Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
In a patient with anaphylaxis and loss of consciousness from stinging insect, suspected to be yellow jacket, the sIgE was significantly positive to all vespids, but honeybee and paper wasp were only 0.44, would you evaluate further with skin testing to wasp and decide on including wasp in treatment based on skin testing being positive or include it with just the low IgE level?
The wasp IgE may be cross-reactive with YJ, and if the YJ is more than 5 times higher than Polistes IgE then this is almost certainly the case, which would suggest that Polistes VIT is not necessary. However, there is no available test to prove the cross-reactivity, so given the severity of the reac...
How do you decide when to obtain genetic testing for suspected autoinflammatory conditions in adults?
We have identified an autoinflammatory disorder that occurs in people of the Southern Appalachian mountains known as "Melungeons." Several have been evaluated at NIH, and while they do not have any of the known markers the diagnosis of familial Mediterranean fever has been confirmed. Dr. Kastner tol...
Is AIT safe to use with an active malignancy such as CTCL?
I'm not aware of any evidence to suggest that AIT would not be safe in stable patients with CTCL, although there are no studies either. If the patient is immune compromised there is a possibility that allergen immunotherapy would be less effective. The main concern with safety would be having to com...
How often do you monitor the eosinophil count after initiating anti-IL5 therapy for HAE?
First, I monitor the eosinophil count to determine that the medication has reduced the numbers of eosinophils. Second, I do not have a regular (established) schedule for testing after that. I do usually obtain a CBC and diff at each clinic, namely about every six months. Third, I pay particular atte...
Would you favor treating HES manifesting with EoE with dupilumab or anti-IL5 therapy?
That depends, and I'd need more information. Is this someone who has elevated peripheral eos and their GI tract is the only organ system involved (sometimes called 'overlap HES')? In this case, I'd ask GI colleagues to perform a colonoscopy as well to look for a lower EGID. I'd also screen for paras...
Do you use asthma or EoE dosing if initiating dupilumab in a patient who meets criteria for treatment for both disorders?
I would do the higher dose (EoE) if starting it for both.
How would you treat autologous GVHD after a thymic transplant but with no thymopoeisis?
I would treat with steroids first, which are usually effective in auto-GvHD, and see how the response is. If it is insufficient, then you can add other immunosuppressive therapies.
Is omalizumab an option for a patient needing a specific antibiotic with an IgE-mediated reaction who continues to have reactions during a desensitization?
Omalizumab is FDA-approved for Asthma, Chronic spontaneous urticaria, chronic rhinosinusitis with nasal polyposis, and food allergy. It is a monoclonal antibody directed at IgE which will deplete circulating IgE and thus specific IgE on the mast cell and basophils will decrease. There is also likely...
Do you utilize urinary leukotrienes as a marker for initiation of montelukast?
No, I don’t. It is not readily available clinically and has not been shown to be predictive of response.
Is separating dust mite and molds still necessary in light of increased addition of glycerol to IT mixtures?
We use mostly Greer products for mold and dust mite. Greer would note that mixing mold and dust mite is risky. Thus in practice, I do not mix dust mite and mold.Is it possible to do it? Yes, if stored in >10% glycerin as noted by Esch (2008). Dr. Macy, who I would argue is a more renown expert, seem...