“People know that asthma sucks. They don’t know that sinus disease sucks. It really impacts people's quality of life. It impacts their function. It needs to be taken very seriously.” — Dr. Andrew Thamboo

Chronic sinusitis doesn’t just clog the nose—it can drag down quality of life, complicate asthma, and leave patients caught between specialists. Dr. Mariam Hanna talks with Dr. Andrew Thamboo, rhinologist at St. Paul’s Sinus Centre in Vancouver and clinical associate professor at UBC, about how to identify, manage, and treat this stubborn condition. A leader in chronic sinus disease research, Dr. Thamboo explains how understanding inflammation, using the right investigations, and choosing the right therapies can make a real difference for patients who feel like nothing works.

In this episode:

• How to distinguish chronic rhinosinusitis from acute sinusitis, and why type 2 inflammation matters
  
  
• The role of CT scans in diagnosis and when to order one before referral
  
  
• What nasal endoscopy patterns reveal about atopy and when allergy testing changes the treatment plan
  
  
• Why saline irrigations combined with topical steroids remain the baseline therapy, and why oral corticosteroids are falling out of favour
  
  
• When medical management has gone far enough and surgery becomes the next step
  
  
• The evolving place of biologics, cost considerations, and how biosimilars could shift the future of care
  
  
  
• Why managing sinus disease seriously improves both airway and overall health

Sinus disease may suck, but as Dr. Thamboo explains, understanding inflammation, anatomy, and timing can make all the difference for patients and physicians alike.

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The Allergist is produced for CSACI by PodCraft Productions

“The immune system generally likes to be a well-balanced machine. It’s kind of like Goldilocks — too much is no good, too little is no good, and it’s finding that balance.”  Dr. Vy Kim

Tregs have been called therapists, peacekeepers, and now—thanks to this year’s Nobel Prize—front-page immunology. Dr. Vy Kim joins Dr. Mariam Hanna to unpack why these cells might hold the key to everything from tolerance to therapy response, and what allergists should be watching for next.

• How Tregs bridge central and peripheral tolerance—and why that matters in allergy.
• What their dysfunction reveals about the origins of allergic disease.
• Why allergen-specific Tregs could signal immunotherapy success.
• How far we are from clinical testing and therapeutic manipulation.
• What “Goldilocks” balance really looks like inside the immune system.
• The unanswered questions that will shape the future of Treg-based interventions.

It’s not every day the Nobel Prize lines up with what’s happening in your clinic. This is one of those days.

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The Allergist is produced for CSACI by PodCraft Productions

“Have a high clinical suspicion for contact allergens or irritants in anyone presenting with eczematous rash.” —Dr. Rebecca Pratt

Creams that sting and rashes that won’t quit —welcome to the complex world of contact dermatitis. Dr. Rebecca Pratt joins Dr. Mariam Hanna to unpack why diagnosing and managing this condition is anything but straightforward.

Dr. Pratt is an allergist and clinical immunologist in St. Catharines, Ontario, with a passion for dermatoimmunopathology and practical tools that empower patients. She breaks down when to patch test, what to suspect, and how to help patients take control.

On this episode:

• Why 80% of contact dermatitis cases are irritant—not allergic
  
  
• Clues that point to allergic contact dermatitis, especially in recurring facial, hand, or foot rashes
  
  
• How to approach patch testing in adults and kids, including when immunosuppressants or UV exposure may interfere
  
  
• What to do when results are negative—and why that still matters
  
  
• The reality of managing allergens found in foods, not just topicals
  
  
• Why there’s no one-size-fits-all answer to the sunscreen question—and how physical blockers stack up

There may be no cure for contact allergy, but there’s power in knowing what to avoid.

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The Allergist is produced for CSACI by PodCraft Productions

“If you're already wondering if a patient has an underlying inborn error of immunity, then it’s worthwhile to do that testing.”  — Dr. Catherine Biggs

What if that tough case in your allergy clinic isn’t just unusually severe, but fundamentally different? On this episode of The Allergist, Dr. Mariam Hanna speaks with pediatric immunologist Dr. Catherine Biggs about primary atopic disorders, rare inborn errors of immunity that masquerade as everyday allergy but demand a very different approach.

Dr. Biggs breaks down the clinical signs that should raise your suspicion and explains why early recognition and genetic testing can make all the difference. From STAT6 gain of function to when (and when not) to reach for dupilumab, this episode offers a roadmap for spotting zebras.

On this episode:

• What makes primary atopic disorders different from severe, polygenic allergic disease
  
  
• Red flags: when eczema, asthma, or food allergy suggest an underlying immune disorder
  
  
• Which patients warrant genetic testing—and how to approach it in practice
  
  
• The most important lab work to order (and why it might still come back normal)
  
  
• STAT6 gain of function and other key genetic culprits allergists should know
  
  
• When biologics are appropriate, and when they might delay definitive treatment
  
  
• The power of collaborative care: how one hospital built a severe atopy working group

Don’t let these patients fall through the cracks, because sometimes, it’s not “just” allergy.

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The Allergist is produced for CSACI by PodCraft Productions

“It doesn’t have to start with a huge trial. It starts with a patient and it starts with a problem.” —Dr. Gord Sussman

How do we move from the exam room to the frontlines of discovery? On this episode of The Allergist, Dr. Mariam Hanna talks with Dr. Gord Sussman about how curiosity—not a research grant—launched his decades-long contribution to allergy science. From identifying the early signs of latex allergy to shaping the treatment landscape for urticaria and hereditary angioedema, Dr. Sussman shares what keeps him asking the next question, and how any allergist can get involved.

On this episode:

• Why Dr. Sussman initially thought he’d never pursue research—and what changed his mind
  
  
• How one nurse's anaphylactic reaction to latex launched a field of study
  
  
• What it was like to design and run early research trials for food allergy challenges and peanut desensitization
  
  
• Why recruiting patients for trials has become harder—not easier—over time
  
  
• What makes a good research coordinator and why infrastructure is critical
  
  
• How to identify patients who may be open to research, and when not to push
  
  
• Why some promising drugs never reach market—and what frustrates Dr. Sussman most
  
  
• What advice he gives to allergists who are research-curious but hesitant
  
  

You don’t need a lab coat to help change practice. Just curiosity, commitment—and maybe a really good clinical coordinator.

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The Allergist is produced for CSACI by PodCraft Productions

“We have to keep in mind that urticaria has to be treated until it's completely gone. So, absolute control of the disease.” 

— Dr. Herminio Lima

Chronic spontaneous urticaria has long been managed with the goal of complete symptom control. But for many patients, that goal remains elusive. In this episode of The Allergist, Dr. Mariam Hanna talks with dermatologist and clinical immunologist Dr. Herminio Lima about the updated urticaria guidelines—and how new treatment options are giving clinicians more ways to act, and more hope for getting patients all the way to control.

On this episode:

• What’s new in the 2025 guideline—including additional second-line options beyond antihistamines
  
  
• Why nearly 40% of patients may need to escalate to biologics
  
  
• How remibrutinib compares to omalizumab and what its trials revealed
  
  
• What the CUPID studies say about dupilumab, especially in biologic-naive patients
  
  
• Key safety signals and clinical considerations for the new treatment options
  
  
• How to move toward full disease control—and why suboptimal outcomes are no longer acceptable

Complete control is still the destination, but the path to get there is about to get a lot more flexible.

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The Allergist is produced for CSACI by PodCraft Productions

 "The emergence of biologics has really significantly transformed the management of these patients for me."
 — Dr. Yvonne Chan

When it comes to nasal polyps, the landscape is shifting fast. On this episode of The Allergist, Dr. Mariam Hanna is joined by otolaryngologist Dr. Yvonne Chan to talk about how biologics, surgery, and multidisciplinary care are working together to reshape care for this stubborn condition. From recognizing key symptoms to navigating the latest therapeutic options, Dr. Chan shares practical insights to help physicians better support patients with nasal polyps.

On this episode:

• How to differentiate nasal polyps from other causes of chronic nasal obstruction
  
  
• When imaging should be ordered and what findings are suggestive of polyps
  
  
• The role of allergy testing and comorbid conditions like asthma and AERD
  
  
• How biologics have changed the game—and which patients are ideal candidates
  
  
• When surgery is still needed, even in the era of advanced medical therapies
  
  
• The importance of long-term follow-up and multidisciplinary collaboration

Listen now, because when it comes to managing nasal polyps, the right team and the right tools can make all the difference.

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The Allergist is produced for CSACI by PodCraft Productions

"We are all learning and we are all teaching." – Dr. Lori Connors

What makes a great medical educator—and how do you actually become one? On this episode, Dr. Mariam Hanna is joined by Dr. Lori Connors, an allergist, seasoned teacher, and newly appointed Associate Dean of Continuing Professional Development and Medical Education at Dalhousie University. 

