Dr. Dareen Siri discusses key points from her lecture Allergy/Immunology Workup for the Dermatology APP at the 6th Annual Elevate-Derm Alliance Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

In conversation with Veronica Richardson, Dr. Siri explains that primary immunodeficiency is "more common than we think," driven by a broader trend of immune dysregulation, and that more patients now live longer with severe immune problems thanks to bone marrow transplantation, newer medications, and better public health. She flags the signals dermatology APPs should notice: recurrent skin infections without a clear reason, septic joints, osteomyelitis, hospitalization for sepsis, recurrent sinusitis, and pneumonia ("you get one pass"). Unusual pathogens like Serratia, non-resolving or extensive warts, and recurrent Candida should prompt the thought, "hmm, that's odd"—and a consideration of immunodeficiency. Even an adult on antibiotics for an ear infection is unusual and worth noting.

Turning to allergies, she notes new-onset adult food allergy is uncommon but can occur at any age and to any complex food protein—most often nuts or shellfish—and describes oral allergy (food-pollen) syndrome linking severe pollen or dust-mite allergy to foods like watermelon–ragweed, apple–birch, and dust mite–shellfish. For prevention in atopic infants, she emphasizes good skin barrier care plus early introduction of high-allergen foods around four to six months, echoing Dr. Lio's line, "through the skin, allergies begin; through the diet, allergies stay quiet." She closes on food immunotherapy—sublingual and oral desensitization, including FDA-approved Palforzia for peanut—stressing it uses microscopic doses and must never be attempted at home.

  • Suspect primary immunodeficiency when infections are recurrent, severe, or unusual: recurrent skin infections, septic joints, osteomyelitis, sepsis hospitalizations, recurrent sinusitis, extensive non-healing warts, recurrent Candida, or odd pathogens like Serratia.
  • Pneumonia earns "one pass"—more than one episode in a lifetime is a red flag, and even recurrent ear infections in adults are unusual and worth investigating.
  • Adult-onset food allergy is uncommon but possible at any age; watch for oral allergy syndrome (mouth itching, swelling, angioedema) tied to severe pollen or dust-mite allergy, since shellfish is essentially "a big dust mite."
  • Allergy risk is largely genetic—about 50% with one atopic parent, 80–90% with two—but severity can be modified with moisturizers, healthy diet, and early introduction of high-allergen foods to build tolerance through the gut.
  • Food immunotherapy (sublingual drops, oral immunotherapy, and FDA-approved Palforzia for peanut) now offers desensitization for selected, committed patients, but requires an experienced physician and microscopic dosing—never DIY at home.