Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Can you safely use a cephalosporin in a patient who previously developed acute interstitial nephritis to amoxicillin?
Amoxicillin-associated interstitial nephritis is most often a type IV hypersensitivity reaction. Cross-reactivity with other beta-lactams is possible but poorly studied. I would try hard to find an alternative.
How long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
If a patient had a non-anaphylactic IgE mediated reaction to Augmentin but can tolerate amoxicillin, would you directly proceed with an oral challenge to augmentin?
It is difficult to respond to this question, as “non-anaphylactic IgE-mediated reaction” is a bit vague. I assume this was an immediate cutaneous reaction with respiratory or cardiovascular manifestations. The issue, from my perspective, is that mild systemic reactions that appear to be IgE-mediated...
How are you using SLIT if that is the method you use to treat allergic rhinitis?
In our practice, we only use the FDA-approved SLIT tablets Grastek, Ragwitek, and Odactra. That said, it is not something used often, as most patients are polysensitized. We give the first dose in the clinic and monitor for 30 minutes. Admin at home thereafter with Epinephrine accessible. Most studi...
Does switching arms enhance the efficacy of subcutaneous allergen immunotherapy?
I wish we knew. Many of us switch arms with immunotherapy doses routinely to try to minimize local reactions and "spread out allergen evenly," so to speak. It is the latter concept that is relevant to the question. I do not know of any data as it pertains to allergen immunotherapy. However, there is...
Why are total IgE levels often less than the summation of food allergy component testing?
I have a couple of thoughts, although the maker would know the best. It may be because the different allergenic proteins (components) are not represented in a perfectly similar concentration in the component test and the total peanut test. In addition, there may be some subtle interference in IgE bi...
Do allergy shots play a role in preventing recurrence of nasal polyps?
No
In a patient with selective IgM deficiency who is completely asymptomatic in terms of infections, what is your typical laboratory work up?
B cell phenotyping, lymphocyte subsets, IgG to diphtheria, tetanus and S pneumonia. Evaluate the humoral function, as it is important to know and possibly follow with time, but with an asymptomatic treatment is not warranted.
Do you perform genetic testing in all patients with CVID?
I perform genetic testing in almost all of my CVID patients, and in 100% of those with evidence of immune dysregulation (e.g., lung, liver, or gut involvement; autoimmunity; cytopenias; or lymphoproliferation).
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...