They explore the journey to becoming a great medical educator, how competency by design is reshaping training, and how to support the next generation of learners.

Here’s what you’ll learn:

• How Dr. Connors’ path to teaching began with a strong mentor (and a family full of educators)
  
  
• The evolution of medical education: from informal teaching to formal training, portfolios, and competence committees
  
  
• Why observation and feedback—good feedback—are key to coaching for change
  
  
• How residency programs are adapting to incorporate wellness, fatigue risk management, and cultural competence
  
  
• The case for moving beyond shame-based “pimping” toward safer, more effective ways of questioning and challenging learners
  
  
• Strategies to meet different learning styles and generations—plus why podcasts and other media are a growing part of the mix
  
  
• Challenges facing medical educators today, from limited clinic space to a changing educational landscape

Whether you're shaping the next generation or figuring out your own place in it, this episode offers practical insights and a reminder that great educators never stop learning themselves.

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The Allergist is produced for CSACI by PodCraft Productions

“We need time to fix our time problem. And we can get stuck in this loop where we’re like, ‘I have no time to find time to make time to fix time.’”                                                          – Dr. Scott Cameron

Is your schedule running you—or are you running your schedule?

On this episode of The Allergist, Dr. Mariam Hanna is joined by pediatric allergist and clinical immunologist Dr. Scott Cameron to talk about the chaos of clinical practice and how to take back control. With tips that go far beyond time management, Dr. Cameron shares practical strategies for streamlining clinic operations, handling unpredictable days, and investing in smarter workflows—without burning out.

On this episode:

• The hidden culprits of clinic inefficiency—and how intake forms can help fix them
• How to triage patients better, with tips for predicting complex visits
• How to schedule around unpredictability—like anaphylaxis challenges—so they don’t derail your entire day
• The “project day” concept: why setting aside time for workflow projects can save you hours down the line
• Cutting down on admin overload with physician-driven templates, better patient communication, and targeted uses of AI
• How pairing with trainees can preserve teaching time and clinic flow
• Making time-saving tools work for you: from smart goals and macros to QR codes and intake automations

Get practical. Get faster. Get home on time. It’s all about working smarter—not harder.

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The Allergist is produced for CSACI by PodCraft Productions

"The key to the diagnosis of these disorders is the suspicion of these disorders."

— Dr. Luis Murguia Favela

Immune dysregulation isn’t just about infections—autoimmunity, inflammation, and even malignancy can be clues that something deeper is at play. With over 500 known inborn errors of immunity, allergists are increasingly on the front lines of identifying these conditions. But when should we suspect immune dysregulation, and what does cutting-edge treatment look like today?

Dr. Mariam Hanna is joined by Dr. Luis Murguia Favela, pediatric immunologist and founding chair of the Clinical Immunology Network for Canada, to break down the growing world of immune dysregulation and how allergists can spot it.

On this episode:

• What is immune dysregulation? How inborn errors of immunity have expanded far beyond primary immune deficiencies.
• The 11th warning sign: Why early-onset, unusual, or difficult-to-treat autoimmunity, inflammation, or malignancy should raise red flags.
• Not just for kids: Many inborn errors of immunity present in childhood, but 30% of cases emerge in adults—and often go unrecognized.
• Suspicion before sequencing: Why a strong clinical suspicion is more important than access to genetic testing.
• Targeted treatments and the future of immunology: From biologics to gene therapy, where immune dysregulation treatment is headed.

With a growing number of identified inborn errors of immunity, the role of allergists in spotting immune dysregulation has never been more critical. Be suspicious, always.

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The Allergist is produced for CSACI by PodCraft Productions

“Most penicillin allergy labels are not indicative of any meaningful penicillin allergic reaction, and the vast majority can be de-labelled with direct oral challenges of amoxicillin."  — Dr. Kimberly Blumenthal

Penicillin allergy is one of the most commonly reported drug allergies—but here’s the twist: most people who carry this label aren’t actually allergic. So how did we get here, and what can be done to fix it?

On this episode, Dr. Mariam Hanna sits down with Dr. Kimberly Blumenthal, an allergist, immunologist, and clinical researcher at Massachusetts General Hospital, and an associate professor at Harvard Medical School. Dr. Blumenthal is internationally recognized for her work on penicillin allergy and the real-world impact of unnecessary labels on patient care, antibiotic resistance, and health equity.

We cover:

• Why penicillin allergy is so commonly (and incorrectly) diagnosed
• How de-labelling can improve antibiotic stewardship and patient outcomes
• Risk stratification: who needs testing, who can go straight to a challenge, and who should avoid penicillin?
• The role of allergists in leading the charge on de-labelling efforts
• Special populations, including pregnant patients, children with serum sickness-like reactions, and marginalized communities with less access to allergy care
• International practices that complicate the picture—like routine penicillin pre-screening in some countries

With the vast majority of penicillin allergy labels being inaccurate, this episode highlights why it's time to stop assuming and start testing.

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The Allergist is produced for CSACI by PodCraft Productions

"We use thresholds every day without even thinking about it. When we do a food challenge in our office, whether we know it or not, we're relying on the fact that there is a threshold for every patient. Some are going to be on the first dose, some are going to be at the last. And that's just part of what a threshold is." 

– Dr. Doug Mack

Food allergies aren’t one-size-fits-all, but we don’t talk enough about thresholds—the amount of an allergen it actually takes to trigger a reaction. Should every patient be following the same strict avoidance rules? Or should we be aiming for something more precise?

To help us make sense of thresholds, we welcome back Dr. Douglas Mack, pediatric allergist, clinical immunologist, and Vice President of CSACI. Dr. Mack is known for his work on food allergy treatment, including oral immunotherapy, epinephrine use, and—you guessed it—thresholds.

On this episode, Dr. Mack and Dr. Mariam Hanna dig into:

• What a threshold actually is and why it matters in clinical practice – How thresholds shape food challenges, oral immunotherapy, and allergen risk assessments, even when we don’t explicitly discuss them.
• How much allergen is too much? – Why two patients with the same allergy can have vastly different tolerance levels, and why strict avoidance isn’t always the best approach.
• Eliciting dose, cumulative dose, and the numbers that matter most – How clinical trials define reaction thresholds, and how allergists can use these data points to guide patient care.
• Real-world factors that affect thresholds – How co-factors like exercise, illness, sleep deprivation, and even hot showers can shift a patient’s threshold and increase reaction risk.
• Precautionary labels, airplane bans, and the science behind food allergy risk in everyday life – What research tells us about trace exposures, why precautionary labeling varies worldwide, and how allergists can help patients navigate the gray areas of food safety.

Thresholds aren’t just theoretical—they impact how we advise patients, assess risk, and tailor treatments. Dr. Mack walks us through the science behind these numbers and how allergists can apply them in daily practice.

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The Allergist is produced for CSACI by PodCraft Productions

“Don't just rely on the textbook definition of when the pollen seasons are. You need to have reliable data to know when the pollen seasons are starting, when they're ending, and when they're peaking.”  Dawn Jurgens

Allergy season may be winding down, but for allergists, the work never really stops. This is the moment between ragweed and winter — a brief respite before the cycle begins again. On this episode, Dr. Mariam Hanna is joined by Dawn Jurgens, Director of Operations and Quality Management at Aerobiology Research Laboratories. She breaks down the science behind pollen and spore counts, why forecasts matter, and how shifting seasons are changing the game for patients and clinicians alike.

• Timothy grass is the most common and potent trigger globally, while birch remains the most clinically relevant pollen in Canada. Pine releases large amounts of pollen but isn’t highly allergenic.
  
  
• Pollution and thunderstorms can make pollen more potent by breaking it apart and exposing allergenic epitopes, intensifying symptoms.
  
  
• Cross-reactivity stems from conserved epitopes, meaning patients sensitized to one pollen may react to related species — or even certain foods.
  
  
• Mold spores, especially Alternaria, Cladosporium, and Basidiospores, can mimic ragweed season and are major fall culprits.
  
  
• Canada’s pollen seasons are starting earlier than they did 30 years ago, though the fall season hasn’t yet extended.
  
  
• Simple strategies — like showering before bed, keeping windows closed, using filters, brushing pets outside, and checking reliable forecasts — can meaningfully reduce exposure.

Pollen season may be taking a break, but planning for the next wave starts now.

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The Allergist is produced for CSACI by PodCraft Productions

"Although omalizumab is not a cure, it's a major step forward for patients as the first monoclonal antibody or biologic therapy to become FDA-approved to treat food allergy."   — Dr. Brian Vickery

Is omalizumab set to change the food allergy landscape? And how should clinicians use it in practice? On this episode of The Allergist, Dr. Mariam Hanna sits down with Dr. Brian Vickery, professor of pediatrics and chief of the Division of Allergy and Immunology at Emory University, to break down what allergists need to know about this new FDA-approved biologic for food allergies.

