Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What is your preferred biologic in children and adolescents with T2 high asthma?
It depends on patient age, biomarkers (IgE levels, eosinophil counts, FeNO, allergy testing results), comorbidities, what insurance will cover, and how frequently a patient can tolerate injections, adverse effects. Also, clinical outcomes such as wanting to improve FEV1 can play a role in the decisi...
Is there utility in doing a baked egg versus lightly cooked egg challenge for FPIES?
For patients that have reacted to concentrated egg and do not have experience with baked egg, baked egg challenges can be useful. The few papers that reported on this limited this to patients with non-severe FPIES reactions.
How do you manage introduction of other seeds when the patient has never been exposed and has a sesame allergy?
Since there is considerable cross-reactivity between other seeds, but also with nuts and other foods, one needs to do allergy testing in a sesame seed allergic patient before introducing other seeds. That can be either with prick skin testing or in-vitro testing. However, if one is negative with one...
Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?
The advice is limited by the fact that there are no randomized controlled trials in adults on daily antibiotic prophylaxis post-splenectomy. There are trials in children with sickle-cell disease that do show a benefit, but it is not clear that these can be extrapolated to splenectomized adults. Furt...
For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?
If a patient can be identified as low-risk by history they should be considered for either historical removal of the label of direct oral challenge. If the history is not compatible with allergy (e.g. they have a family history or have tolerated another drug like Augmentin), historical de-labeling i...
Is there a role for biologics to improve lung function in patients who have severe asthma with daily symptoms and reduced lung function but do not experience frequent exacerbations?
Biologic therapy in severe asthma not only reduce exacerbation but also improve lung function based on several RCT.
Are you using any molecular allergen diagnostics for predicting the long-term outcomes of venom-specific immunotherapy and as guidance to stop VIT?
At the moment, we are not. Component-resolved diagnostics (CRD) for venom have been widely available in Europe for some time and were approved by US Food and Drug Administration for venom allergy diagnosis in April 2020. The primary use for CRD will likely be in differentiating patients who are trul...
What methods have you found successful in getting young children to use nasal sprays?
Intranasal corticosteroid nasal sprays (INCS) are beneficial in controlling symptoms in children with allergic rhinitis but acceptance is often a barrier to use. I advise parents first start with a gentle nasal saline spray to help their child accept the sensation of liquid in the nose. Parents can ...
Are you initiating/discussing peanut OIT in most children less than age 2 due to the benefits of desensitization and remission?
The relative risks and benefits must be weighed as an alternative to omalizumab or in combination with omalizumab. Between 25-40% of patients who are allergic to peanuts are also allergic to at least one tree nut. Although omalizumab has the advantage of providing protection for multiple food allerg...
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.