Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Does switching arms enhance the efficacy of subcutaneous allergen immunotherapy?
I wish we knew. Many of us switch arms with immunotherapy doses routinely to try to minimize local reactions and "spread out allergen evenly," so to speak. It is the latter concept that is relevant to the question. I do not know of any data as it pertains to allergen immunotherapy. However, there is...
Do you use skin prick testing wheal size/grade or serum IgE levels when deciding what dose of allergen immunotherapy to start a patient on?
Generally, regardless of the degree of sensitization, I start my patients' immunotherapy with a 1:1000 dilution and build up to 1:1 over several months. However, I may consider the degree of sensitization when writing the extract prescription. I typically dose in the lower range for allergens with m...
How long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
What data exist regarding treatment for facial erythema from dupilumab in children <5 years of age?
In AD patients >6 years, the incidence of facial erythema for dupilumab was 1% vs placebo 0.7% (Paller et al., PMID 41163262). The placebo-controlled LIBERTY AD PRESCHOOL trial (Paller et al., PMID 36116481) and the subsequent open-label trial up to 2 years (Paller et al., PMID 41926052) for 6-month...
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
How do you approach selection of systemic treatment in a patient with atopic dermatitis with severe itch?
The good news is we have 6 approved options here, 4 biologics and 2 small molecules, and all of these therapies have excellent itch data. Selecting a systemic therapy needs to take other comorbid conditions, medications, delivery preference (pill or injection), lifestyle, and other patient attribute...
Is the timing of childhood eczema onset useful as a prognostic factor in predicting food allergy tolerance?
It is the case that eczema and food allergy are correlated comorbidities. Studies have demonstrated that the age of presentation of the eczema may affect the development of food allergy. The HealthNuts study in Australia was a prospective cohort study looking specifically at the development of the a...
Any thoughts on whether oral immunotherapy versus Xolair would provide a better chance of outgrowing a food allergy?
Because oral immunotherapy is only approved for peanut, the response to this question will be limited to peanut allergy. Any discussion about outgrowing peanut allergy should mention the natural course of peanut allergy. Although some studies suggested that peanut allergy was persistent, subsequent ...
How do you manage high-threshold food allergies beyond strict avoidance?
Thanks for the question Dr. @Dr. First Last.The field is moving beyond a strict avoidance-only option, and this is an evolving area in managing patients who have food allergies but react at higher thresholds.For patients with evidence of a higher reaction threshold, I still start from a foundation o...
If you have a patient with EoE on Dupixent 300 mg weekly, and they have severe tree nut allergies, would it be safe to add Xolair for severe food allergy?
Yes, it would be safe to add Xolair if deemed absolutely necessary through shared decision making with the family. However, I generally do not recommend using more than one biologic medication at a time. Additionally, while Dupixent has not been approved for the treatment or mitigation of food aller...