• What makes omalizumab a milestone treatment? The first FDA-approved biologic for food allergies, covering multiple allergens and all age groups from one year and up.

• How does it work? A deep dive into its mechanism, from intercepting free IgE to its broader immunological effects.

• The implications of the OUTMATCH trial: What the numbers really say about efficacy across different foods, including why cashew results looked weaker than peanut but might just be an artifact of study design.

• Who should consider it? A practical look at patient selection—where omalizumab might be an ideal option and where OIT or other strategies may still be preferable.

• Where do we go from here? The future of biologics in food allergy treatment, including whether other monoclonals like dupilumab could play a role down the line.

Join us as we unpack the data, the clinical applications, and the questions still left unanswered.

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"I think that asthma’s at a great time right now for some really cool interventions moving ahead that can maybe make big differences in our patients’ lives."
  —Dr. William Anderson

On this episode of The Allergist, Dr. Mariam Hanna is joined by Dr. William Anderson to explore one of the most pressing and evolving questions in asthma care: remission. Together, they unpack the concept of asthma remission, what it truly means for patients and physicians, and how modern therapies are shaping its future.

Dr. Anderson helps break down:

• What remission really means: The key criteria—from absence of symptoms to stable lung function—and the differences between spontaneous remission and remission on treatment.
• The role of biologics: Are these cutting-edge therapies just controlling asthma, or could they be disease-modifying?
• Risk factors for persistent asthma: Why early exacerbations, smoking, and other factors can influence the trajectory of the disease.
• Transitioning from pediatric to adult care: How to ensure adolescents stay on track with self-management during this critical handoff.
• Future directions in asthma care: The exciting possibilities of AI, early interventions, and electronic medication monitoring to improve outcomes.

If you’re curious about the potential for asthma remission or looking for actionable ways to refine your approach to care, this episode is packed with valuable insights. Equip yourself with fresh perspectives and practical tools to help your patients stay on the path to better health.

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“I do think it's important that we understand that not all the foods are the same, and I think anyone who's seen patients in clinics understands this.” – Dr. Edwin Kim

Could sublingual immunotherapy (SLIT) be the peanut allergy solution allergists have been waiting for? In this episode, Dr. Mariam Hanna welcomes Dr. Edwin Kim, Division Chief of Pediatric Allergy and Immunology at the University of North Carolina, to dive into the science, practicality, and potential of SLIT. With a reputation for safety and ease of use, SLIT is gaining traction—but as Dr. Kim emphasizes, the evidence for other foods like milk, egg, and tree nuts remains extremely limited.

On this episode:

• What is SLIT? A low-dose therapy held under the tongue, offering bite-proof protection with minimal side effects like mouth itch, making it a low-risk option for many patients.
• Why choose SLIT? Why some patients prefer SLIT’s simplicity, including fewer restrictions on exercise and observation, compared to oral immunotherapy.
• Why peanuts? SLIT shows strong results for peanuts, but research on expanding to milk, egg, and tree nuts is still in its early stages, with unique challenges for each food.
• Who benefits most? Younger patients who thrive on routine and those seeking protection from accidental exposures without needing to eat large quantities of allergens.
• What lies ahead? Optimizing dosing for different foods, improving outcomes for patients with low thresholds, and expanding access to non-peanut allergens.

Whether you’re curious about incorporating SLIT into clinical practice or exploring its limits, this episode delivers evidence-based insights. Tune in now to see if SLIT is the right fit for your patients!

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This is an encore presentation of our most downloaded episode of 2024.

“Early introduction is the time-proven and research-proven prevention target for every child and every food.” -- Prof. Jonathan Hourihane

Venture into the evolving landscape of food allergy management as Dr. Mariam Hanna welcomes Professor Jonathan Hourihane, a leading figure in pediatric allergy and immunotherapy from the Royal College of Surgeons in Ireland. Together, they explore the latest strategies in dietary advancement therapies and the critical role of early food introduction.

On this episode:

Early Introduction: Professor Hourihane emphasizes the importance of introducing allergenic foods early to prevent long-term allergies. He challenges traditional cautious approaches and highlights the effectiveness of starting reintroductions at home for allergens like milk and egg.

Impact of Parental Anxiety: How parental emotions play a crucial role. Professor Hourihane shares his findings on the negative effects of high parental anxiety on the success of food reintroduction. He underscores the need for allergists to provide support to help parents navigate these challenges confidently.

Advocacy in Allergy Management: Reflecting his passion for patient advocacy, Professor Hourihane advocates for a proactive approach to managing food allergies. He discusses the necessity of empowering both patients and their families to take informed steps toward reintroducing allergenic foods safely and effectively.

Shifting Perspectives: They discuss how these approaches necessitate a shift in how allergists view food allergies—from a condition to be feared to one that can be actively managed through strategic, informed actions.

Join Dr. Hanna and Professor Hourihane for an insightful discussion that promises to reshape your understanding of food allergy management, emphasizing early intervention and patient empowerment. This episode is a must-listen for anyone involved in allergy care, offering essential insights that could transform your clinical approach. 

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“If that medicine is associated with fear of an injection, then we are giving the impression that a diagnosis of food allergy is worse than a life sentence.”
— Dr. Paul Turner

When it comes to managing anaphylaxis, epinephrine is the gold standard. But even with its life-saving potential, misconceptions abound, and newer delivery methods like nasal and sublingual formulations are raising questions for allergists and patients alike. In this episode, Dr. Mariam Hanna sits down with Dr. Paul Turner, pediatric allergist, clinical immunologist, and global expert on anaphylaxis, to explore the science, controversies, and clinical realities surrounding epinephrine use.

On this episode:

• Anaphylaxis demystified: Why the "ABC" symptoms (airway, breathing, circulation) are crucial for timely diagnosis.
• Epinephrine explained: How it works, why timing matters, and when it’s not enough.
• Alternative delivery methods: Intranasal and sublingual epinephrine—why Dr. Turner is skeptical about their use in clinical practice without robust evidence of efficacy.
• When epi fails: Understanding the limitations of autoinjectors in severe reactions and the role of IV infusions.
• Improving patient confidence: Strategies for addressing fears and teaching appropriate use to improve outcomes.

Whether you're an allergist navigating these evolving treatment landscapes or a clinician seeking clear guidance for patient care, this episode provides critical insights and practical advice. Tune in to strengthen your understanding of epinephrine’s role in anaphylaxis management and gain clarity on when—and how—it should be used.

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"Plastic has been found everywhere—lungs, breast milk, liver, spleen, placenta, even blood." – Dr. Magdalena Zemelka-Wiecek

Every week, we’re ingesting the equivalent of a credit card’s worth of plastic—through food, water, and even the air we breathe. In this episode, Dr. Mariam Hanna speaks with Dr. Magdalena Zemelka-Wiecek, associate professor of clinical immunology at Wroclaw Medical University, about the pervasive presence of plastics in our environment and their potential role in influencing human health. For allergists, understanding the links between plastic exposure and emerging health concerns—including its impact on the immune system—is increasingly relevant in patient care.

On this episode:

• Nano and microplastics explained: What they are, how they form, and why they’re turning up in surprising places like tap water and even breast milk.
• Health risks and immune implications: Exploring the connections between plastic exposure and inflammatory disorders, with emerging evidence on gut and liver health.
• Plastics and the microbiome: How microplastics might disrupt the gut microbiome, a key player in immune function.
• One Health perspective: Why reducing plastic use benefits not just individuals but ecosystems, emphasizing a shared responsibility for health.
• Actionable insights: Tips for counseling patients on simple steps to limit exposure while research continues.

Whether you're exploring the intersections of environmental and immune health or seeking guidance for patient discussions, this episode offers evidence-based insights and practical advice tailored to your clinical practice.

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The Allergist is produced for CSACI by PodCraft Productions

“I do not think families typically should be getting rid of pets if they're having symptoms. There are very, very well tolerated medications that we can use. We can use desensitization therapy with immunotherapy, and I think that's the discussion that should revolve around how to manage these.”  — Dr. Shahzad Mustafa

For many, pets are like family, which makes pet allergies a particularly sensitive issue. On this episode, Dr. Mariam Hanna invites Dr. Shahzad Mustafa, Chief of Allergy, Immunology, and Rheumatology at Rochester Regional Health, to explore practical, evidence-based approaches for managing pet allergies in patients who can’t imagine life without Fido or Fluffy. Together, they break down the latest on diagnosis, medical management, and the myths that often cloud pet allergy discussions.

On this episode:

• Pet allergies explained: How exposure, family history, and genetics factor in.
• Hypoallergenic pets: Do they make a difference in reducing allergic reactions?
• Is the pet causing asthma or eczema? Understanding pets as contributors, not causes.
• Environmental controls: what’s the evidence that this actually works and what’s just wishful thinking.
• Effective medical therapies: From nasal corticosteroids to antihistamines and nasal ipratropium.
• Exploring immunotherapy options: Shots, sublingual tablets, and even intralymphatic injections.

