Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Are your performing food challenges prior to starting OIT or omalizumab to determine if these patients have a threshold dose that would actually benefit from the intervention?
This is a great question! I’m curious about other allergists' practices as well. My response to this question is that it depends. I have patients who undergo a food challenge but do not pass. They then decide they would like to pursue OIT or omalizumab. We are then able to track their response to th...
Can you have an allergic reaction to paprika if you have tree nut allergy?
Patients with tree nut allergies do not typically react to paprika. Paprika allergy is primarily associated with the celery-birch-mugwort-spice syndrome, where cross-reactivity occurs through pathogenesis-related proteins (PR-10), and profilins shared with birch and mugwort pollen, rather than throu...
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
When do you consider de-escalating therapy such as dupilumab in eosinophilic esophagitis?
It is first important to recognize that EoE is a chronic condition. In a patient whose EoE is successfully being treated (whether it be with PPI therapy, swallowed steroids, food elimination, or dupilumab), the disease will invariably become active again over time if therapy is stopped. This is why ...
In which patients with CHE will you prioritize early use of delgocitinib?
I can't think of any that I'd prioritize specifically compared to other patients. Trial of high-potency topical steroids, then Anzupgo next visit if not doing great. Other key point is to stop the steroid when you start the Anzupgo - topical steroids have a very strong negative impact on barrier fun...
How do you counsel patients with chronic urticaria on the role of stress management strategies in their treatment plan?
There are certain situations or times of the year when increased aeroallergen exposure is expected. It follows that increased vigilance is a management technique for those who suffer with sensitivity to these aeroallergen-induced symptoms in the areas of environmental control, pharmacotherapy, and, ...
What data exist regarding treatment for conjunctivitis from dupilumab in children <5 years of age?
The long-term dupilumab study in young children (Paller et al., PMID 41926052) showed 19% conjunctivitis (n = 121), all are mild to moderate and did not require treatment. Median time of resolution was 8 days. Therefore, if a young child with more severe conjunctivitis due to dupilumab lasting longe...
Does food sensitivity testing for IgG subclasses help guide your management of food allergy?
No, it absolutely does not. For clinical concerns about an IgE mediated event, the food specific IgE testing is what we reach for. For other adverse food reactions including intolerances or sensitivities, food IgG or subclass testing doesn't correlate with symptoms either. The presence of food speci...
Would you perform a bone marrow biopsy in a patient who had systemic anaphylaxis with hypotension to a stinging insect?
I would start with checking a serum tryptase and D816V mutation. Also, apply a REMA score and do a good skin exam. With normal tryptase and copy number, still check for KIT mutation.
What are the best labs to trend improvement in HLH?
Unfortunately, there is not one specific laboratory test to definitively trend responses to HLH directed therapy. In general, our approach is to obtain baseline inflammatory labs including CBC with differential, ferritin, soluble IL2 receptor (sIL2r), triglycerides, coagulation studies (PT/PTT) incl...