Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Would rhapsido be beneficial in patients with MCAS who experience anaphylaxis?
Remibrutinib is the first FDA-approved BTK inhibitor (BTKi). The efficacy data shared were specifically in patients with CSU who failed 4x antihistamine therapy. This class of medication holds promise and may be applicable to other conditions we treat, including anaphylaxis. I refer you to an intere...
Are your performing food challenges prior to starting OIT or omalizumab to determine if these patients have a threshold dose that would actually benefit from the intervention?
This is a great question! I’m curious about other allergists' practices as well. My response to this question is that it depends. I have patients who undergo a food challenge but do not pass. They then decide they would like to pursue OIT or omalizumab. We are then able to track their response to th...
Is it necessary to test for all tree nuts when a patient presents with IgE mediated symptoms to an isolated tree nut?
Having an allergy to a specific tree nut does not mean a patient will be allergic to others, but there are some that are cross-reactive, and it may be worthwhile testing for the cross-reactive tree nut as opposed to testing for all. For example, if the patient had a reaction to cashew, testing for p...
Can you have an allergic reaction to paprika if you have tree nut allergy?
Patients with tree nut allergies do not typically react to paprika. Paprika allergy is primarily associated with the celery-birch-mugwort-spice syndrome, where cross-reactivity occurs through pathogenesis-related proteins (PR-10), and profilins shared with birch and mugwort pollen, rather than throu...
Is it necessary to test both english walnut and black walnut when evaluating for a walnut allergy?
English walnuts are the standard grocery store walnut, and are great for everyday baking and snacks. Compared to Black walnut, they are mild, sweet, and buttery. Black walnuts are used in some specialty desserts, but are less commonly used. The two walnuts are greatly cross-reactive, so testing for ...
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
When do you consider de-escalating therapy such as dupilumab in eosinophilic esophagitis?
It is first important to recognize that EoE is a chronic condition. In a patient whose EoE is successfully being treated (whether it be with PPI therapy, swallowed steroids, food elimination, or dupilumab), the disease will invariably become active again over time if therapy is stopped. This is why ...
Do you reflexively test for tree nut allergies when you diagnose a peanut allergy?
My decision to test tree nuts when a patient is diagnosed with a peanut allergy depends on multiple factors. In the past, children diagnosed with a peanut allergy were told to avoid all tree nuts due to the risk of co-existent allergy. That practice evolved over time as more research was conducted. ...
Do you perform food challenges after starting Xolair for IgE-mediated food allergy to ensure efficacy?
I don't do food challenges after starting Xolair for multiple food allergy treatment. Way too cumbersome and I don't see the clinical need as the patient must still avoid the foods.
In which patients with CHE will you prioritize early use of delgocitinib?
I think about delgocitinib early in patients with recurrent flares, lack of efficacy or adverse events with steroids, or those with a significant impact on daily function or work ability. I would consider skipping steroids entirely, but typically, when I see patients, they have already tried topical...