Whether it’s dogs, cats, or anything furry in between, this episode offers compassionate, informed guidance for balancing allergy management with the realities of pet ownership. Tune in to get clarity on how to help patients breathe easy—without breaking their bond with their beloved pets.

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“A lot of people are either being diagnosed or self-diagnosing (with MCAS), I would say somewhat inappropriately, without any actual evidence of mast cell activation. We're seeing it more and more commonly.” -- Dr. Tim Olynych

On this episode of The Allergist, Dr. Mariam Hanna teams up with Dr. Timothy Olynych, a clinical immunologist and allergist and PhD in mast cells, to unravel the mystery of mast cell activation syndrome (MCAS). This elusive condition requires some serious detective work, with clues scattered across a complex array of symptoms that don’t always add up. Together, they crack the case on how to spot MCAS in its various disguises and offer a roadmap for managing this puzzling disorder.

On this episode:

• Understanding Mast Cell Activation Syndrome: MCAS is a complex condition characterized by a constellation of symptoms rather than one clear diagnostic feature. Dr. Olynych highlights why it’s often confused with other conditions, making diagnosis a challenge for clinicians.
• The Role of Tryptase Testing: Learn how tryptase testing is crucial in diagnosing MCAS, especially when levels spike during symptom flares, though normal levels don’t always rule out MCAS.
• Common Misconceptions and Comorbidities: Dr. Olynych addresses the frequent confusion between MCAS and conditions like POTS and Ehlers-Danlos syndrome. 
• Treatment Approaches: Dr. Olynych outlines a treatment approach that mirrors how chronic spontaneous urticaria is managed, using H1 and H2 blockers and mast cell stabilizers like cromolyn sodium. 
• Patient Care Beyond the Allergist’s Office: This episode highlights the importance of a multidisciplinary approach to MCAS, including when to refer patients to other specialists. 

Join us as we dig deeper into the enigma of mast cell activation syndrome, uncovering practical clues and actionable insights for healthcare providers eager to crack the case on this complex and often misunderstood condition.

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The Allergist is produced for CSACI by PodCraft Productions

 “Introduce those allergens early, diversify that microbiome, and don't let fear rule you.”  -- Dr. Priya Bansal

On this episode of The Allergist, Dr. Mariam Hanna teams up with Dr. Priya Bansal, a triple board-certified allergist, to tackle the challenges of managing food allergies and the anxiety that often comes with them. Together, they walk through real-world cases that allergists frequently encounter, offering practical strategies to support patients and families.

On this episode:

• Introducing Allergens at Home: Handling parents’ hesitancy to introduce allergens like tree nuts in infants who already have a known allergy. Dr. Bansal offers approaches for building trust and using shared decision-making.
• What’s Not a Food Allergy: Dr. Hanna and Dr. Bansal discuss the common misconceptions around what qualifies as a food allergy and how to communicate with patients who might confuse intolerances or other reactions with true food allergies.
• Self-Carrying Epinephrine in Schools: Practical tips for helping children and teens manage epinephrine autoinjectors at school, including discussing comfort levels, age appropriateness, and new technologies like nasal epinephrine.
• School-Wide Allergy Bans: The pros and cons of school-wide bans on allergens like peanuts, and why such bans may cause more harm than good. Dr. Bansal shares alternative strategies for managing food allergies in schools without increasing social isolation.
• Health-Related Anxiety After a Reaction: Managing patients, especially children, who develop restrictive eating behaviors or heightened anxiety following a food allergy reaction. Discover when to involve mental health professionals and how to address fear in the clinic.

Join us as we explore food allergy management and anxiety, with actionable insights designed to support both healthcare providers and patients navigating the challenges of food allergies.

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“A desensitization is really the assumption that they're allergic. It's not a test, it's not a test dose, it's not a graded challenge. A desensitization is the assumption or the confirmation that they are truly allergic to this drug.” -- Dr. Christine Song

Managing drug allergies can be a delicate balancing act, especially when life-saving medications are involved. On this episode of The Allergist, Dr. Mariam Hanna is joined by Dr. Christine Song, an Assistant Clinical Professor at the University of Toronto and drug allergy lead at St. Michael’s Hospital. Together, they unpack the complexities of drug allergies, from distinguishing them from other adverse drug reactions to navigating the tricky terrain of desensitization.

On this episode:

• Understanding Drug Allergies: What distinguishes a true drug allergy from other adverse reactions, and why some medications are more prone to trigger allergies?
• Common Triggers and Mechanisms: Insights into why penicillins, beta-lactams, and fluoroquinolones frequently cause allergic reactions, and how both immediate and delayed allergic mechanisms play a role.
• Diagnostic Challenges: The importance of a thorough patient history, the role of skin testing, and why timelines and details are critical.
• Shared Decision-Making: How allergists work with patients to prioritize which allergies to test, de-label, or manage, with special considerations for pediatric and adult populations.
• Desensitization Protocols: The art and science of safely reintroducing necessary medications through desensitization, and why this process isn’t one-size-fits-all.
• Pre-Medication Strategies: Why there’s no ‘right’ premedication protocol due to a lack of strong evidence supporting their overall effectiveness.
• Unique Cases and Exceptions: From managing chemotherapy allergies to tuberculosis treatments, when and why allergists might push the boundaries of traditional desensitization protocols.
• Practical Tips for Healthcare Providers: Best practices for referring patients, documenting allergic reactions, and communicating effectively to ensure patients receive the care they need.

Prepare to learn how to navigate the complex world of drug allergies with confidence and care.

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“Vaccine counseling is really a team sport. — Dr. Anne Pham-Huy

Vaccines can stir anxiety for patients and confusion for clinicians, especially when biologics enter the mix. Dr. Mariam Hanna is joined by Dr. Anne Pham-Huy, clinical immunologist at CHEO, member of the Special Immunization Clinic Network, NACI member, and chair of Immunize Canada. Together, they break down the science of vaccine responses and tackle some of the trickiest questions allergists face in daily practice.

On this episode:

• The major types of vaccines — from live attenuated to mRNA — and what sets them apart.
  
  
• Why live vaccines often produce strong, durable protection, but may require caution in certain patients.
  
  
• How adult immunization is still underutilized, with gaps in boosters, pneumococcal, HPV, and influenza coverage.
  
  
• Which “special populations” need tailored vaccine strategies, including patients on immunosuppressants, transplant recipients, and those with chronic disease.
  
  
• Practical guidance on timing vaccines around biologic use and which precautions truly matter.
  
  
• When to check titers and antibody responses — and why it’s only relevant for select patient groups.
  
  
• Strategies for counselling vaccine-hesitant patients with empathy, focusing on disease risk and building trust.
  
  
• What’s next: combination mRNA vaccines and nirsevimab for RSV prevention in infants.

The questions are simple — are they vaccinated, special, or special enough — but the answers matter.

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“Don't give a bad antihistamine masking as a sedative. If a person truly needs help with their sleep, then give them a proper sedative.” -- Dr. Marcus Maurer

As allergy seasons ebb and flow, there’s one drug that maintains its place in household medicine cabinets: Benadryl. On this episode, Dr. Mariam Hanna sits down with Dr. Stuart Carr, Chief Medical Officer at Snö Asthma and Allergy in Abu Dhabi and past president of the CSACI, to tackle the lingering myths and outdated uses of first-generation antihistamines. From their history to their ongoing role in primary care, they uncover the risks of these older drugs, and the clear benefits of second-generation antihistamines.

On this episode:

• The pharmacology of first-generation antihistamines: How do they really work?
• Are first-generation antihistamines still necessary?
• Debunking the myth of Benadryl as a first-line treatment for allergic reactions.
• Undesirable side effects: impaired cognitive function, disrupted sleep, increased risk of dementia, and cardiac risks like ventricular arrhythmias.
• Special considerations for pediatric and elderly populations.
• The future of antihistamine treatments: What’s on the horizon?

Arm yourself with the latest knowledge to “fight the good fight” against first-generation antihistamines. 

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

"History, history, skin test or serum IgE, and then consider doing the other test just to round out your testing until you're sure you've detected everything you need to detect.”  -- Dr. David Golden

As the leaves begin to fall, and the wasps begin to invade every patio lunch, Dr. Mariam Hanna sits down with Dr. David Golden, a leading expert on venom allergies and retired associate professor from Johns Hopkins. Together, they explore the swarm of complexities surrounding venom immunotherapy, from the nuances of diagnosis to emerging treatments on the horizon.

In this episode:

• Understanding venom allergies: The basics and beyond
• Large local reactions vs. systemic reactions: What’s the real risk?
• The role of skin testing vs. serum IgE in diagnosing venom allergies
• Venom immunotherapy: How effective is it, really?
• Emerging trends and treatments in venom allergy management
• Practical advice for managing venom allergies 

Prepare to get the buzz on everything venom-related in this insightful conversation. Tune in now!

