In this episode, we explore the growing role of biomarkers in asthma and allergic diseases and why they are becoming essential in modern diagnosis, phenotyping, monitoring, and personalised treatment. We discuss key asthma biomarkers and allergy biomarkers, including blood eosinophils, FeNO (fractional exhaled nitric oxide), total and specific IgE, and their relevance in identifying type 2 inflammation, allergic asthma, severe asthma, and other allergic conditions.

This episode looks at how biomarkers in asthma can help support accurate diagnosis, guide targeted biologic therapy, improve asthma management, and advance precision medicine in allergy and respiratory care. We also consider the wider application of biomarkers in allergic rhinitis, eczema, food allergy, and eosinophilic disease, highlighting their importance in shaping more individualised and effective treatment strategies.

Whether you are a paediatrician, allergist, respiratory clinician, trainee, healthcare professional, researcher, or someone interested in the latest advances in asthma care and allergic disease management, this episode provides a practical and accessible overview of how biomarkers are transforming clinical decision-making in asthma and allergy medicine.

Sources:

1. Agrawal, N. and Kraft, M. (2025) 'Novel biomarkers in asthma', Current Opinion in Pulmonary Medicine, 31(3), pp. 243-250.
2. Alving, K., Diamant, Z., Lucas, S., Magnussen, H., Pavord, I.D., Piacentini, G., Price, D., Roche, N., Sastre, J., Thomas, M., Usmani, O. and Bjermer, L. (2019) 'Point‐of‐care biomarkers in asthma management: Time to move forward', Allergy, DOI: 10.1111/all.14045.
3. Custovic, A., Siddiqui, S. and Saglani, S. (2022) 'Considering biomarkers in asthma disease severity', Journal of Allergy and Clinical Immunology, 149, pp. 480-487.
4. Karaulov, A.V., Garib, V., Garib, F. and Valenta, R. (2018) 'Protein Biomarkers in Asthma', International Archives of Allergy and Immunology, 175(4), pp. 189-208.
5. Leru, P.M. (2021) 'Biomarkers in Asthma - Interpretation, and Utility in Current Asthma Management', Current Respiratory Medicine Reviews, 17(2), pp. 62-68.
6. Shamji, M.H. and Boyle, R.J. (2021) 'Biomarkers in asthma and allergic diseases', Clinical and Experimental Allergy, DOI: 10.1111/cea.13988.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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How does cigarette smoke affect asthma? In this episode, we discuss the relationship between asthma and cigarette smoke exposure, including secondhand smoke, passive smoking, and the impact of tobacco smoke on airway inflammation, wheeze, cough, breathlessness, asthma attacks, and long-term asthma control. Learn why smoke exposure is a major asthma trigger, how it affects children and adults, and what families and healthcare professionals can do to minimise exposure and protect lung health. A clear, practical episode for anyone interested in asthma prevention, asthma triggers, respiratory health, and smoke-free living.

Sources:

1. Bråbäck, L., Lodge, C.J., Lowe, A.J., Dharmage, S.C., Olsson, D. and Forsberg, B. (2018) 'Childhood asthma and smoking exposures before conception—A three-generational cohort study', Pediatric Allergy and Immunology, 29, pp. 361–368. Available at: https://doi.org/10.1111/pai.12883.
2. Kamga, A., Rochefort-Morel, C., Le Guen, Y., Ouksel, H., Pipet, A. and Leroyer, C. (2022) 'Asthma and smoking: A review', Respiratory Medicine and Research, 82, p. 100916. Available at: https://doi.org/10.1016/j.resmer.2022.100916.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Asthma care is changing. In this episode, we explore the concept of treatable traits in asthma and why a personalised, precision-medicine approach is transforming the way we assess and manage patients. Rather than viewing asthma as a single disease, the treatable traits model helps clinicians identify specific biological, clinical, and behavioural factors that drive symptoms, poor control, and exacerbations.

We discuss how traits such as eosinophilic inflammation, poor inhaler technique, allergen exposure, obesity, smoking, dysfunctional breathing, anxiety and comorbid rhinitis can all influence asthma outcomes—and how targeting these individually can lead to better control, fewer attacks and improved quality of life.

