaneous reaction with respiratory or cardiovascular manifestations. The issue, from my perspective, is that mild systemic reactions that appear to be IgE-mediated...
How are you using SLIT if that is the method you use to treat allergic rhinitis?
In our practice, we only use the FDA-approved SLIT tablets Grastek, Ragwitek, and Odactra. That said, it is not something used often, as most patients are polysensitized. We give the first dose in the clinic and monitor for 30 minutes. Admin at home thereafter with Epinephrine accessible. Most studi...
Do allergy shots play a role in preventing recurrence of nasal polyps?
No
In a patient with selective IgM deficiency who is completely asymptomatic in terms of infections, what is your typical laboratory work up?
B cell phenotyping, lymphocyte subsets, IgG to diphtheria, tetanus and S pneumonia. Evaluate the humoral function, as it is important to know and possibly follow with time, but with an asymptomatic treatment is not warranted.
Do you perform genetic testing in all patients with CVID?
I perform genetic testing in almost all of my CVID patients, and in 100% of those with evidence of immune dysregulation (e.g., lung, liver, or gut involvement; autoimmunity; cytopenias; or lymphoproliferation).
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...
Would rhapsido be beneficial in patients with MCAS who experience anaphylaxis?
Remibrutinib is the first FDA-approved BTK inhibitor (BTKi). The efficacy data shared were specifically in patients with CSU who failed 4x antihistamine therapy. This class of medication holds promise and may be applicable to other conditions we treat, including anaphylaxis. I refer you to an intere...