Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?
We have a fairly large number of ABPA patients on Omalizumab. It works great. One of the issues we frequently encounter is that ABPA patients sometimes have too high of IGE counts for the approved highest Omalizumab dosage. In these patients, we initially treat them with standard prednisone therap...
In those patients who are initiated on omalizumab for multiple food allergies, how long should you wait before performing baked egg and baked milk challenges?
In the OuTMATCH trial, patients were on omalizumab for 16-20 weeks before undergoing food challenges. However, the primary outcome of the study was consumption of certain amounts of a food allergen without developing anaphylaxis. In Fiocchi's study entitled, Impact of Omalizumab on Food Allergy in P...
When do you refer pediatric patients with eczema to an allergist?
I refer concerns about immediate-type hypersensitivity symptoms (e.g. anaphylaxis, rhinitis, or asthma) to an allergist. Eczema is delayed-type hypersensitivity from contact with an inorganic or a protein allergen. Many dermatologists and allergists perform extended patch testing for these contribut...
How do you approach patients that develop atopic dermatitis while on biologics for psoriasis?
We have a few patients on dual-biologic therapy who have features of both psoriasis and atopic dermatitis, where each is severe enough to merit systemic therapy on their own. Probably a little less now with more JAK inhibitors available, but we still have some patients maintaining on these regimens....
Is the efficacy and dose same for subcutaneous vs intravenous IVIGs being used for dermatomyositis?
Thank you for the very interesting question:When considering the best answer, there is a bit of background I think is important to keep in mind. (I'll put my final thoughts about dosing at the end of this background) First and foremost, although IVIG has been used as a de facto treatment for multipl...
Have you been able to safely use other bisphosphonates in patients who developed an allergic reaction (angioedema) to fosamax?
Hypersensitivity with urticaria in someone on alendronate is quite rare. I am not aware of any publications showing another bisphosphonate safely used in this setting. Although there are significant chemical differences between the various oral and IV bisphosphonates, I personally would avoid the en...
Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?
This is an interesting question. Clearly, patients with autoimmune or immune-mediated diseases because of their immunosuppressed status are at an increased risk of H. zoster, regardless of age. Presently, the recommendations from the CDC, different professional societies, etc., are to immunize patie...
Which ANCA vasculitis patients are better candidates for cyclophosphamide rather than rituximab?
Both can be used for induction in GPA/MPA vasculitis. I would use rituximab (RTX) if the patient has previously been treated with cyclophosphamide (CYC) and developed a relapse/flare and in patients who are young and with fertility concerns. In GPA/MPA, I tend to use RTX most of the time for inducti...
What patients with food allergies do you screen for EoE?
If a patient has symptoms of esophageal dysfunction, they should be screened for EoE. Because symptoms can be ill-defined in children, this may be more challenging. Growth failure, unexplained abdominal pain, or vomiting are indications for GI referral with consideration for endoscopy. Indiscriminat...
What functional assays do you recommend to determine if MGRPRX2 receptor activation has led to a non-IgE mediated anaphylaxis?
At present, I’m not aware of any functional assays available to determine whether MGRPRX2 activation is taking place. This topic is being studied extensively in research labs internationally; Dr. Didier Ebo in Antwerp is one of the leading researchers in this area. At present, the best markers and m...