Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Is there a specific group of children that you start on AIT for prevention of asthma?
There are a few factors I consider in my decision to start allergy immunotherapy (AIT) in children with asthma. The age of the child, whether their asthma symptoms correlate with allergen trigger(s), the ability and willingness of the family to devote the time to build up and continue AIT. Asthma co...
Do you consider the efficacy of different nasal sprays when prescribing for allergic rhinitis or conjunctivitis?
When it comes to prescribing or recommending different nasal sprays for rhinitis, I tend to focus on the other considerations rather than efficacy, as for the most part all of the intranasal steroids are effective. The differences that I might highlight and/or consider include odor, drippiness, cost...
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
How are you choosing between Xolair, Dupixent or Rhapsido for patients with CSU?
Patient choice, many patients prefer a monthly shot as opposed to BOD meds every day or even q 2 weeks shot; also, co-morbidities--FA, eczema...
What are the implications of checking post-vaccine titers after administration of Prevnar 20 compared to PPSV23?
The landscape of pneumococcal vaccine choices has undergone considerable change in the past few years. Notably, the expanded pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) approved for a broad age range which provide almost overlapping coverage of the pure polysaccharide pneumococcal vaccine ...
Are there specific conventional DMARDs and/or biologics that are contraindicated in patients with alpha-gal allergy?
Here is a Q&A from AAAAI (American Academy of Allergy, Asthma and Immunology) addressing this question for etanercept and other monoclonal antibodies that are manufactured in cell lines that glycosylate with alpha-gal. The author concludes, "The risk is not zero, but likely very low".
Which patient factors drive you to pursue patch testing in the workup of chronic hand eczema?
Seasonal hand eczema occurring only during the cold season is usually irritant and best addressed by minimizing hand washing and using cotton under occlusive gloves with frequents changes for wet work. Careful examination for signs of psoriasis and anti-synthetase syndrome is important. Next step is...
Would you still restrict live viral vaccines in a pediatric patient with CD4 count <500 even though they had previously tolerated them and before CD4 testing was obtained?
No. Generally, I follow the guidelines of CD4>400, CD8>200, and look at the response of other vaccines like Tetanus.
Which biologics for asthma have data regarding mucus plugging?
There have been multiple studies on biologics investigating the effects on mucus plugging (as measured by the CT mucus plug score of the number of pulmonary segments with a mucus plug, established by Dunican et al., PMID 29400693). In these studies, high mucus plug scores correlate with T2 high biom...
Do you see GLP-1 receptor agonists as a potential adjunctive therapy in patients with T2-low asthma and obesity who remain symptomatic on ICS-LABA, prior to escalation to tezepelumab?
Initial research is promising but needs more data.