Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Would you test/treat a middle aged adult male who was stung in his 30s and developed immediate lip swelling that resolved with antihistamines in 15 minutes?
This is not a description of anaphylaxis and therefore does not require testing or VIT according to published Practice Parameters. Resolution was rapid and spontaneous (antihistamines don't work in under 15 minutes), also suggesting a very mild reaction. This was either a normal local reaction (if h...
How often do you find a food allergy on a skin test in an EoE patient that when avoided will result in significant resolution of EoE?
I do not skin test for food allergies when seeing a pediatric patient with EoE unless they have symptoms consistent with IgE mediated food allergy. My approach is to discuss different treatment options including dupilumab, swallowed steroids, and diet therapy (assuming the patient has already been t...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
For patients with progessive CKD with comorbid conditions, do you adjust IVIG or switch to SCIG to prevent further progession in GFR reduction?
SCIG would be preferred, but can also adjust IVIG.
Should IVIG dosing in patients with autoimmune disease (i.e., dermatomyositis) who become pregnant continue to be based on actual weight at the time of each infusion, or should it be limited to pre-pregnancy weight?
This is a very interesting and incredibly pragmatic question, but not one with an easy answer.By way of background:The treatment of pregnant DM patients is understandably complicated by the need to balance adequately treating disease activity against the maternal/fetal toxicity of medications. In ad...
How do you determine if a positive thimerosal patch test isn't a false positive?
Thimerosal is commonly positive on patch testing and frequently not relevant. In fact, it was voted (non) Allergen of the Year by the American Contact Dermatitis Society. While small amounts are used in some influenzae vaccines, there is not much else that contains this. At one time, it was a preser...
What treatments would you recommend for patients with chronic urticaria who have minimal improvement with anithistamines and Xolair?
Cyclosporine, no question about it. I start at about 3 mg/kg/d of modified cyclosporine if omalizumab been failed, then try to taper once it is well controlled. I also want to give glucosamine at about 25 mg/kg/d - which has been shown in a randomized double-blind placebo-controlled clinical trial t...
What is your approach to treating patients with dupilumab induced facial redness?
Literature is quite clear that the majority of these patients have Malassezia hypersensitivity as the etiology and the pathophysiology is essentially the same as seborrheic dermatitis. The IL-4 blockade allows upregulation of Th17 activity, which is the inflammatory pathway for seborrheic dermatitis...
Do you recommend weekly SQ immunoglobulin replacement for an asplenic patient who only responded to 4/23 pneumococcal serotypes after the Prevnar 20 vaccine?
Immunoglobulin replacement therapy is indicated for those with evidence humoral immune dysfunction. This is typically evaluated in a T cell independent fashion using a pneumovax as a challenge mechanism (or possibly Salmonella typhi vaccine which is also polysaccharide). Poor response to prevnar is ...
How exhaustive (especially considering cost) should an immunological workup be for patients with extensive, recurrent, or deep seated Staph aureus infections without obvious immunocompromise (e.g. cancer, diabetes, steroids) or recurrent breaks in skin integrity?
Obviously, children with recurrent Staph aureus infections should be evaluated for both CGD (chronic granulomatous disease) and IgM deficiency. However, the majority of adults with recurrent SA infections do not have a known systemic immunodeficiency. We should keep in mind that Staph aureus is an a...