Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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...
Which biologics for asthma have data regarding mucus plugging?
There have been multiple studies on biologics investigating the effects on mucus plugging (as measured by the CT mucus plug score of the number of pulmonary segments with a mucus plug, established by Dunican et al., PMID 29400693). In these studies, high mucus plug scores correlate with T2 high biom...
If you perform skin testing for a penicillin allergy, do you find skin prick testing necessary or do you only perform intradermal testing?
It’s time to take a serious look at the relative value of prick puncture testing for penicillin. With the exception of patients who have a history of severe anaphylaxis, intradermal testing should become standard.
Do you utilize cytokine panels to guide treatment of patients with EGPA?
Whether biomarkers can guide treatment decisions or predict disease relapse is a critical area of study in ANCA associated vasculitis. However, efforts to identify biomarkers that are predictive in EGPA are at an early stage currently. There have been multiple negative studies of biomarkers being ab...
What is your approach for female patients with severe atopic dermatitis well controlled on Dupixent planning to conceive or already pregnant?
Based on published data, I have a few concerns. However, the clinical trials of Dupixent failed to study effects on learning and memory.IL-4 and IL-13 are known to be important for learning and memory in mice. IL-4-producing T cells accumulate in the meningeal spaces, and acute depletion of these ce...
In a young patient who was vaccinated to chickenpox as a child (no previous varicella infection) should the patient receive a shingles vaccine prior to starting Rinvoq?
Yes. The vaccines are different and current vaccine is to prevent zoster for patients who have been previously exposed to varicella or vaccinated for varicella.
Do you read contact patch tests on removal at 48 hours, and do those results matter if negative at 72 or 96 hours?
Great question, and one that comes up frequently in clinical practice. I remove patches at 48 hours, and at that point I do perform a quick read or, at a minimum, have the tested areas thoroughly photographed. While it is difficult to draw firm conclusions from a 48-hour read alone, it is genuinely ...
How soon after stopping oral steroids can patch testing be performed?
Dose strength and duration of oral steroid therapy should factor into the equation. I would say at least 2 weeks to be on the less cautious side and up to 1 month if there is no urgency to patch test.
For patients with chronic spontaneous urticaria who remain symptomatic despite maximally dosed second-generation H1 antihistamines, do you notice any meaningful difference in symptom response with add-on montelukast versus famotidine?
So, I am not impressed with the addition of H2 blockers, and the guidelines support my lack of enthusiasm. As for montelukast, a couple of articles suggest benefit, and it may be worth a 3-week trial, but if there is no benefit in a month, I would drop it off. There are a couple of manuscripts sugge...
What is your approach to diagnosing insulin allergy in patients with diabetes?
Insulin allergy, though uncommon since the advent of recombinant human insulin (estimated prevalence ~2%), remains a serious clinical concern. It can manifest as type I (IgE-mediated), type III (immune complex-mediated), or type IV (T-cell-mediated) hypersensitivity, ranging from local cutaneous rea...