Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What is your approach to treating patients with dupilumab induced facial redness?
Literature is quite clear that the majority of these patients have Malassezia hypersensitivity as the etiology and the pathophysiology is essentially the same as seborrheic dermatitis. The IL-4 blockade allows upregulation of Th17 activity, which is the inflammatory pathway for seborrheic dermatitis...
Do you recommend weekly SQ immunoglobulin replacement for an asplenic patient who only responded to 4/23 pneumococcal serotypes after the Prevnar 20 vaccine?
Immunoglobulin replacement therapy is indicated for those with evidence humoral immune dysfunction. This is typically evaluated in a T cell independent fashion using a pneumovax as a challenge mechanism (or possibly Salmonella typhi vaccine which is also polysaccharide). Poor response to prevnar is ...
How exhaustive (especially considering cost) should an immunological workup be for patients with extensive, recurrent, or deep seated Staph aureus infections without obvious immunocompromise (e.g. cancer, diabetes, steroids) or recurrent breaks in skin integrity?
Obviously, children with recurrent Staph aureus infections should be evaluated for both CGD (chronic granulomatous disease) and IgM deficiency. However, the majority of adults with recurrent SA infections do not have a known systemic immunodeficiency. We should keep in mind that Staph aureus is an a...
Do you recommend food elimination diets for GI eosinophilic disorder not affecting the esophagus?
Yes, food elimination diets would be recommended for eosinophilic gastritis and duodenitis, as per clinical studies and experience (Gonsalves et al., PMID 37462600).
Do you still skin test for a penicillin allergy if the symptoms are consistent with an IgE mediated reaction (Grade 2 or less), even if the reaction was 30+ years ago?
Do an oral challenge.
What treatments do you consider for cholinergic urticaria refractory to high dose H1 blockers and omalizumab?
Generally, my initial approach to cholinergic urticaria (CholU) is the same for chronic spontaneous urticaria and other forms of chronic inducible urticaria [1]. Most patients with antihistamine-refractory cholinergic urticaria (CholU) will respond to omalizumab 300 mg monthly. Those individuals wit...
Would you consider prescribing NAC for a patient with OCD and a documented sulfa allergy?
I would consider using NAC if needed in a patient with a documented sulfa allergy because, although NAC is a sulfur-containing compound, it is chemically different from sulfonamides.However, as with any new medical trial on a patient, individual hypersensitivity is a possibility. Provided there is a...
Based upon recently published information in the journal Science, would you offer zileuton to a high-risk food allergy patient who declines oral immunotherapy and omalizumab?
I am not aware of any clinical data on this subject. The mouse data is interesting, but many exciting discoveries in mice have failed in human trials. One would think there would have at least been case reports of food allergic patients, on zileuton for their asthma, who noted they were spared anaph...
Which patient characteristics or scenarios drive you to choose tezepelumab over dupilumab for asthma?
I typically put adult patients with T2 high, and allergic phenotype on dupilumab whereas those that are T2 high only or T2 low are on tezepelumab. Additionally, if the patient has nasal polyps or AD, then I would prefer dupilumab over tezepelumab. I always have a discussion with the patient regardin...
Is there any genetic testing available for the CDHR3 receptor?
A common variant in CDHR3, Cys529Tyr, leads to susceptibility to a variety of respiratory symptoms, including symptomatic rhinovirus, asthma, chronic rhino sinusitis and more. Depending on the ethnic background, between 15%-35% of the population carries at least one copy. There are no clinical uses ...