Allergy & Immunology
Expert discussions on allergic conditions, immunodeficiencies, drug hypersensitivity, and immunotherapy approaches.
Recent Discussions
Do you stop oral antihistamines before checking a serum tryptase?
I do not stop oral antihistamines before checking a serum tryptase. Oral antihistamines target the histamine receptor and should not have an impact on serum tryptase.
What signs and symptoms in a patient are you having GI evaluate for an EGID?
Non-EoE eosinophilic gastrointestinal disorders can be challenging to diagnose on several different levels. One is the type of symptoms the patient is having. These symptoms of non-EoE eosinophilic gastrointestinal disorders can vary based on the portion of the GI tract that is affected. I initiate ...
How often do you monitor the eosinophil count after initiating anti-IL5 therapy for HES?
After initiating anti-IL5 therapy, I monitor the peripheral blood eosinophil count on a monthly basis until the peripheral blood eosinophil count decreases to less than 1,500. After the peripheral blood eosinophil count decreases to less than 1,500, I then monitor every 3 months for the first year a...
Should KIT D816V be checked in all patients with a stinging insect allergy, even with a normal tryptase, so that mastocytosis is not missed in patients with a normal tryptase?
Perhaps not in all patients but certainly in those with hypotensive, syncopal, or presyncopal symptoms regardless of tryptase levels, as well as in those with tryptase levels above 8 ng/ml.
With multiple step-up therapies for urticaria, which are you finding most successful the first time for remission of symptoms?
Omalizumab at 300 mg works best, but if needed, I can increase the dose for a better response.
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 patients with a PEG allergy have a contraindication to receiving mRNA vaccines?
While early anecdotal reports suspected that PEG allergy may be linked to allergic reactions to mRNA COVID vaccines, subsequent research disproved this. Therefore, even patients with true IgE-mediated allergy to PEG (which is extremely rare) do not have a contraindication to receiving mRNA vaccines....
Do you regularly check switched memory B cells in CVID?
Yes, about once a year, I get B cell subsets.
What specific comorbidities do you routinely screen for, beyond food allergy, in a child with moderate-to-severe atopic dermatitis?
I routinely screen for psychosocial dysfunction in all my patients, which is especially important for those with significant symptoms like pruritus or pain impacting quality of life, as in children with moderate-to-severe atopic dermatitis. This screening specifically includes quality of sleep (whic...
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...