Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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...
What therapies would be considered safe and effective in pregnant patients with EoE?
Would start with two-diet elimination, milk and wheat can give you close to 50% success. If needed can add esomeprazole, and you should be closer to 70%.
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 ...
Can someone get sensitized to an allergen if they receive it in an AIT mix but they are not initially allergic to it?
Allergic sensitization occurs on a bell-shaped curve, meaning that the likelihood of sensitization increases with increasing exposure, but only to a point. At high enough concentrations, desensitization occurs, which is the principle of immunotherapy for environmental allergens. So, while it is poss...
Is addition of SLIT likely to provide additional benefit for isolated dust mite allergy that is not completely treated with SCIT?
I offer both and have patient decide.
Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?
I would not routinely perform genetic testing. Multicenter studies (Labrosse et al., PMID 33862010; and Otttaviano et al., PMID 35892275) show that genetic testing returns a low yield, <5%. Several authors suggest that the risk of persistent hypogammaglobulinemia due to PID is increased if there is ...
How are you selecting between oral therapies and parenteral treatments for managing hereditary angioedema attacks?
I use shared decision making by explaining the route of therapy, how often the medicine is given, the efficacy, and the side effects of the medications and allow the patient to decide what drug they would prefer.
In a patient with HAE and on prophylaxis for HIV, who has failed Tazhyro and Orladeyo and breakthrough on Cinryze, what do you recommend for prophylaxis?
First of all, the failure to respond to lanadelumab and berotralstat makes me think that the patient may not have hereditary Angioedema. If they did, I would suspect it would be a patient with the diagnosis of hereditary Angioedema with normal C1-inhibitor. The first thing I would ask is if the pati...
What is your experience managing patients with chronic spontaneous urticaria occurring only at night?
When I have patients with Chronic Spontaneous Urticaria (CSU) that is not responding like CSU should to medications, the first thing I wonder is if this is really CSU. In these situations, I will order additional lab work-up for CSU and conditions mimicking CSU, as discussed in a recent review in JA...
How do you think about using Ropeginterferon Alfa 2B for polycythemia vera in patients with active autoimmune disease?
Great question. In general, I avoid interferons in patients who have an autoimmune disease. In the PROUD-PV/CONTI-PV study, a medical history of autoimmune disease was an exclusion criterion. There have been reported cases of interferon-induced autoimmune disease, most commonly autoimmune thyroiditi...