Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
When do you consider extending the dosing interval for patients on biologics with CRSwNP?
In patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) who are on biologics, I would wait four (4) symptom-free months before considering extending the dose interval. I can only cite personal experience and not evidence in the medical literature.
Does gastric bypass increase the risk of developing food allergies?
Not in the development of new/de novo food allergies. However, procedure can increase the sensitivity and/or severity of existing food allergies.
Should in-office oscillometry for lung function measurements be utilized in pediatric patients who are unable to reliably perform spirometry?
We don't use oscillometry right now in our office, but the current issue of Annals has several outstanding editorials and reviews looking at oscillometry and how to implement it in your practice. I highly recommend looking at these papers:Link to whole issueEditorials: Oscillometry-determined small ...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
How do you manage atopic dermatitis in pediatric patients who has failed dupilumab?
If dupilumab fails a preschool-aged patient, I consider UVB, methotrexate, or cyclosporine.
Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?
The evidence for this is not very clear and limited. I think a honest discussion about the risk of JAKs and IVIG with the patient will be the most important; but as long as there is no clotting history or high risk of DVTs/PEs, and this is documented, and if a patient needs both medications to attai...
Is there any way to perform a baked egg challenge in an infant, or best to wait until developmentally able to consume baked egg?
We have had great success with using the Mt Sinai Baked Egg Muffin recipe for older infants and toddlers. The muffin can be mixed in with tolerated foods such as apple sauce. While the actual efficacy of baked egg ingestion vs OIT may be less for the resolution of egg allergy, I do find baked egg c...
Can Xolair (omalizumab) be safely used in combination with biologics for patients with rheumatic disease?
Ghazanfar & Thomsen, PMID 30132352 The above article addresses combined Xolair and Enbrel. Keep in mind, if RA flares or worsens after starting Xolair, it could be SE as it is well known to have a polyarticular small joint pattern similar to RA. So, the timing of Xolair initiation to RA loss of cont...
How do you approach patients who develop eczema flare after food exposure?
It depends on the timing of the eczema flare; if there are other immediate symptoms, it could be an IgE-mediated reaction. But if it is an isolated, delayed flare of eczema, it is a rare association; management depends on how reproducible the association is and the severity of the eczema. The age of...
Is there a role for biologic therapies in asthma-COPD overlap syndrome with evidence of type 2 inflammation?
While there are ongoing studies regarding the potential role of biologics in COPD care, to date, the data remains unclear. The whole issue of COPD/ asthma overlap syndrome remains controversial and I know of no clear data defining a role of biologics. However, I would suggest that the stronger the a...