Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you switch from 0.15 mg to 0.3 mg epinephrine at 55 lbs or 66 lbs?
Dr. @Dr. First Last, thank you for posting this question. I see variances in practice among both allergy and primary care practices on when a patient is prescribed the 0.3mg dose of epinephrine. Our practice is to switch patients to 0.3mg when they are 25 kg to prevent underdosing and inadequate res...
Given the various trials in the literature studying different target maintenance doses, particularly as it pertains to peanut allergy, how do you determine your target maintenance dose for each patient undergoing oral immunotherapy?
Indeed, many studies use different maintenance doses in OIT. Our practice uses 3 g of peanut protein (3 teaspoons of pure peanut powder like PB2), which is one approach. The goal is the same irrespective of the given patient. There are limited studies looking at the efficacy of the maintenance dose,...
Is dog immunotherapy effective in patients monosensitized to Can f 5?
Theoretically, yes, but I would not guarantee it. Can f 5 is found in most commercial extracts, but amount is variable. Can f 5 is only found in male dogs, so the variability in Can f 5 component could be related to how much of the allergen/extract is obtained from male vs female dogs.
Is it necessary to test both english walnut and black walnut when evaluating for a walnut allergy?
English walnuts are the standard grocery store walnut, and are great for everyday baking and snacks. Compared to Black walnut, they are mild, sweet, and buttery. Black walnuts are used in some specialty desserts, but are less commonly used. The two walnuts are greatly cross-reactive, so testing for ...
Why are total IgE levels often less than the summation of food allergy component testing?
I have a couple of thoughts, although the maker would know the best. It may be because the different allergenic proteins (components) are not represented in a perfectly similar concentration in the component test and the total peanut test. In addition, there may be some subtle interference in IgE bi...
Do you perform food challenges after starting Xolair for IgE-mediated food allergy to ensure efficacy?
I don't do food challenges after starting Xolair for multiple food allergy treatment. Way too cumbersome and I don't see the clinical need as the patient must still avoid the foods.
Do you feel high dose Symbicort or Dulera is appropriate to use for SMART despite these doses not being studied in clinical trials?
One of the primary purposes of SMART therapy is to provide extra doses of ICS to patients inadequately controlled enough to use rescue inhalers. The other major purpose is to do this with a single inhaler instead of 2 or 3. So if the patient's baseline asthma is severe enough to require high-dose Sy...
How do you approach treating patients who develop psoriasis while on Dupixent?
Stop the Dupixent. These patients likely had a non-Th2 driven type of dermatitis e.g. Malassezia yeast hypersensitivity, which is Th17 driven, or stasis dermatitis with autoeczematization, or eczematous drug reaction. Revisit the Diagnostic Checklist for Generalized Dermatitis.
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
Is there an optimal number of aeroallergens to test for that captures cross-reactivity without having an extensive panel?
Answers will depend greatly on the location of the patient population which primarily determines relevant seasonal allergens.