Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you recommend food elimination diets for GI eosinophilic disorder not affecting the esophagus?
Yes, food elimination diets would be recommended for eosinophilic gastritis and duodenitis, as per clinical studies and experience (Gonsalves et al., PMID 37462600).
Do you plan to use benralizumab to treat acute exacerbations of asthma or COPD associated with eosinophilia?
Currently, I do not use benralizumab for acute exacerbations of asthma or COPD, even with eosinophilia. Its role is in long-term maintenance for severe eosinophilic asthma, not in the acute setting where rapid-acting therapies are required. I’ll reconsider if emerging data support the benefit in exa...
Do you still skin test for a penicillin allergy if the symptoms are consistent with an IgE mediated reaction (Grade 2 or less), even if the reaction was 30+ years ago?
Do an oral challenge.
Do you generally favor nebulizers, HFAs or other devices in children aged 5 and younger with asthma?
When used correctly, MDI used with a spacer has been shown to be clinically equivalent in terms of efficacy and safety (Dhuper et al., PMID 19081697; Cates et al., PMID 24037768). Treatment with MDIs also offers a broader range of controller medication options, offering maximum flexibility for treat...
Do you reflexively test for tree nut allergies when you diagnose a peanut allergy?
Approximately 23-68% of peanut allergic children have co-existent tree nut or seed allergies. At some point, the child may accidentally ingest a tree nut/seed, or the parents may be interested in introducing tree nuts into the diet. Because many tree nut and seed reactions can be as severe or more s...
What treatments do you consider for cholinergic urticaria refractory to high dose H1 blockers and omalizumab?
Generally, my initial approach to cholinergic urticaria (CholU) is the same for chronic spontaneous urticaria and other forms of chronic inducible urticaria [1]. Most patients with antihistamine-refractory cholinergic urticaria (CholU) will respond to omalizumab 300 mg monthly. Those individuals wit...
Would you consider prescribing NAC for a patient with OCD and a documented sulfa allergy?
I would consider using NAC if needed in a patient with a documented sulfa allergy because, although NAC is a sulfur-containing compound, it is chemically different from sulfonamides.However, as with any new medical trial on a patient, individual hypersensitivity is a possibility. Provided there is a...
Based upon recently published information in the journal Science, would you offer zileuton to a high-risk food allergy patient who declines oral immunotherapy and omalizumab?
The data suggests that zileuton was not effective in preventing anaphylaxis.
Which patient characteristics or scenarios drive you to choose tezepelumab over dupilumab for asthma?
I typically put adult patients with T2 high, and allergic phenotype on dupilumab whereas those that are T2 high only or T2 low are on tezepelumab. Additionally, if the patient has nasal polyps or AD, then I would prefer dupilumab over tezepelumab. I always have a discussion with the patient regardin...
Is there any genetic testing available for the CDHR3 receptor?
A common variant in CDHR3, Cys529Tyr, leads to susceptibility to a variety of respiratory symptoms, including symptomatic rhinovirus, asthma, chronic rhino sinusitis and more. Depending on the ethnic background, between 15%-35% of the population carries at least one copy. There are no clinical uses ...