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“FPIES is real, both acute and chronic FPIES. It's not a myth, and it can be an allergic emergency.” -- Dr. Nowak-Wegrzyn

Join Dr. Mariam Hanna for a comprehensive discussion on Food Protein-Induced Enterocolitis Syndrome (FPIES) with Dr. Anna Nowak-Wegrzyn, a leading expert in pediatric allergy and immunology at NYU Grossman School of Medicine. Dr. Nowak-Wegrzyn sheds light on this unique and often perplexing condition, offering critical insights for healthcare providers.

On this episode:

Understanding FPIES:

• Dr. Nowak-Wegrzyn explains FPIES, a non-IgE mediated food allergy that manifests differently from traditional food allergies. She details the typical presentation of FPIES, including severe vomiting, lethargy, and pallor, which can occur a few hours after food ingestion.

Difference in Presentation Between Children and Adults:

• Learn about how FPIES presents in different age groups. While it typically begins in infancy, Dr. Nowak-Wegrzyn discusses the mysterious cases where FPIES emerges in adults who have tolerated the triggering food for years.

How FPIES Differs from IgE-Mediated Food Allergies:

• Understand the key differences between FPIES and IgE-mediated food allergies. Dr. Nowak-Wegrzyn outlines why skin and blood tests may be negative in FPIES cases, despite the severity of symptoms.

Prognosis and Counseling Parents:

• Discover the prognosis for children with FPIES, with many outgrowing the condition by age three to five. Dr. Nowak-Wegrzyn emphasizes the importance of educating and empowering parents through careful counseling and shared decision-making.

Management and Treatment:

• Dr. Nowak-Wegrzyn discusses current strategies for managing FPIES, including dietary modifications, careful introduction of new foods, and the potential use of ondansetron for managing symptoms at home. She also addresses the use of epinephrine in atypical FPIES cases with IgE sensitization.

Tune in to this episode for an in-depth exploration of FPIES, offering practical advice and valuable insights for healthcare providers navigating this challenging condition.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“I feel like the term "immunity debt" has become fashionable but has lost all its meaning for me."  -- Dr. Samira Jeimy

Join Dr. Mariam Hanna for a deep dive into secondary immunodeficiencies with Dr. Samira Jeimy, an assistant professor in the Division of Clinical Immunology and Allergy at Western University. Dr. Jeimy shares her extensive knowledge on acquired immunodeficiency, providing valuable insights for healthcare providers.

On this episode:

Understanding Acquired Immunodeficiency:

• Dr. Jeimy explains acquired immunodeficiencies, also known as secondary immunodeficiencies, and how they result from external factors rather than genetic anomalies.

Types and Diagnosis:

• Understand the diagnostic process, including measuring immunoglobulin levels and considering clinical and family history.

Clinical Manifestations and Triggers:

• Learn about the diverse clinical manifestations of acquired immunodeficiency and common triggers, such as infections, chronic diseases like diabetes and renal failure, and medications.
• Dr. Jeimy discusses the controversial and often misunderstood causes of immunodeficiency, including stress and post-COVID conditions.

Management and Treatment:

• Discover current strategies for managing acquired immunodeficiencies, including the use of immunosuppressive treatments and the importance of early diagnosis and intervention.
• Dr. Jeimy emphasizes the need for personalized medicine and collaboration among healthcare providers for effective treatment.

Patient Care and Support:

• Dr. Jeimy underscores the importance of comprehensive care and support for patients with acquired immunodeficiencies.
• She highlights the significance of early involvement of immunologists in the patient journey to optimize treatment outcomes.

Tune in to this episode for an in-depth exploration of acquired immunodeficiency, offering valuable insights and practical advice for healthcare providers.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“HAE is a different disease than it was because of the advancement of treatments…make sure that you're offering the best form of therapy available to patients and their families.”  -- Dr. Stephen Betschel

Join Dr. Mariam Hanna in an enlightening conversation with Dr. Stephen Betschel, an associate professor in the Department of Medicine and Clinical Immunologist and Allergist at St. Michael's Hospital, University Health Network. Dr. Betschel, a global authority on hereditary angioedema (HAE), shares his extensive knowledge on this rare and potentially life-threatening condition.

On this episode:

Understanding Hereditary Angioedema:

Dr. Betschel provides a detailed explanation of HAE, an autosomal dominant condition characterized by C1 inhibitor deficiency. He discusses how this deficiency leads to the overproduction of bradykinin, causing swelling in various parts of the body, including the hands, feet, face, abdomen, and throat.

Types and Diagnosis:

Explore the different types of HAE (type 1, type 2, and hereditary angioedema normal) and the importance of accurate diagnosis. Dr. Betschel explains the diagnostic process, which includes measuring C4 and C1 inhibitor levels and function, and emphasizes the role of clinical and family history in identifying potential cases. Genetic testing can also be useful in certain cases.

Clinical Manifestations and Triggers:

Learn about the varying clinical manifestations of HAE, which can differ significantly even among patients in the same family. Dr. Betschel highlights common triggers for HAE attacks, such as infections, trauma, and spontaneous episodes, emphasizing the importance of understanding these triggers for effective management.

Management and Treatment:

Discover the latest advancements in HAE treatment, including on-demand therapies for acute attacks and long-term prophylaxis options. Dr. Betschel discusses medications such as Icatibant, intravenous and subcutaneous C1 inhibitors, and the promising future of oral treatments and gene therapy.

Patient Care and Support:

Dr. Betschel underscores the importance of providing comprehensive care and support for HAE patients. He advises healthcare providers to engage with patients actively, optimize attack control, and improve quality of life through personalized treatment plans.

Tune in to this episode for an in-depth exploration of hereditary angioedema, offering valuable insights and practical advice for healthcare providers.

Have an idea for the show or a comment, send us a text!

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The Allergist is produced for CSACI by PodCraft Productions

“It's important to recognize that fresh fruits and vegetables can cause local reactions in the mouth and gut. But if they're not causing symptoms of a more severe allergic reaction, don't panic. Chances are good that this is not something that's going to lead to more worrisome features.”  -- Dr. Anne Ellis

Dr. Mariam Hanna sits down with Dr. Anne Ellis, professor of medicine and chair of the Division of Allergy and Immunology at Queen's University, to explore the intricacies of Pollen Food Allergy Syndrome (PFAS), also known as Oral Allergy Syndrome. Dr. Ellis, a leading expert in allergic diseases, guides listeners through the complex landscape of PFAS, offering insights into diagnosis, management, and patient care.

On this episode:

Understanding Pollen Food Allergy Syndrome:

Dr. Ellis provides a comprehensive overview of PFAS, explaining how it affects primarily the mouth and tongue but can impact the entire GI tract. She discusses the common allergens associated with PFAS, such as birch pollen, and the cross-reactivity from fruits like apples and tree nuts.

Diagnosis and Misconceptions:

Explore the diagnostic process for PFAS. Dr. Ellis clarifies the difference between PFAS and other food allergies, emphasizing the role of accurate diagnosis through skin tests and serum-specific IgE testing.

Management Strategies:

Learn about effective management strategies for PFAS. Dr. Ellis shares insights on how to reduce symptoms through avoidance of raw fruits and vegetables and the role of immunotherapy in treating underlying environmental allergies.

Patient Care and Red Flags:

Dr. Ellis highlights key aspects of patient history that may indicate more severe allergic reactions, discussing the importance of distinguishing between local symptoms and systemic IgE-mediated reactions.

Advice for Primary Care Providers:

Gain valuable tips for primary care providers on recognizing and managing PFAS. Dr. Ellis emphasizes the significance of a detailed medical history and the reassurance that most PFAS cases do not require an epinephrine auto-injector.

Tune in to this episode for an in-depth discussion on Pollen Food Allergy Syndrome, offering practical advice and expert insights for both healthcare providers and patients.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“I'm still getting told from families and other physicians that you can't make a diagnosis of asthma until they're six. Why?  Why is this still happening? We can diagnose preschoolers with asthma.”  -- Dr. Tiffany Wong

Join Dr. Mariam Hanna as she sits down with Dr. Tiffany Wong who pushes back on the persistent and unfounded skepticism about whether preschoolers can be diagnosed with asthma. Dr. Wong is an associate clinical professor at the University of British Columbia and the medical lead of the BC Children's Hospital allergy clinic. She covers the intricacies of diagnosing and managing preschool asthma, dispels common myths and emphasizes the importance of accurate diagnosis and effective management in young children.

On this episode:

Diagnosing Preschool Asthma:

Dr. Wong clarifies the myths and realities of diagnosing asthma in preschool children. She emphasizes that a detailed medical history and physical examination can often suffice, debunking the misconception that spirometry is always necessary.

