Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
For a positive anti-TPO and normal TSH in the workup of CSU, are you referring to endocrinology?
I typically do not refer these patients to endocrinology. I do provide the patient with these results and have them communicate this with their PCP and/or communicate with the PCP myself so they can monitor for any symptoms associated with thyroid dysfunction.
Is there any way to perform a baked egg challenge in an infant, or best to wait until developmentally able to consume baked egg?
We have had great success with using the Mt Sinai Baked Egg Muffin recipe for older infants and toddlers. The muffin can be mixed in with tolerated foods such as apple sauce. While the actual efficacy of baked egg ingestion vs OIT may be less for the resolution of egg allergy, I do find baked egg c...
What patients with food allergies do you screen for EoE?
If a patient has symptoms of esophageal dysfunction, they should be screened for EoE. Because symptoms can be ill-defined in children, this may be more challenging. Growth failure, unexplained abdominal pain, or vomiting are indications for GI referral with consideration for endoscopy. Indiscriminat...
Would you consider upfront, time-limited anti-IL-5 therapy for I-HES or L-HES to avoid steroid side effects?
There are two parts to this question: Are there better options than steroids for the treatment of iHES and L-HES? The answer is an emphatic yes. These are chronic diseases, and steroids are really not the optimal therapy. IL-5 inhibitors such as mepolizumab and benralizumab are effective in reducing...
In a female patient in her 50s with ovarian cancer who developed a whole-body rash and lip swelling 7 days after her first cycle of carboplatin, paclitaxel, and bevacizumab, how would you proceed with pretreatment for cycle 2, assuming this was a delayed reaction to carboplatin or paclitaxel?
It is very important to characterize any delayed rash after treatment with its timing, morphology, severity, and whether features of a severe cutaneous adverse reaction are present. A benign delayed rash is the most common scenario and can generally be treated with symptomatic management and enhance...
What is the shortest amount of time SCIT buildup for aeroallergens can be performed if you are not using a cluster or rush protocol?
We prefer to do a half day RUSH protocol. Patients prefer it and feel better sooner.
How often are you performing CT screening in CVID patients to screen for ILD?
CT once every 1-2 years, depending on symptoms and PFTs. PFTs, including DLCO, are annually performed.
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
How often, if at all, do you monitor a CBC with differential to assess peripheral eosinophilia in patients with type 2 inflammatory asthma who have been started on dupilumab?
For most patients, a baseline CBC with differential followed by a recheck at approximately 3 months aligns with the observed pharmacokinetics of eosinophil rebound. GINA 2026 notes transient blood eosinophilia occurs in 4–13% of patients, with rare EGPA cases potentially unmasked following OCS reduc...
When a patient does not have comorbid atopic dermatitis or nasal polyposis, how do you determine when to use the 200 mg vs 300 mg maintenance dosing for Dupixent for asthma?
One might consider the nonbiologic baseline therapy and severity of the asthma that is driving the potential initiation of a biologic like dupilumab to treat the asthma. Assuming I have decided to use dupilumab instead of a different biologic for improving management of the patient's asthma, I would...