Whether you are a healthcare professional, trainee, or simply interested in modern respiratory medicine, this episode offers a practical overview of how asthma care is moving beyond labels toward truly personalised management.

Tune in to discover why identifying and addressing treatable traits may be one of the most important advances in asthma care today.

Sources:

• Gibson, P.G. and McDonald, V.M. (2024) 'Integrating hot topics and implementation of treatable traits in asthma', European Respiratory Journal, 64, 2400861. Available at: https://doi.org/10.1183/13993003.00861-2024.
• Melhorn, J., Howell, I. and Pavord, I.D. (2022) 'Should we apply a treatable traits approach to asthma care?', Annals of Allergy, Asthma & Immunology, 128, pp. 390–397.
• Shi, H. and Huang, K. (2025) 'Asthma treatable traits: How far do we have to go?', Chinese Medical Journal, 138(7), pp. 757–762. Available at: https://doi.org/10.1097/CM9.0000000000003507.
• Tay, T.R. and Hew, M. (2018) 'Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation', Allergy, 73, pp. 1369–1382. Available at: https://doi.org/10.1111/all.13370.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Frey’s syndrome can look exactly like a food allergy: facial flushing, warmth, sweating (sometimes even a “rash-like” redness) that appears within minutes of eating. Parents panic, clinicians worry about IgE-mediated reactions, and children can end up labelled with a food allergy they don’t actually have.

In this episode, we unpack Frey’s syndrome (gustatory sweating)—why it happens, who gets it (including infants and children), and the classic pattern: unilateral or patchy facial redness/sweating triggered by eating, with no systemic symptoms like wheeze, vomiting, hypotension, or widespread urticaria. We’ll contrast it with true food allergy and anaphylaxis, highlight the history clues that make the diagnosis, and talk through practical management—reassurance, avoiding unnecessary dietary restriction, and when (rarely) referral or treatment is needed.

If you’ve ever seen a child “react” to strawberries, citrus, or spicy foods with facial redness but otherwise looks completely well—this one’s for you.

Sources:

1. Blanc, S., Bourrier, T., Boralevi, F., Sabouraud-Leclerc, D., Pham-Thi, N., Couderc, L., Deschildre, A., Dutau, G., Albertini, M., Tran, A. and Giovannini-Chami, L. (2016) 'Frey Syndrome', J Pediatr, 174, pp. 211-217.
2. Smith, A. and Jonas, N. (2020) 'Frey’s Syndrome', N Engl J Med, 382(15), p. 1456.
3. Tillman, B. N., Lesperance, M. M. and Brinkmeier, J. V. (2015) 'Infantile Frey’s syndrome', International Journal of Pediatric Otorhinolaryngology, 79, pp. 929-931.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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In this episode, we unpack The Foetal Origins of Allergy and the idea that the foundations of allergic disease may be laid before birth. Using the lens of early nutritional programming (often discussed within the DOHaD – Developmental Origins of Health and Disease framework), we explore how the in-utero environment can influence immune development, tolerance, and later risk of conditions like eczema, food allergy, allergic rhinitis, and asthma.

We’ll break down what the science actually suggests about key influences such as maternal diet quality, vitamin D and fatty acids, metabolic health and inflammation, microbiome signals, and the wider exposome (stress, pollution, and lifestyle factors). Most importantly, we’ll translate this into practical, evidence-informed takeaways: what clinicians should consider in antenatal counselling, what parents can focus on without anxiety, and where the research is still evolving.

If you’ve ever wondered whether allergy risk can be “programmed” early—and what that means for prevention—this episode is for you.

Sources:

• Jenmalm, M.C. and Duchén, K. (2013) 'Timing of allergy-preventive and immunomodulatory dietary interventions – are prenatal, perinatal or postnatal strategies optimal?', Clinical & Experimental Allergy, 43, pp. 273–278.
• Goldring, S.T., Griffiths, C.J., Martineau, A.R., Robinson, S., Yu, C., Poulton, S., Kirkby, J.C., Stocks, J., Hooper, R., Shaheen, S.O., Warner, J.O. and Boyle, R.J. (2013) 'Prenatal Vitamin D Supplementation and Child Respiratory Health: A Randomised Controlled Trial', PLoS ONE, 8(6), p. e66627.
• Warner, J.O. and Warner, J.A. (2022) 'The Foetal Origins of Allergy and Potential Nutritional Interventions to Prevent Disease', Nutrients, 14(8), p. 1590.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Brought to you by - Goodlife Creations (2026).