Management Strategies:

Gain insights into effective management strategies for preschool asthma. Dr. Wong discusses the importance of categorizing patients according to their risk of future exacerbations, which helps in tailoring treatment plans for both healthcare providers and families.

Follow-Up Care:

The critical role of regular follow-up in managing preschool asthma is highlighted. Dr. Wong stresses that continuous monitoring allows for better understanding of each patient's evolving clinical narrative and ensures timely adjustments to treatment plans.

Empowering Families:

Learn how to support families dealing with preschool asthma. Dr. Wong provides valuable tips on training families to recognize and report symptoms accurately, ensuring they are equipped to manage their child's condition effectively.

Tune in to this episode for a deep dive into preschool asthma, with practical tips and expert insights for both healthcare providers and caregivers.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“When you fly, the flight attendant is always telling you, put on your oxygen mask first before you help somebody else. And it's so true. We’re way more efficient in a clinic setting when we have taken care of ourselves.”   -- Dr. Maureen Petersen

Dr. Mariam Hanna sits down with Dr. Maureen Petersen, a pediatric allergist and immunologist from North Carolina Chapel Hill to explore the challenges of managing chronic illness from the perspective of both the physician and the parent. Dr. Petersen brings a unique personal connection to this topic, having navigated her daughter's chronic illnesses while pursuing a medical career. 

On this episode:

Navigating Chronic Illness: Dr. Petersen shares her experiences with treating chronically ill children, emphasizing the importance of empathy and understanding in patient-caregiver relationships. She illustrates the unique challenges faced by families and offers strategies to improve communication and support.

Physician's Perspective: Dr. Petersen discusses the impact of chronic illness on physicians, highlighting techniques for maintaining compassion and methods to avoid burnout while delivering high-quality care.

Self-Care for Physicians: Practical advice on how physicians can manage their well-being amidst demanding careers. Dr. Petersen emphasizes the importance of finding joy, setting personal goals, and prioritizing self-care to maintain a balanced and fulfilling medical career.

Empowering Families: Learn how to support families dealing with chronic illness. Dr. Petersen provides valuable tips on encouraging open communication, validating parent’s experiences, and offering necessary resources without overwhelming them, ensuring they feel seen and heard.

Tune in to this episode for an insightful discussion on the intricacies of chronic illness care and the vital role of self-care for physicians, offering practical advice and expert perspectives for healthcare providers and caregivers alike.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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The Allergist is produced for CSACI by PodCraft Productions

“I felt I was actually controlling my condition. It wasn't controlling me.” 

                                                                                                                        -- Patient of Dr. Philippe Begin

Join Dr. Mariam Hanna as she sits down with Dr. Philippe Begin, a renowned expert in allergy and immunology from the University of Montreal. They dive into the complexities of adult food allergies, distinguishing them from childhood allergies and discussing both clinical insights and patient experiences.

On this episode:

Understanding Adult Food Allergies: Dr. Begin explains the unique characteristics of adult food allergies, including the differences in allergens and symptoms between adults and children. He sheds light on the under-researched area of adult food allergy practice.

Diagnosis and History: Learn about the critical elements in diagnosing IgE-mediated food allergies in adults. Dr. Begin emphasizes the importance of timing, symptom duration, and consistency in patient history to accurately identify food allergies.

Management Strategies: Dr. Begin shares his approach to managing adult food allergies, highlighting the importance of recognizing patients' experiential knowledge and their tolerance to risk. He discusses the role of food challenges and the careful use of food diaries.

Psychosocial Aspects: Explore the psychological and social dimensions of living with food allergies as an adult. Dr. Begin talks about the varying reactions to food allergies, from fear to confidence, and how past experiences shape these responses.

Empowering Patients: Discover how empowering patients to manage their food allergies can transform their lives. Dr. Begin's stories of patients taking control of their conditions provide valuable insights for both patients and healthcare providers.

Tune in to this episode for a comprehensive look at the evolving field of adult food allergies, offering practical advice and expert perspectives that are essential for anyone dealing with this condition.

Have an idea for the show or a comment, send us a text!

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The Allergist is produced for CSACI by PodCraft Productions

"Usually when patients have really strong feelings, what they're really trying to tell you is what their priorities are and what they are most afraid of"  -- Dr. Michael Cyr

Join Dr. Mariam Hanna as she welcomes Dr. Michael Cyr, a leader in allergy and clinical immunology, to explore the vital role of shared decision-making in the modern practice.

On this episode:

Understanding Shared Decision-Making: Dr. Cyr breaks down the concept of shared decision-making, emphasizing its importance in integrating patient preferences with evidence-based medicine. He highlights the need for physicians to present all treatment options and their associated risks and benefits clearly.

Recognizing and Overcoming Biases: Dr. Cyr discusses the cognitive biases that affect both patients and physicians. He shares strategies for identifying these biases and ensuring they do not impede the decision-making process.

Effective Communication: Dr. Cyr stresses the importance of taking time to listen to patients. By understanding their priorities and fears, physicians can better guide them through their treatment options. He provides practical advice on framing risks and benefits to help patients make informed choices.

The Art of Medicine: Highlighting the art of medicine, Dr. Cyr shares his approach to balancing strong medical advice with patient autonomy. He uses examples such as oral food challenges to illustrate how different patients may make different decisions based on their unique perspectives.

Building Therapeutic Relationships: Dr. Cyr emphasizes the importance of maintaining a strong therapeutic relationship. He advises physicians to be patient and persistent, acknowledging that not all decisions will be straightforward and may require ongoing dialogue and trust-building.

Join Dr. Hanna and Dr. Cyr for an enlightening discussion on how shared decision-making can enhance patient care and improve outcomes in allergy and immunology. This episode is essential for healthcare professionals seeking to refine a balanced approach to patient-centered care and evidence-based practice.

Have an idea for the show or a comment, send us a text!

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“Atopic dermatitis is not just about what you see on the skin. It's about what the patient's experiencing.” Dr. Melinda Gooderham

Eczema care has become a world of creams, cleansers, oils, and myths — but what actually works? Dr. Mariam Hanna is joined by Dr. Melinda Gooderham, assistant professor at Queen’s University and consultant physician at the Peterborough Regional Health Centre. As principal investigator for more than 250 clinical trials, Dr. Gooderham brings both evidence and practical wisdom to the table.

On this episode, they explore:

• Why barrier repair remains the cornerstone of therapy, and how humectants, emollients, and occlusives play distinct roles
  
  
• The evidence behind natural oils (and why olive oil is out while coconut, sunflower seed oil, and shea butter may have a place)
  
  
• Bathing basics: frequency, water temperature, and whether bleach baths still matter
  
  
• How to choose topical steroid potency and when to pivot toward non-steroidal options
  
  
• The promise of newer agents: calcineurin inhibitors, PDE-4 inhibitors like roflumilast, and topical JAK inhibitors
  
  
• When to escalate to systemic therapy, with itch and quality of life as key markers

Eczema may be complex and misunderstood, but Dr. Gooderham reminds us that consistent barrier care, adequate product use, and asking the right questions about itch can simplify management and improve patient outcomes.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“Early introduction is the time-proven and research-proven prevention target for every child and every food.” -- Prof. Jonathan Hourihane

Venture into the evolving landscape of food allergy management as Dr. Mariam Hanna welcomes Professor Jonathan Hourihane, a leading figure in pediatric allergy and immunotherapy from the Royal College of Surgeons in Ireland. Together, they explore the latest strategies in dietary advancement therapies and the critical role of early food introduction.

On this episode:

Early Introduction: Professor Hourihane emphasizes the importance of introducing allergenic foods early to prevent long-term allergies. He challenges traditional cautious approaches and highlights the effectiveness of starting reintroductions at home for allergens like milk and egg.

Impact of Parental Anxiety: How parental emotions play a crucial role. Professor Hourihane shares his findings on the negative effects of high parental anxiety on the success of food reintroduction. He underscores the need for allergists to provide support to help parents navigate these challenges confidently.

Advocacy in Allergy Management: Reflecting his passion for patient advocacy, Professor Hourihane advocates for a proactive approach to managing food allergies. He discusses the necessity of empowering both patients and their families to take informed steps toward reintroducing allergenic foods safely and effectively.

Shifting Perspectives: They discuss how these approaches necessitate a shift in how allergists view food allergies—from a condition to be feared to one that can be actively managed through strategic, informed actions.

Join Dr. Hanna and Professor Hourihane for an insightful discussion that promises to reshape your understanding of food allergy management, emphasizing early intervention and patient empowerment. This episode is a must-listen for anyone involved in allergy care, offering essential insights that could transform your clinical approach. 

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The Allergist is produced for CSACI by PodCraft Productions

“I guarantee you, within the next five years or within my lifetime, there may be a permanent solution to a lot of medical conditions including (asthma)."  -- Dr. Jason Lee

Asthma remains a formidable foe, particularly when it escalates to its severe form. This episode of "The Allergist," Dr. Mariam Hanna, explores the complexities of severe asthma and the revolutionary impact of biologic therapies.

