Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What do you consider an appropriate observation period following resolution of anaphylaxis signs and symptoms given the risk of biphasic reactions?
4 hours.
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
Chronic urticaria (6 weeks or longer) is often a self-limited disorder seemingly idiopathic in etiology. There are certain autoimmune disease more prevalent in patients with chronic urticaria including systemic lupus erythematosus, Sjogren's syndrome, autoimmune thyroid disease, celiac sprue, and rh...
For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?
When deciding whether it is safe to re-challenge with rituximab after an infusion reaction, the most important consideration is the type of reaction that the patient experienced. This will help to risk stratify and determine whether same day or future infusions of RTX should be used. Importantly, th...
What were your top takeaways from ACAAI 2025?
I really liked the session titled "Practical approaches to mast cell concerns".My colleagues and I were discussing this recently seems like we are seeing more people concerned about mast cell activation syndrome, but their history and symptoms do not meet the criteria. What to do? Some interesting a...
What type of DES should you opt for if a patient has or is concerned about possible nickel allergy?
For a coronary stent, I would lean toward a Medtronic DES. There are published recommendations for nitinol with a durable polymer. That said, I cannot remember more than one case in 25 years where I thought that a metal allergy may have played a role in a patient receiving a stent and that was prior...
Can someone get sensitized to an allergen if they receive it in an AIT mix but they are not initially allergic to it?
Allergic sensitization occurs on a bell-shaped curve, meaning that the likelihood of sensitization increases with increasing exposure, but only to a point. At high enough concentrations, desensitization occurs, which is the principle of immunotherapy for environmental allergens. So, while it is poss...
Is addition of SLIT likely to provide additional benefit for isolated dust mite allergy that is not completely treated with SCIT?
I offer both and have patient decide.
Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?
I would not routinely perform genetic testing. Multicenter studies (Labrosse et al., PMID 33862010; and Otttaviano et al., PMID 35892275) show that genetic testing returns a low yield, <5%. Several authors suggest that the risk of persistent hypogammaglobulinemia due to PID is increased if there is ...
How are you selecting between oral therapies and parenteral treatments for managing hereditary angioedema attacks?
I use shared decision making by explaining the route of therapy, how often the medicine is given, the efficacy, and the side effects of the medications and allow the patient to decide what drug they would prefer.
In a patient with HAE and on prophylaxis for HIV, who has failed Tazhyro and Orladeyo and breakthrough on Cinryze, what do you recommend for prophylaxis?
First of all, the failure to respond to lanadelumab and berotralstat makes me think that the patient may not have hereditary Angioedema. If they did, I would suspect it would be a patient with the diagnosis of hereditary Angioedema with normal C1-inhibitor. The first thing I would ask is if the pati...