Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you continue shots when a patient transfers under your care and has been receiving less than effective doses of AIT, but insist they have been effective?
It depends. If the patient says IT has been effective, can we claim that they received "ineffective" doses (presumably meaning less-than-recommended doses)? And how long has the patient been on AIT? As noted by Dr. @Dr. First Last, it might be time to do a trial discontinuation, anyway. I would not ...
Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?
Familial HLH (fHLH) is a pediatric disease. Therefore, there is no place for genetic testing to establish a diagnosis of fHLH in adults, and treatment for HLH should not be delayed while waiting for genetic testing. However, there are hypomorphic polymorphisms in the fHLH genes that may be a contrib...
Do you routinely take a cancer history from patients being evaluated for atopy?
I do take a cancer history (not only in the patient's PMH but the family history as well). Given the evidence described above (which is even more robust in the literature than mentioned above), therapies that alter immune function (such as AIT) should have shared decision-making as part of the proce...
What is the lowest maintenance dose you will use if a patient continues to have anaphylaxis when trying to achieve maintenance dosing?
Another approach might be to give a lower dose, perhaps 1.5 ml of a 1:1 every 2 weeks, so that the monthly dose would be a minimum of 0.3 ml. George GottliebDecatur GA
With regard to cat immunotherapy, if testing is positive for cat pelt and cat hair, do you include include 50% pelt and 50% hair if doing immunotherapy?
The answer will likely depend on which extracts you have available and potentially on whether you can do any additional component resolved diagnostic testing. The major allergen in cat hair is Fel d 1. The major allergens in cat pelt are Fel d 1 and albumin. You could consider doing component testin...
Should the RSV vaccine be administered to pregnant mothers even if it is not seasonally circulating but they are 32-36 weeks pregnant?
Here is the official CDC/ACIP recommendation (accessed 3/30/2025): "CDC recommends one dose of Pfizer’s Abrysvo for women who are 32 0/7 weeks’ through 36 6/7 weeks’ gestation. Pregnant women who are more than 36 weeks 6 days pregnant should not be vaccinated, as it is unlikely there will be enough ...
Does a patient with known systemic mastocytosis need a bone biopsy of lytic vertebral lesions to rule out other etiologies?
Yes, as long as other etiologies have been ruled out, such as cancer, osteomyelitis, or other infections. Even though osteoporosis is more common in systemic mastocytosis patients, bone lytic lesions are not.
What is your preferred regimen for remission induction and maintenance in EGPA with cardiac involvement?
Cardiac involvement in EGPA is associated with a poor prognosis and is an independent predictor of mortality. Therefore, it needs to be treated aggressively. Depending on the study, between 15-30% of EGPA patients present with or develop cardiac manifestations. The manifestations are highly variable...
What features on PFT or flow-volume loops do you look at to suspect small airway dysfunction?
I would strongly advise against using the flow-volume loop to diagnose small airway dysfunction. It is difficult if not impossible to visually distinguish between small airway dysfunction and normal aging (I would point out that part of normal aging involves changes in small airway function). Althou...
Do you feel high dose Symbicort or Dulera is appropriate to use for SMART despite these doses not being studied in clinical trials?
One of the primary purposes of SMART therapy is to provide extra doses of ICS to patients inadequately controlled enough to use rescue inhalers. The other major purpose is to do this with a single inhaler instead of 2 or 3. So if the patient's baseline asthma is severe enough to require high-dose Sy...