Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Are there any special considerations when evaluating patients with non-malignant hematologic or immunodeficiency disorders for allogeneic transplant?
In most malignant diseases, we prefer to take patients to allogenic transplant either in complete or partial remission as it will take few months before post-transplant immune-reconstitution results in effective graft-versus-disease response. In non-malignant diseases, we take patients to transplant...
How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?
When end-organ manifestations are present, my initial treatment approach is similar for drug-induced and non-drug induced AAV and typically consists of glucocorticoids and rituximab, including pulse glucocorticoids with severe end-organ involvement. Common drug culprits such as PTU, hydralazine, min...
How does a history of splenectomy alter how you counsel patients on the infection risk of TNF inhibitors or other biologics?
In general, a history of splenectomy would lead to an increased concern regarding infections with parasitemia and encapsulated organisms (particularly Strep. pneumoniae, Haemophilus influenzae type b, and Neisseria meningitides). However, I would not consider prior splenectomy an absolute contraindi...
Which EGPA patients are most likely to benefit from treatment with anti-IL-5 agents such as mepolizumab?
This is a question that is an important area of current investigation in vasculitis. In my view, patients who have primarily pulmonary and sinonasal symptoms (e.g., asthma, rhinosinusitis) are most likely to benefit from mepolizumab, given current knowledge.It is unknown to what degree mepolizumab a...
Is it okay to use medications associated with drug-induced lupus in patients with SLE?
In the current era, I find it useful to divide drug-induced lupus into two classes. First, the traditional medications such as procainamide and hydralazine that are associated with ANA by IFA, anti-histone antibodies, and a type of drug induced lupus not characterized by certain clinical features su...
How do you advise patients who had autoimmune diseases "triggered" by COVID infections on getting COVID vaccination?
To date, it is unclear whether there is a causal link between COVID-19 and incident autoimmune disease at a rate higher than the incidence of autoimmune diseases in the general population, although, there are several case reports and case series describing new cases of autoimmune disease that began ...
How would you advise patients with known stable autoimmune thrombocytopenia regarding the Ad26.COV2.S (Johnson & Johnson/Janssen) vaccine?
For patients with autoimmune thrombocytopenia due to SLE, I favor avoiding vaccines that employ a viral vector due to concerns for viral induced lupus flare.For patients with thrombocytopenia in association with antiphospholipid antibodies, would avoid the Johnson & Johnson (as well as Astra-Zeneca)...
Is there a role for antibody testing to confirm vaccine response for patients on rituximab after COVID-19 vaccination?
It's a great question, but I do not feel that routinely performing COVID antibody testing would help in the management of these patients: We don't know how well most commercial antibody testing correlates with neutralizing antibody/immune-status (esp. if qualitative testing is performed), and I have...
In which patients with autoimmune or inflammatory conditions are you recommending a 3rd dose of the mRNA COVID vaccine?
We found that many of the patients on immune suppressive medications do not have an appropriate response to the initial 2 doses of mRNA COVID19 vaccines. At this point, I recommend a 3rd dose to all the patients on immune suppressive medications, prioritizing the ones with known low titers of SARS-C...
How are you timing the third dose of the COVID-19 mRNA vaccine in patients on rituximab?
At this point, I am advising the patients to do the 3rd vaccine at least 5 months after the previous Rituximab dose. Whenever feasible, I test them for B cell reconstitution prior to vaccination, and may delay the vaccination if B cells are undetectable.