Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
If a patient has chronic spontaneous urticaria refractory to Xolair and is already on plaquenil, do you stop plaquenil and then initiate cyclosporine, or do you co-administer and then gradually stop plaquenil over time?
I would first increase the dose of Xolair, actually, up to 600 mg every 2 weeks.
How does being on dupixent for eczema affect food allergy SPT and IgE testing?
I have multiple patients on Dupixent (atopic dermatitis, nasal polyps, asthma, and food allergies). Most recently, a patient in their 60s with an IgE of 7,000 and Class 5 to shellfish with well-controlled asthma, chronic sinusitis/nasal polyps, atopic dermatitis, and food allergy to shellfish passed...
Do you plan to use benralizumab to treat acute exacerbations of asthma or COPD associated with eosinophilia?
Currently, I do not use benralizumab for acute exacerbations of asthma or COPD, even with eosinophilia. Its role is in long-term maintenance for severe eosinophilic asthma, not in the acute setting where rapid-acting therapies are required. I’ll reconsider if emerging data support the benefit in exa...
Do you recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?
I don't recommend desensitization for allopurinol-allergic patients. There was a time when this made sense due to the lack of a viable alternative therapy. The process is cumbersome in a private practice setting and not as simple as providing the patient with a prescription for febuxostat.Febuxostat...
Are there benefits to adding IL5/IL5 receptor blockade in patients with vasculitic manifestations of EGPA?
While IL-5/IL5 receptor blockade has been shown to be efficacious in treating "eosinophilic" manifestations of EGPA, including asthma and nasal polyps, there are real-world studies that demonstrate its effectiveness in what we consider "vasculitic" manifestations of the disease as well. I personally...
What therapies would be considered safe and effective in pregnant patients with EoE?
Management of EoE during pregnancy should be individualized using a shared decision-making model. Food elimination can lead to remission, but some patients have difficulty following the diet. Proton pump inhibitors, such as omeprazole and esomeprazole, and swallowed budesonide are safe during pregna...
Should a biologic be started for prevention of asthma-related exacerbations and hospitalizations if these are infrequent and patient is well controlled outside of flares, but is also on prednisone that they cannot get off indefinitely due to adrenal insufficiency?
Biologics have transformed the management of severe asthma by reducing symptoms, decreasing exacerbation rates, improving lung function, and, in selected patients, reducing or eliminating the need for maintenance oral corticosteroids. In the scenario you describe, however, the patient is already rec...
Do you test adults for food allergies if they have non-IgE mediated symptoms to provide them reassurance?
I would like to say that I never get IgE food testing if the clinical history does not justify it. That's the easy answer, as it is almost always the correct one. And yet, I'm guessing we have all had patients who have debilitating anxiety, and have already undergone prolonged, extensive elimination...
What has been your experience using gene expression profiles (GEPs) to predict treatment response in atopic dermatitis?
Thanks for your request. I don't use GEPs to predict treatment response in AD. I advise against using similar tests in general, as they tend to add cost without improving treatment outcomes.
Would you stop Dupixent in an asthma patient who has good asthma control and notes improvement in loss of smell, but shows notable eosinophil elevation after 4-5 doses of the medication?
Transient eosinophilia has been reported in patients treated with Dupixent, likely related to downregulation of eotaxin and adhesion molecules resulting in impaired eosinophil migration into the tissues (Castro et al., PMID 29782217, Olaguibel et al., PMID 35522053). This phenomenon is typically see...