Dr. Jason Lee, a leading expert in allergy and immunology, sheds light on the evolution of asthma treatment. Gone are the days when inhalers and corticosteroids were our only options. Today, biologics offer a promising frontier, not just to manage but potentially to rewrite the course of the disease. Dr. Lee demystifies these powerful medications, tackling common concerns and highlighting the essential role of patient education in fostering adherence.

Dr. Lee offers several actionable tips for physicians on managing severe asthma with biologics. He advises on the importance of patient education about the mechanisms and benefits of biologics to enhance adherence and reduce anxiety about these new treatments. He emphasizes the need for regular monitoring of lung function and inflammation markers to tailor therapy effectively. And Dr. Lee highlights the use of stepped-care approaches and discusses strategic timing for introducing or discontinuing biologic therapy based on patient response and overall asthma control. 

For allergists and healthcare professionals keen on cutting-edge treatments for severe asthma, this discussion is a treasure trove of practical insights and innovative strategies.

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The Allergist is produced for CSACI by PodCraft Productions

“(Urticaria) is not an allergic condition, it's an autoimmune condition, one. Two, it's not dangerous, but it can last long. Three, we have very good strategies to control it.”                                                                                                                         
                                                                                                                                - Dr. Moshe Ben-shoshan

Hives are probably one of the most misunderstood rashes by the general public. Hives are not life-threatening, but they're debilitating. They're not an allergy, but they're often blamed for being one. They're a marker of autoimmunity with little to do with one particular disease and their course and triggers in one particular person is at best challenging to predict.

Dr. Moshe Ben-shoshan tackles the intriguing world of chronic urticaria; cutting through common misconceptions, and walking us through the latest in diagnostic strategies and management options for hives. From the targeted effectiveness of second-generation antihistamines to the advanced treatment possibilities offered by biologics like omalizumab, and even the role of immunosuppressants such as cyclosporine. Special attention is given to the nuances of chronic urticaria in children versus adults.

Emphasizing the critical role of disease scoring systems, Dr. Ben-shoshan explains how these tools are vital for assessing severity and guiding treatment decisions. The conversation also sheds light on the diagnostic value of blood tests, showcasing the multifaceted approach required to effectively manage hives.

Dr. Ben-shoshan tip-toes into the delicate territory of how to handle the increasing requests for testing and dietary modifications. We also take a quick glimpse into the future of urticaria management including targeted pediatric guidance and new biologics on the horizon. 

This episode offers an indispensable resource for allergists and healthcare professionals seeking to enhance their understanding of chronic urticaria. It’s packed with practical insights and a look towards promising advancements in the field.

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The Allergist is produced for CSACI by PodCraft Productions

“Worst allergy season ever? Might not be an exaggeration for that patient.” 
                                                                                                                                   -- Dr. Adam Byrne

On this episode, Dr. Mariam Hanna is joined by Dr. Adam Byrne, an expert allergist and clinical immunologist, to unravel the complex relationship between climate change and allergic diseases. Dr. Byrne sheds light on how rising global temperatures, increased pollution, and changing ecosystems are not just environmental issues but are directly impacting the prevalence and severity of allergic conditions.

Together, they dissect the science behind why we're seeing an uptick in cases of asthma, allergic rhinitis, and atopic dermatitis. But the conversation doesn't stop at diagnosis and treatment; it also covers practical advice for allergists and patients alike on mitigating the health impacts of climate change. From advocating for cleaner air policies to adjusting daily routines, Dr. Byrne offers actionable strategies to address the evolving landscape of allergies.

This episode is essential listening for anyone in the allergy field, providing a comprehensive overview of the challenges and opportunities that lie ahead in managing allergies in a changing climate. Whether you're a healthcare professional or someone navigating the complexities of living with allergies, Dr. Byrne's insights offer valuable guidance for adapting to our planet's new normal.

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“Food allergy tests are not screening tests…I will pause for dramatic effect…Food allergy tests are not screening tests.” Dr. David Stukus

Dr. Mariam Hanna is joined by Dr. David Stukus, a leading pediatric allergist and clinical immunologist from Nationwide Children's Hospital in Columbus, Ohio. Together, they dive into the critical issues surrounding food allergy diagnostics and the latest advancements in treatment options, including developments in the field of oral immunotherapy (OIT) and the recent FDA approval of Omalizumab for food allergies.

Dr. Stukus debunks common misconceptions about testing and emphasizes the importance of a nuanced approach to interpreting results when diagnosing food allergies He advocates for evidence-based practices and the necessity of individualized treatment plans, highlighting the role of clinicians in guiding patients through the complexities of managing food allergies.

The conversation also explores the future of food allergy treatments, with Dr. Stukus expressing optimism about the potential for more personalized therapies that cater to the unique needs of each patient. He stresses the importance of shared decision-making between clinicians and patients, ensuring that treatment choices are informed, thoughtful, and tailored to achieve the best possible outcomes.

This episode is a must-listen for allergists aiming to keep ahead of the evolving landscape of food allergy management, offering deep insights into the challenges, innovations, and hopes for the future. 

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions

“People think leadership has to be a loud person standing in front of everybody, declaring themselves the leader. Leadership isn't a dictatorship. Leadership is not always that loud person.”  -- Dr. Zainab Abdurrahman

On this episode of "The Allergist," we explore what leadership in medicine actually means with Dr. Zainab Abdurrahman, an accomplished allergist and clinical immunologist. Dr. Abdurrahman, who wears many hats including that of an assistant clinical professor of pediatrics at McMaster University and the incoming president-elect of the Ontario Medical Association, shares her insights on what it means to be a leader in the medical field.

Leadership, as Dr. Abdurrahman explains, is not just about being at the forefront; it's about inspiring and motivating others, guiding teams towards a common goal, and sometimes, leading from behind to allow others to shine. This episode is not just about the theoretical aspects of leadership but also about its practical applications in the challenging landscape of healthcare.

Dr. Abdurrahman's journey is a testament to the diverse forms leadership can take, from being the team lead in mock codes to shaping the future direction of healthcare in Ontario. She discusses the challenges and opportunities that come with being a female leader in medicine, breaking stereotypes, and paving the way for future generations.

So, whether you're an aspiring leader, a medical professional, or someone curious about the intersection of leadership and medicine, this episode offers valuable insights and inspiration. Join Dr. Mariam Hanna and Dr. Zainab Abdurrahman on "The Allergist" as they explore the essence of leadership in medicine and how it shapes the healthcare landscape.

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The Allergist is produced for CSACI by PodCraft Productions

“We don't do any fresh food skin testing because they have not been validated.  And we know, if we put food on skin, we may well get a positive test, but we have no idea how to interpret that. And I think that's really important.” -- Dr. Douglas Mack

On this episode of "The Allergist," we're climbing the food ladder with Dr. Douglas Mack, a pediatric allergy, asthma, and immunology specialist. Dr. Mack brings his expertise to the table, discussing the nuances of milk and egg allergies in children. Are all allergies created equal? Spoiler alert: they're not. We dive into the world of phenotypes, genetic markers, and the big question – can we predict who's going to outgrow their allergies and who's in it for the long haul?

We're not just talking science; we're talking practical, real-world applications. Dr. Mack sheds light on the shift from 'ladders' for non-IgE mediated food allergy to IgE mediated ones. It's a journey through the evolution of allergy treatments.

And for those thinking, "What about the risks?" – we've got you covered. Dr. Mack doesn't shy away from discussing the potential dangers and the importance of understanding patient-specific risks. It's a candid conversation about the realities of treating food allergies, the challenges allergists face, and the hope for future advancements.

So, grab your headphones and join us. Whether you're a seasoned allergist or just starting to climb the allergy ladder, "The Allergist" is here to guide you every step of the way. 

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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The Allergist is produced for CSACI by PodCraft Productions

"Collaboration and communication is how we make change." - Dr. Victoria Cook

Join Dr. Mariam Hanna in a fast paced conversation with Dr. Victoria Cook, a trailblazer in Quality Improvement, as they discuss how QI is not just reshaping patient care but also revitalizing the healthcare workforce by mitigating burnout.

On this episode:

• Unveiling the science and strategy behind Quality Improvement and its profound impact on healthcare systems and patient outcomes.

• Demystifying the Model of Improvement and the Plan-Do-Study-Act (PDSA) cycle, and their instrumental role in driving systematic changes in healthcare.

• Addressing the common challenges in implementing QI and unveiling practical solutions to overcome these hurdles.

• Highlighting the significant role of QI initiatives in reducing physician burnout, fostering a healthier work environment, and ensuring the well-being of healthcare professionals.

• Gaining insightful perspectives on the future of QI in medicine, its growing prominence, and its potential to redefine patient care and healthcare delivery.

