Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?
I don't recommend desensitization for allopurinol-allergic patients. There was a time when this made sense due to the lack of a viable alternative therapy. The process is cumbersome in a private practice setting and not as simple as providing the patient with a prescription for febuxostat.Febuxostat...
How do you manage high-threshold food allergies beyond strict avoidance?
Thanks for the question Dr. @Dr. First Last.The field is moving beyond a strict avoidance-only option, and this is an evolving area in managing patients who have food allergies but react at higher thresholds.For patients with evidence of a higher reaction threshold, I still start from a foundation o...
How often, if at all, do you monitor a CBC with differential to assess peripheral eosinophilia in patients with type 2 inflammatory asthma who have been started on dupilumab?
For most patients, a baseline CBC with differential followed by a recheck at approximately 3 months aligns with the observed pharmacokinetics of eosinophil rebound. GINA 2026 notes transient blood eosinophilia occurs in 4–13% of patients, with rare EGPA cases potentially unmasked following OCS reduc...
In patients with severe asthma who are candidates for biologics, do you put them on an ICS/LABA/LAMA rather than high dose ICS/LABA?
I have done both. Once I need to go to high-dose ICS/LABA or ICS/LABA/LAMA, I start looking at options for biologics. I work exclusively with children, so it depends on the age of the child and what is approved for their age. It is easier to add a LAMA under age than a biologic.
What is the shortest amount of time SCIT buildup for aeroallergens can be performed if you are not using a cluster or rush protocol?
We prefer to do a half day RUSH protocol. Patients prefer it and feel better sooner.
Would you consider upfront, time-limited anti-IL-5 therapy for I-HES or L-HES to avoid steroid side effects?
There are two parts to this question: Are there better options than steroids for the treatment of iHES and L-HES? The answer is an emphatic yes. These are chronic diseases, and steroids are really not the optimal therapy. IL-5 inhibitors such as mepolizumab and benralizumab are effective in reducing...
How does being on dupixent for eczema affect food allergy SPT and IgE testing?
I have multiple patients on Dupixent (atopic dermatitis, nasal polyps, asthma, and food allergies). Most recently, a patient in their 60s with an IgE of 7,000 and Class 5 to shellfish with well-controlled asthma, chronic sinusitis/nasal polyps, atopic dermatitis, and food allergy to shellfish passed...
Why do foods seem to not have a refractory period when performing testing as is often the case with venom testing?
This is one of 2 important misconceptions about food anaphylaxis. There is actually good evidence of a refractory (anergic) period after anaphylaxis to foods, drugs, and peri-operative agents, but it is only about 7-10 days (and variable among individuals) rather than 4-6 weeks, as widely stated. It...
What is your approach for female patients with severe atopic dermatitis well controlled on Dupixent planning to conceive or already pregnant?
Based on published data, I have a few concerns. However, the clinical trials of Dupixent failed to study effects on learning and memory.IL-4 and IL-13 are known to be important for learning and memory in mice. IL-4-producing T cells accumulate in the meningeal spaces, and acute depletion of these ce...
Should KIT D816V be checked in all patients with a stinging insect allergy, even with a normal tryptase, so that mastocytosis is not missed in patients with a normal tryptase?
Perhaps not in all patients but certainly in those with hypotensive, syncopal, or presyncopal symptoms regardless of tryptase levels, as well as in those with tryptase levels above 8 ng/ml.