Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
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?
It depends on the patient and their co-morbidities. For poor compliance, Trelegy can be a game-changer due to ease of administration.
Do you withhold performing skin testing for aeroallergens, foods or venoms based on poor lung function?
I do not. However, if a known severe trigger of asthma by history, such as a cat, I instruct staff to wipe off the allergen if a large skin wheal occurs. Additionally, if lung function is compromised, starting the patient on a short course of oral steroids prior to testing will not compromise skin t...
When should we suspect ‘climate-amplified’ rhinitis/asthma versus poor control from other causes?
Before labeling rhinitis or asthma as “climate-amplified,” we must first exclude common causes of poor control: adherence issues, suboptimal controller dosing, inhaler technique, indoor allergen exposure, occupational triggers, and comorbidities (GERD, CRS, OSA, obesity). These remain far more commo...
Should a patient on medium-dose ICS/LABA with normal PFTs, but who shows a greater than 10% decrease in FEV1 if their PFTs are done after 24 hours off their inhaler, be started on a biologic?
A little more clinical information would be useful to better answer the question. How well controlled is the patient on the LABA/ICS? What is the ACT score? The FEV1 decreased by greater than 10% (with volume >200 ml ?) when LABA/ICS was stopped for 24 hours - how quickly did it normalize when the i...
What are your top takeaways from AAAAI 2026?
The presentations related to the treatment of systemic mastocytosis (SM) were the highlight of the AAAAI meeting. They demonstrated that patients with non-advanced SM (NonAdvSM) can achieve complete remission of SM where WHO diagnostic criteria are no longer met. The rate of remission (where WHO dia...
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.
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 ...