Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How long do you try an inhaler before increasing the dose because it was inadequate/failed to control the patients asthma?
ICS inhalers should improve asthma control in weeks, not months, especially in steroid naive patients.
Do you routinely recommend epinephrine auto-injectors for patients with isolated oral allergy syndrome, or only when there are risk factors for progression to systemic reactions?
What are those risk factors?
What role do you feel topical steroids play in the management of atopic dermatitis with the growing availability of non-steroid topicals?
Corticosteroids remain my first-line topical treatment for atopic dermatitis due to their availability, cost, and efficacy. Obviously, topical corticosteroids are not an ideal long-term treatment for continuous use due to their cumulative local toxicity. Calcineurin inhibitors are more sustainable i...
Do you reflexively test for tree nut allergies when you diagnose a peanut allergy?
My decision to test tree nuts when a patient is diagnosed with a peanut allergy depends on multiple factors. In the past, children diagnosed with a peanut allergy were told to avoid all tree nuts due to the risk of co-existent allergy. That practice evolved over time as more research was conducted. ...
How do you time concurrent therapy with rituximab and IVIG?
Rituximab has about the same half-life as regular IgG. If the regular IVIG treatment can be delayed, it will be less likely to increase the catabolism of Rituximab. If the regular IgG is given at 3-4 week intervals, I would give the Rituxan halfway between IVIG doses. Complement is needed for optima...
How would you approach diagnosis of a patient with recurrent episodes of abdominal pain, severe myalgias, low grade fevers and urticaria?
Without the mEFV variant, from a rheumatologist viewpoint, the differential includes IBD, a periodic fever syndrome such as FMF or FCAS, and MCAS. Therefore, I would consider that workup with genetic testing (anyone can send!), fecal calprotectin, and MCAS eval with A/I. I don't think of urticarial ...
In a patient with eosinophilic asthma that is controlled daily in between exacerbations, but has very symptomatic exacerbations which lead to ER visits and steroid bursts about 2 to 3 times per year, would you consider starting a biologic agent for prevention of exacerbations even though outside of flares patient is controlled?
A pragmatic approach to a patient like this is consideration of SMART (Single Maintenance And Reliever Therapy) with a single inhaler containing inhaled corticosteroid (ICS) and formoterol. Although controlled most of the time, the exacerbation profile suggests suboptimal control of inflammation at ...
Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?
There is no good-quality evidence supporting a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients. The efficacy of nitazoxanide in viral gastroenteritis is supported by a small manufacturer-sponsored randomized, double-blind trial in non-immunocompromised ...
In a patient with multiple organ abscesses, no known predisposing factors, negative genetic panel testing for CGD and normal oxidative burst, what other testing modalities should be considered?
I would work the patient up for CVID. Also, I would find all the culture and sensitivity results to ensure it’s not MRSA. Also, culture results may open the door to other etiologies.
Why do foods seem to not have a refractory period when performing testing as is often the case with venom testing?
This is one of 2 important misconceptions about food anaphylaxis. There is actually good evidence of a refractory (anergic) period after anaphylaxis to foods, drugs, and peri-operative agents, but it is only about 7-10 days (and variable among individuals) rather than 4-6 weeks, as widely stated. It...