Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
With emerging therapies, what is your general treatment ladder for chronic spontaneous urticaria (CSU)?
Antihistamines remain the first-line therapy for chronic spontaneous urticaria (CSU), and doses should be optimized before turning to other therapies. If patients fail a trial of adequately dosed first- and second-generation antihistamines, montelukast is a reasonable adjunct. For patients with high...
What data exist regarding treatment for facial erythema from dupilumab in children <5 years of age?
In AD patients >6 years, the incidence of facial erythema for dupilumab was 1% vs placebo 0.7% (Paller et al., PMID 41163262). The placebo-controlled LIBERTY AD PRESCHOOL trial (Paller et al., PMID 36116481) and the subsequent open-label trial up to 2 years (Paller et al., PMID 41926052) for 6-month...
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...
Would you stop Dupixent in an asthma patient who has good asthma control and notes improvement in loss of smell, but shows notable eosinophil elevation after 4-5 doses of the medication?
Transient eosinophilia has been reported in patients treated with Dupixent, likely related to downregulation of eotaxin and adhesion molecules resulting in impaired eosinophil migration into the tissues (Castro et al., PMID 29782217, Olaguibel et al., PMID 35522053). This phenomenon is typically see...
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.
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
Do you utilize cytokine panels to guide treatment of patients with EGPA?
Whether biomarkers can guide treatment decisions or predict disease relapse is a critical area of study in ANCA associated vasculitis. However, efforts to identify biomarkers that are predictive in EGPA are at an early stage currently. There have been multiple negative studies of biomarkers being ab...
If a patient has chronic spontaneous urticaria refractory to Xolair and is already on plaquenil, do you stop plaquenil and then initiate cyclosporine or do you co-administer and then gradually stop plaquenil over time?
I would first increase the dose of Xolair, actually, up to 600 mg every 2 weeks.
When a patient does not have comorbid atopic dermatitis or nasal polyposis, how do you determine when to use the 200 mg vs 300 mg maintenance dosing for Dupixent for asthma?
One might consider the nonbiologic baseline therapy and severity of the asthma that is driving the potential initiation of a biologic like dupilumab to treat the asthma. Assuming I have decided to use dupilumab instead of a different biologic for improving management of the patient's asthma, I would...
Do you recommend allopurinol desensitization in gout patients who develop a rash on allopurinol therapy?
I don't recommend desensitization for allopurinol-allergic patients. There was a time when this made sense due to the lack of a viable alternative therapy. The process is cumbersome in a private practice setting and not as simple as providing the patient with a prescription for febuxostat.Febuxostat...