Don't miss out on this deep dive into QI because, you are already doing Quality Improvement, you just need to do it well. Listen now!

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The Allergist is produced for CSACI by PodCraft Productions

“We cannot be dogmatic about what we say about epinephrine…we need as a field to stop being so dogmatic and do more studies to understand."   -- Dr. Matthew Greenhawt

Join us on this eye-opening episode, where we explore the latest breakthroughs in allergy and immunology with Dr. Matthew Greenhawt as he walks us through the pivotal articles of 2023 that are redefining the field.

On this episode:

• Review penicillin allergy delabeling and why this is ready to incorporate into your medical practice.
• Understand the evidence for various atopic dermatitis treatment strategies using evidence-based graded recommendations.
• Discover the potential of dupilumab in its two newest indications - eosinophilic esophagitis and COPD. 
• Delve into our latest understanding of epinephrine doses and future directions in research on this fundamental medication.
• Exclusive insights into the EPITOPE trial from the lead author.

This episode is a must-listen for allergists and immunologists looking for a quick literature review and key highlights from 2023. Tune in now for a journey into the heart of the articles that will change the field of allergy!

Links to articles mentioned in the episode:

The Safety of the Direct Drug Provocation Test in Beta-Lactam Hypersensitivity in Children: A Systematic Review and Meta-Analysis - PubMed (nih.gov) 

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations - PubMed (nih.gov)

Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis - PubMed (nih.gov)

Dupilumab for COPD with Type 2 Inflammation Indicated by Eosinophil Counts - PubMed (nih.gov)

Optimal dose of adrenaline auto-injector for children and young people at risk of anaphylaxis: A phase IV randomized controlled crossover study - PubMed (nih.gov)

Phase 3 Trial of Epicutaneous Immunotherapy in Toddlers with Peanut Allergy - PubMed (nih.gov)

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The Allergist is produced for CSACI by PodCraft Productions

Happy New Year! 

We're taking a brief pause and will return with our next regularly scheduled podcast next week. We have some very exciting episodes lined up to kick off the new year. Our next full episode will be on January 9th, focusing on the top articles from 2023 that will change your practice. 

Following that, we'll explore the world of quality improvement and its integration into practice. Also, we'll discuss food ladders and the buzz surrounding them. Stay tuned for these and other great content. 

Wishing you a happy, prosperous, and healthy new year. Thank you for listening. Sincerely, The Allergist.

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“You will think it is mastocytosis much more often than you'll actually diagnose mastocytosis.” — Dr. Matthieu Picard

Mastocytosis is rare, complex, and often confused with other mast cell disorders. To help clinicians cut through the confusion, Dr. Mariam Hanna welcomes Dr. Mathieu Picard, allergist and clinical immunologist, who has built a dedicated practice caring for patients with mast cell diseases. Together, they explore what physicians need to know about diagnosis, monitoring, and management.

On this episode:

• Adults: Around 80% of adults with skin lesions have systemic mastocytosis, and the disease typically persists.
• Children: Pediatric cases are almost always cutaneous and often resolve by puberty.
• When to order a tryptase — and why a normal result doesn’t rule out systemic disease
• The role of KIT D816V mutation testing and why biopsy technique matters
• Key risks to monitor in indolent systemic mastocytosis: anaphylaxis, osteoporosis, and rare progression to advanced disease
• Practical tips for patient care, including venom immunotherapy considerations, osteoporosis screening, and symptom control strategies

Mastocytosis may be rare, but it doesn’t take uncommon skill to spot — just the right tools, a sharp eye, and maybe a tongue depressor scratched five times.

Have an idea for the show or a comment, send us a text!

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The Allergist is produced for CSACI by PodCraft Productions

“Don't be afraid of using these disease modifying therapies. They're safe, they're effective, they will actually let you get away with using less medication.”  -- Dr. Anne Ellis

Venture into the realm of allergic rhinitis as Dr. Mariam Hanna welcomes Dr. Anne Ellis, co-author of the latest Canadian guidelines for this common condition. Together, they unravel the complexities of this disease and explore the latest treatment protocols.

On this episode:

• Defining Allergic Rhinitis: Dr. Ellis sheds light on what allergic rhinitis really is and the driving force behind the new guidelines.
• Testing for Immunotherapy: Serum specific IgE vs. skin prick testing – which is more effective for identifying the right candidates?
• First-Line Defense: The role of second-generation antihistamines and nasal corticosteroids, and why first-generation antihistamines fall short.
• Combining Forces: The effectiveness of combination therapies and the place of leukotriene receptor antagonists in treatment.
• Immunotherapy in Focus: Why it's time to consider immunotherapy earlier, including sublingual and subcutaneous options.
• Customized Care: Tailoring treatment to individual allergen profiles and addressing the rare but notable side effect of eosinophilic esophagitis.
• Empowering Patients: Urging those with allergic rhinitis to seek proactive treatment and consider the long-term benefits of immunotherapy.

Dive deep into the world of allergic rhinitis and emerge with a wealth of knowledge that could change your approach to treatment. Don't miss out on these critical insights. Listen now!

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The Allergist is produced for CSACI by PodCraft Productions

“The allergist has many important roles in the management of EoE patients in the multidisciplinary EoE team.” - Dr. Edmond Chan

Join Dr. Mariam Hanna in an enlightening conversation with Dr. Edmond Chan, a leading voice in eosinophilic esophagitis (EoE). Dive into the ever-evolving landscape of this intriguing condition and explore the latest in medical management.

On this episode:

• Understanding EoE: Redefining a Decade of Change.

• The Allergist's Role: Navigating Patient Management and Dietary Choices.

• Steroids and Biologics: Breaking Down Treatment Options.

• The Art of Shared Decision-Making in EoE Treatment.

• Future Frontiers: The Imperative for Ongoing EoE Research.

• Food Elimination Risks and Oral Food Challenges: What Patients Need to Know.

Physicians, empower yourselves with this comprehensive guide to EoE, and join us in fostering informed decisions in healthcare. Tune into this essential episode now!

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The Allergist is produced for CSACI by PodCraft Productions

“A patient does not need to avoid penicillin if a family member is allergic to penicillin.” Dr. Ana-Maria Copaescu

Join Dr. Mariam Hanna along with expert allergy and immunology specialist Dr. Ana-Maria Copaescu on this episode of The Allergist, as they unravel the intricacies of penicillin allergy, a commonly misunderstood health concern.

On this episode:

• The PALACE Study Breakthrough: How direct oral penicillin challenge is reshaping allergy testing.
• Understanding the PEN-FAST Score: A crucial tool in evaluating the likelihood of penicillin allergy.
• Symptoms and Safety: Understanding the common symptoms of penicillin allergy and associated risks.
• A Closer Look at Fatalities: Debunking fears and highlighting the rarity of severe reactions.
• Safety in Pregnancy: Exploring the findings on the safety of direct oral penicillin challenge in pregnant patients.
• Rethinking Drug Allergy Labels: Dr. Copaescu's perspective on why these labels are not life sentences.
• The Path Forward: The importance of clinical evaluations by an allergy immunologist.

Prepare to have your assumptions challenged and your understanding deepened. This enlightening discussion sheds light on a topic that affects many, yet is often misinterpreted. Tune in now to discover the truths about penicillin allergy with Dr. Hanna and Dr. Copaescu!

Have an idea for the show or a comment, send us a text!

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The Allergist is produced for CSACI by PodCraft Productions

"I just would like to take this moment to be a bit smug about how the immune system is really the issue in many, many disorders, although it is not acknowledged as such. It's really all about the immune system." - Dr. Rae Brager

Join Dr. Mariam Hanna as she delves into the intricate world of immunodeficiency with pediatric immunologist and allergist, Dr. Rae Brager. In a conversation that illuminates the often-overlooked complexities of the immune system, they shed light on the multifaceted nature of immunodeficiencies, from battling infections to immune dysregulation.

On this episode:

• Decoding the spectrum of immunodeficiency: More than just an inability to fight infections.
• The conundrum of diagnosing immunodeficiency in children as many common childhood illnesses are not indicative of a deficiency.
• The critical role of context and clinical acumen in the evaluation of immunodeficiencies.
• Celebrating the leaps in immunology: Newborn screening, gene therapy, and the revolutionary CAR T-cell therapy.
• Busting myths around cord blood banking: Understanding the real need and advocating for cord blood donation.
• Three pivotal takeaways: The complexity and mystery of the immune system, the rarity of true immunodeficiency in common concerns, and the adaptive prowess of our bodily defenses.

Prepare to be enlightened on the marvels and misconceptions of the immune system. Tune in for a masterclass on immunodeficiency with Dr. Hanna and Dr. Brager. Listen now for a dose of wisdom on the body's misunderstood protector!

Have an idea for the show or a comment, send us a text!

Visit the Canadian Society of Allergy and Clinical Immunology

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions