Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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...
In those patients who are initiated on omalizumab for multiple food allergies, once baked egg and baked milk are introduced into the diet, how long should you wait until a prepared egg and whole milk challenge is conducted?
In the OuTMATCH trial, patients were on omalizumab for 16-20 weeks before undergoing food challenges, but as in every situation, the clinical history is important. Skin testing and serum IgE testing may not be reliable on omalizumab, but if the patient is tolerating and eating baked and cooked egg a...
How do you perform patch testing in patients who are allergic to adhesives?
True allergy to the Scanpor tape most often used in patch testing is rare, even in patients allergic to colophony, p-tert-butyl phenol formaldehyde resin, rubber, or acrylate-based adhesives. What is more common, especially in atopic patients with microbial dysbiosis driving their dermatitis, is fla...
Do you recommend IM Kenalog injection for refractory CRSwNP in a patient already on maximal therapy?
For refractory CRSwP on maximal therapy, IM Kenalog would not be my drug of choice. I would rather suggest Dupixent. A number of published papers including some from Klaus Bachert clearly show the benefit of Dupixent in this subgroup of patients. IM kenalog might help for a short time, but Dupixent ...
How does omalizumab play a role in the armamentarium of atopic dermatitis?
There are various reports (>30 citations) in the literature documenting Xolair efficacy in atopic dermatitis. The study designs include randomized placebo-controlled trials, retrospective case series, and case studies.A review of the literature published in 2019 by Holm & Thomsen, PMID 30717578 prov...