Anaphylaxis doesn’t always look like hives and swelling. In up to 20% of cases, the skin is completely clear, making the diagnosis easy to miss. On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash speaks with Dr. Payel Gupta, allergist and immunologist at Mount Sinai in New York City, about how to recognize and manage anaphylaxis.

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Timestamps

00:00 - Introduction
02:02 - Defining Anaphylaxis and Key Signs
04:09 - Anaphylaxis Versus Shock
05:54 - Diagnostic Pitfalls
12:43 - Epi First Epi Fast
32:33 - ER Or Observe
42:31 - Allergy Testing Limits
47:16 - New Anaphylaxis Therapies
51:34 - Public Awareness and Advocacy
01:02:55 - Final Pearls and Wrap up

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More about this episode

Dr. Gupta and Dr. Kahwash first define anaphylaxis and review common diagnostic pitfalls, including absent skin findings, overlap with asthma, atypical presentations, delayed reactions, and the effects of beta-blockers. Dr. Gupta emphasizes the importance of early treatment with intramuscular epinephrine. Antihistamines and steroids are discussed as adjunctive therapies and the episode reviews the risk and management of biphasic reactions. The conversation also covers optimal timing for tryptase testing, post-reaction counseling, evolving guidance on emergency department referral, and appropriate timing for allergy testing after a reaction. Dr. Gupta discusses emerging options such as intranasal epinephrine and the use of omalizumab to increase reaction thresholds in food allergy. The episode concludes with a discussion of public misconceptions around the term “allergy,” barriers to appropriate care, and Dr. Gupta’s advocacy and educational work.

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Resources

Dr. Payel Gupta
https://www.zocdoc.com/doctor/payel-gupta-md-facaai-571583