You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



A Tale of Two Cases in Allergic Diseases: How Will You Treat These Patients With Asthma and Chronic Spontaneous Urticaria?

  • Authors: Anil Nanda, MD, FAAAAI
  • CME Released: 1/27/2023
  • Valid for credit through: 1/27/2024, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This activity is intended for allergists, clinical immunologists, primary care physicians, and dermatologists.

The goal of this activity is for learners to be better able to integrate understanding of advances in treatment for allergic asthma and CSU into treatment decisions for patients with refractory symptoms.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Identifying patients with uncontrolled allergic disease
    • Selecting appropriate treatment for uncontrolled allergic disease


AAAAI Disclosure Policy 

Pursuant to the Code of Ethics for the American Academy of Allergy, Asthma & Immunology (AAAAI) and the Standards for Commercial Support of Continuing Medical Education of the Accreditation Council for Continuing Medical Education, the AAAAI requires disclosure of certain information from faculty members of educational activities designated for CME credit by the AAAAI. Prior to the activity, authors and reviewers are required to disclose all relationships that meet the following parameters: 

  • Employment. Name of employer and job title. 
  • Financial interests. All organizations, other than the employer, from which the faculty member receives annual remuneration in any amount (including grants, honoraria and consulting fees). 
  • Research interests. All organizations which support research projects for which the faculty member serves as an investigator. 
  • Legal Consultation Services/Expert Witness Testimony: All topics on which the faculty member provided legal consultation and/or expert witness testimony during the previous calendar year. 
  • Organizational interests: All organizations, other than the AAAAI, for which the faculty member holds volunteer positions. 
  • Gifts. All organizations from which the faculty member have received a gift of any amount in the last year. 
  • Other interests. All interests of the faculty member that would be judged by a majority of his/her peers to be more than casual and/or likely to impact his/her ability to exercise independent judgment. This includes any financial interest in or relationship with any manufacturer of a commercial product, and any financial interest or relationship with any organization that provides commercial support to AAAAI-sponsored educational activities. 

The information disclosed by the speakers, planning committee, and reviewers was reviewed in accordance with the AAAAI Disclosure Policy. All potential conflicts of interest were mitigated by the planners, faculty, and reviewers prior to their participation in the development of this activity.

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


  • Anil Nanda, MD, FAAAAI

    Asthma and Allergy Center
    Lewisville, Texas


    Anil Nanda, MD, FAAAAI, has no relevant financial relationships.


  • Briana Betz, PhD

    Medical Education Director, Medscape, LLC


    Briana Betz, PhD, has no relevant financial relationships.

Compliance Reviewer

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

  • Robert Corriel, MD, FAAAA

    Lake Success Allergy and Clinical Immunology, Lake Success, NY

    Disclosures: Robert Corriel, MD, FAAAAI, has no relevant financial relationships.


    Disclosures: Robert Corriel, MD, FAAAAI, has no relevant financial relationships.

Accreditation Statements

Developed through a partnership between Medscape and American Academy of Allergy Asthma & Immunology (AAAAI).

Interprofessional Continuing Education

The American Academy of Allergy, Asthma and Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    For Physicians

  • The American Academy of Allergy, Asthma & Immunology designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Contact this provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

AAAAI Privacy Policy

​To verify your participation in educational activities, you may be asked to provide your name, contact information, and/or other descriptors. The AAAAI will not release this information to outside entities. It may be used internally to inform you of other AAAAI educational activities. If you wish to have your information excluded from this process, please contact us at [email protected]


A Tale of Two Cases in Allergic Diseases: How Will You Treat These Patients With Asthma and Chronic Spontaneous Urticaria?

Authors: Anil Nanda, MD, FAAAAIFaculty and Disclosures

CME Released: 1/27/2023

Valid for credit through: 1/27/2024, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

Case 1

The first patient case in this series is a 26-year-old woman with a history of comorbid allergic asthma, eczema, and allergic rhinitis.


Patient Medical History

The patient was diagnosed with allergic asthma when she was 6 years old following an emergency department visit for an exacerbation. She had not been previously diagnosed with the condition, but her parents had reported a history of frequent nighttime coughing, which worsened with respiratory infections. Following discharge from the emergency department, she was prescribed medium-dose inhaled corticosteroids (ICS) together with a long-acting β-agonist (LABA). Symptoms were stable on this treatment combination throughout childhood. This treatment was switched during adolescence to montelukast in response to improved symptoms. However, montelukast was subsequently ineffective, and the patient was reverted to low-dose ICS plus LABA, which controlled her symptoms until approximately 1 year ago.

Allergy testing performed approximately 15 years ago was positive for tree pollens, grass pollens, dog dander, and dust mites, leading to the diagnosis of comorbid allergic rhinitis. Her allergic rhinitis is treated with topical fluticasone nasal spray and oral cetirizine daily. Eczema has also been present since childhood and is considered mild. It is currently managed with topical steroids and moisturizers, as required. She is a non-smoker (never smoked), works as an administrative assistant in an office, lives alone with 2 cats, and does not take any other medications.

The patient is attending the clinic because she has been experiencing frequent asthma exacerbations. In total, she has experienced 3 exacerbations in the past year, of which 2 were in the last 6 months. She currently uses rescue medications approximately 3 to 4 times per week and wakes up due to her asthma at least once a week. Her ICS dose was increased to a medium dose about 10 months ago and then a high dose approximately 5 months ago. A physical exam of the nasal cavity revealed mild edema, pale mucosa, and no polyps. A lung exam was normal, but pulmonary function tests revealed a mild obstruction.

  • Print