Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
What is your threshold to start triple therapy in mild to moderate asthma/COPD overlap with minimal functional limitation?
The question is vague as it does not define functional limitations. If the patient has frequent exacerbations (not defined by the question), Triple therapy would be recommended. If she just has minimal SOB for instance an exercise induced type picture SABA/LAMA prn with LABA ICS (w/o LAMA) would be ...
What is your approach to checking IgG levels post vaccination to detect common variable immunodeficiency in patients with systemic lupus?
I recommend that this type of workup for primary immunodeficiency disorders be done as soon as a diagnosis of systemic lupus erythematosus (SLE) is made. In other words, order quantitative immunoglobulins (IgA, IgM, IgG) plus IgG subclasses during your initial workup.Reasons being: Some primary immu...
Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?
I have checked M-M-R, Td, and pneumococcal titers in patients with hx of infection and low Ig levels to see if they are making an immunological response. If any of these immune titers are low or the immunization is “due” by routine schedules, I recommend immunization and repeat testing in 6 weeks. T...
How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?
Needs more information. Is the issue unresponsiveness or intolerance? Frequently, patients report GI intolerance and don't really take it. It's crucial to inquire about this and consider trying different preparations to find a suitable option. What was the nature of the iron sucrose allergy? Sometim...
What is the optimal timing for Zoster vaccine administration for a patient who recently recovered from herpes zoster infection and is now planning to start B-cell depletion therapy?
This is a complicated question that must balance two competing factors. First, in general, most experts counsel waiting, approximately one year after zoster before vaccination in attempt to take advantage of endogenously boosted immunity and a low rate of recurrence within 12 months. On the other ha...
Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?
I use only intermittent.
How do you manage recurrent urticarial lesions in a patient with underlying connective tissue disease that is otherwise well-controlled?
Similar to other cases of chronic urticaria - skin-directed therapy with TCS + high dose daily antihistamines (e.g. fexofenadine 180 mg bid + doxepin 10 mg qhs). Then in recalcitrant cases, you can use urticaria drugs (can go for dapsone, MTX or MMF if you want to also target underlying CTD or can g...