Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
How do you choose between delgocitinib & ruxolitinib for patients with CHE?
Delgocitinib has broader inhibition (JAKs 1, 2, 3, and TYK2 pathways) compared to ruxolitinib and costs twice as much wholesale price, so I prefer to start with ruxolitinib. I view all dermatitis as some combination of irritant, allergic (Th1 and Th2), and microbial (Th17) factors. CHE usually invol...
How do you manage atopic dermatitis in patients who have failed dupilumab?
The therapeutic landscape for atopic dermatitis is being updated every year, meaning that this question will have different answers in the next few years. In fact, new guidelines are being updated more frequently to capture new drug approvals. As always, medication selection should weigh risks and b...
How do you counsel patients on safety and toxicity of delgocitinib?
I request all eligible patients to complete the vaccines for herpes zoster prior to starting. Delgocitinib has been reported to cause neutropenia, suggesting there is systemic absorption, so I do not recommend it for patients with a history of VTE. I rarely see highly immunosuppressed patients with ...
Where in the current treatment algorithm for CHE do you feel delgocitinib best fits?
I see delgocitinib fitting in early in the algorithm after emollients, barrier repair, and avoidance strategies; particularly for patients who either fail a brief potent steroid course or who are not good candidates for ongoing steroid use, whether it be preference or previous experience. It can als...
How often do you rely on using the C1 inhibitor functional assay versus the quantitative level alone to diagnose HAE?
We have seen a significant increase in lab costs billed to well-insured patients for some of the more "esoteric", detailed testing associated with immune/inflammatory disorders such as HAE. The cheapest screen is a C4 level, which, if normal during an active angioedema episode, makes C1 inhibitor de...
Do you prescribe silvadene cream for patients with a sulfa allergy?
No. I will consider hydrogel wound dressings in those situations
Should thunderstorm asthma be incorporated into asthma action plans?
Thank you for the ongoing dialogue around thunderstorm-associated respiratory events. These episodes represent not just allergen exposure but a combined aeroallergen–irritant phenomenon involving pollen fragmentation, fungal spore surges, PM2.5 downdrafts, ozone shifts, and the priming effects of pr...
How do you approach performing a food challenge in a patient with CSU who is dependent on their H1 blockers?
We will perform food challenges for patients with CSU using 2 approaches depending on the patient and clinical history. Stop H1 blocker and start prednisone at the same time, continue until the day of the oral challenge, use that as a bridge to block the hives, do the challenge, then resume H1 block...
How do you counsel patients with HAE to best ensure timely administration of on-demand treatments for attacks?
Use at the first symptoms or signs of an attack. The earlier the better.
How are you addressing accurate dissemination of information to patients with the increase in inaccurate information in the digital era?
There are some patients who have already “fallen down the rabbit hole” and are unlikely to be convinced of anything other than the inaccurate information. With these patients, I try to use diplomatic speech such as “we don’t have good evidence/data for this,” “that would be pretty atypical,” or “it ...