Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Would you ever use dupilumab for atopic dermatitis in a patient who also has EGPA?
I would consider it if AD was moderate to severe and not improving with TCS, TCI, or Opzelura. I would make sure the skin was biopsied to rule out a vasculitic component to the rash, as EGPA skin manifestations are varied.
Does Dupixent interfere with patch testing?
Dupilumab suppresses Th2 skewed responses such as those associated with systemic contact dermatitis (e.g. propylene glycol, compositae mix, carmine, etc.) so testing while on dupilumab results in incomplete results. Responses to Th1 skewed allergens (e.g. epoxy or methylchloroisothiazolinone) may be...
How do you choose between delgocitinib & ruxolitinib for patients with CHE?
Delgocitinib has broader inhibition (JAKs 1, 2, 3, and TYK2 pathways) compared to ruxolitinib and costs twice as much wholesale price, so I prefer to start with ruxolitinib. I view all dermatitis as some combination of irritant, allergic (Th1 and Th2), and microbial (Th17) factors. CHE usually invol...
How do you counsel patients on safety and toxicity of delgocitinib?
I request all eligible patients to complete the vaccines for herpes zoster prior to starting. Delgocitinib has been reported to cause neutropenia, suggesting there is systemic absorption, so I do not recommend it for patients with a history of VTE. I rarely see highly immunosuppressed patients with ...
Do you prescribe silvadene cream for patients with a sulfa allergy?
No. I will consider hydrogel wound dressings in those situations
Should thunderstorm asthma be incorporated into asthma action plans?
Thank you for the ongoing dialogue around thunderstorm-associated respiratory events. These episodes represent not just allergen exposure but a combined aeroallergen–irritant phenomenon involving pollen fragmentation, fungal spore surges, PM2.5 downdrafts, ozone shifts, and the priming effects of pr...
How do you counsel patients with HAE to best ensure timely administration of on-demand treatments for attacks?
Use at the first symptoms or signs of an attack. The earlier the better.
How are you addressing accurate dissemination of information to patients with the increase in inaccurate information in the digital era?
There are some patients who have already “fallen down the rabbit hole” and are unlikely to be convinced of anything other than the inaccurate information. With these patients, I try to use diplomatic speech such as “we don’t have good evidence/data for this,” “that would be pretty atypical,” or “it ...
Is there a role for phenotyping patients with CSU outside of a research setting by ordering IgG-anti-TPO, IgG-anti-FceRI , total IgE, total IgA etc.?
I do think it can be helpful in patients who have difficult-to-control disease. Many of these (e.g. IgG-anti-TPO, total IgE, anti-thyroglobulin antibody) have been shown to help predict responsiveness to omalizumab treatment or have been associated with disease activity (Højgaard Pedersen et al., PM...
How do you address the discrepancy between traditional allergy skin testing and the Rinkel skin test results?
No one asks about the Rinkel skin test.