Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
For a positive anti-TPO and normal TSH in the workup of CSU, are you referring to endocrinology?
I typically do not refer these patients to endocrinology. I do provide the patient with these results and have them communicate this with their PCP and/or communicate with the PCP myself so they can monitor for any symptoms associated with thyroid dysfunction.
In patients with severe asthma who are candidates for biologics, do you put them on an ICS/LABA/LAMA rather than high dose ICS/LABA?
Similarly to Dr. @Dr. First Last, I usually trial them on ICS/LABA/LAMA if possible, rather than high dose ICS/LABA with the anticipation that biologic may be added next. My preference is for ICS/LABA/LAMA over high-dose ICS/LABA, but unfortunately, I have been running into insurance coverage issues...
Are systemic effects from corticosteroid use greater with budesonide rinses compared to nasal sprays?
With the increased use of budesonide nasal rinses for chronic rhinosinusitis and nasal polyps, it seems appropriate to ask about the systemic effects of rinses versus nasal sprays. Two publications address this point, both of which are in the International Forum of Allergy and Rhinology. The first (...
What treatment approach do you suggests for a patient with nasal polyp disease and asthma who was improved on dupilumab, but over last 2 years has begun to have increased nasal symptoms and rising eosinophil counts?
Dr. @Dr. First Last's comments are quite valuable. It might be more expedient to consider simpler options first, then progress to the less common diagnoses as needed. I very much agree that unless we know what is meant by "increased nasal symptoms", it is difficult to provide precise alternative the...
In patients with moderate persistent asthma and elevated FeNO despite adequate symptom control on omalizumab and ICS-LABA, would you consider switching to another biologic such as dupilumab or tezepelumab?
If they have adequate symptom control, not sure I would switch. If I did switch, I would. Consider Dupiumab or an anti-IL5 or IL5R blocker given the Type 2 inflammation detected by elevated FeNO.
How do you manage a delayed cutaneous reaction to docetaxel after the first cycle of adjuvant TC in early-stage HR-positive, HER2-negative breast cancer?
There is excellent guidance in the literature on management of drug-induced rashes in these patients in Sibaud et al., PMID 27550571. Management generally involves topical and if necessary systemic steroids. I particularly like using lotion versions of topical steroids such as triamcinolone as they ...
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
If you perform skin testing for a penicillin allergy, do you find skin prick testing necessary or do you only perform intradermal testing?
It’s time to take a serious look at the relative value of prick puncture testing for penicillin. With the exception of patients who have a history of severe anaphylaxis, intradermal testing should become standard.
Are you performing genetic testing on all patients that you suspect to have hereditary angioedema with normal C1 inhibitor?
Yes
What is the optimal duration of biologic therapy before assessing for non-response and initiating a switch in patients with uncontrolled asthma?
I generally wait 3-6 months before changing biologic class to allow for the medications to get to a steady state. I will monitor eNO and will not wean steroids prior to 3 months.