Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How do you address the discrepancy between traditional allergy skin testing and the Rinkel skin test results?
No one asks about the Rinkel skin test.
Do you utilize AIT for atopic dermatitis if there is no AR present?
Allergen Immunotherapy (AIT) was included as an adjunctive treatment option for patients with moderate to severe atopic dermatitis (AD) in the updated 2023 Guidelines for Atopic Dermatitis. The recommendation was made based on results from a systematic review and meta-analysis of 23 randomized contr...
Are your performing food challenges prior to starting OIT or omalizumab to determine if these patients have a threshold dose that would actually benefit from the intervention?
This is a great question! I’m curious about other allergists' practices as well. My response to this question is that it depends. I have patients who undergo a food challenge but do not pass. They then decide they would like to pursue OIT or omalizumab. We are then able to track their response to th...
What do you consider an appropriate observation period following resolution of anaphylaxis signs and symptoms given the risk of biphasic reactions?
4 hours.
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...
Do you find that hydroxyzine worsens cognitive symptoms in patients who are already susceptible to cognitive impairment?
Hydroxyzine should not have a direct negative effect on cognition. For decades after its inception, it was lopped in with Benadryl in terms of its receptor binding affinity profile and is listed in several anticholinergic burden scales as being anticholinergic. Similar to the child’s game ‘telephone...
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
Chronic urticaria (6 weeks or longer) is often a self-limited disorder seemingly idiopathic in etiology. There are certain autoimmune disease more prevalent in patients with chronic urticaria including systemic lupus erythematosus, Sjogren's syndrome, autoimmune thyroid disease, celiac sprue, and rh...
For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?
When deciding whether it is safe to re-challenge with rituximab after an infusion reaction, the most important consideration is the type of reaction that the patient experienced. This will help to risk stratify and determine whether same day or future infusions of RTX should be used. Importantly, th...
What were your top takeaways from ACAAI 2025?
I really liked the session titled "Practical approaches to mast cell concerns".My colleagues and I were discussing this recently seems like we are seeing more people concerned about mast cell activation syndrome, but their history and symptoms do not meet the criteria. What to do? Some interesting a...
What type of DES should you opt for if a patient has or is concerned about possible nickel allergy?
For a coronary stent, I would lean toward a Medtronic DES. There are published recommendations for nitinol with a durable polymer. That said, I cannot remember more than one case in 25 years where I thought that a metal allergy may have played a role in a patient receiving a stent and that was prior...