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Ever had a patient (or child) react to fish even when it’s been properly cooked—and the story just doesn’t fit a classic “fish allergy”? This episode dives into Anisakis: the tiny parasitic worm found in marine fish and squid that can trigger allergic reactions ranging from hives and swelling to anaphylaxis—sometimes even without active infection.

We break down:

• What Anisakis is and which fish are most commonly implicated
• How reactions can mimic (or coexist with) true fish/seafood allergy
• Typical symptoms: urticaria, angioedema, wheeze, GI pain, and severe reactions
• The key clinical clues in the history (including reactions after “fresh” or home-prepared fish)
• How testing works (including the role and limitations of specific IgE)
• Practical prevention and safety advice: freezing, cooking, sourcing, and when to avoid fish
• What to tell families—and when to prescribe an adrenaline auto-injector

Whether you’re a clinician, a parent navigating seafood reactions, or simply curious about hidden causes of “fish allergy,” this episode will help you recognise Anisakis-triggered reactions and manage them confidently.

Sources:

1. AAITO-IFIACI Anisakis Consortium (2011) 'Anisakis hypersensitivity in Italy: prevalence and clinical features: a multicenter study', Allergy, 66, pp. 1563–1569. Available at: https://doi.org/10.1111/j.1398-9995.2011.02691.x.
2. Nieuwenhuizen, N.E. and Lopata, A.L. (2014) 'Allergic Reactions to Anisakis Found in Fish', Current Allergy and Asthma Reports, 14(455). Available at: https://doi.org/10.1007/s11882-014-0455-3.
3. Rama, T.A. and Silva, D. (2022) 'Anisakis Allergy: Raising Awareness', Acta Médica Portuguesa, 35(7-8), pp. 578–583. Available at: https://doi.org/10.20344/amp.15908.
4. Uña-Gorospe, M., Herrera-Mozo, I., Canals, M.L., Martí-Amengual, G. and Sanz-Gallen, P. (2018) 'Occupational disease due to Anisakis simplex in fish handlers', International Maritime Health, 69(4), pp. 264–269. Available at: https://doi.org/10.5603/IMH.2018.0042.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Ever seen someone develop flushing, hives, a pounding headache, or even wheeze soon after eating fish—and everyone assumes it’s a “fish allergy”? In this episode, we unpack Histamine (Scombroid) Fish Poisoning, a common and often mislabelled cause of allergy-like reactions after eating fish such as tuna, mackerel, mahi-mahi, sardines, anchovies, and bonito.

You’ll learn why it happens (histamine build-up from improper chilling/handling), how fast symptoms start, and the key clinical clues that help you tell scombroid vs true IgE-mediated fish allergy. We cover typical features like flushing, urticaria, burning/peppery taste, nausea/diarrhoea, palpitations, dizziness, and when to worry about more severe symptoms. We’ll also walk through first-aid at home, when to seek urgent care, and the evidence-based treatment—including why antihistamines usually help quickly and why adrenaline isn’t always necessary (but may be used if there’s genuine anaphylaxis or uncertainty).

Finally, we zoom out to prevention: what safe storage looks like, what to do with leftovers, why multiple people getting ill after the same meal is a big clue, and how to avoid unnecessary lifelong “fish allergy” labels.

Perfect for parents, clinicians, and anyone who loves fish and wants the facts—fast, practical, and myth-busting.

Source:

Feng, C., Teuber, S. and Gershwin, M.E. (2016) ‘Histamine (Scombroid) Fish Poisoning: a Comprehensive Review’, Clinical Reviews in Allergy & Immunology, 50, pp. 64–69. doi:10.1007/s12016-015-8467-x.  

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Shellfish allergy can feel scary—especially when reactions can be sudden and severe. In this episode, we break down shellfish allergy in a clear, practical way: common symptoms (from hives to breathing problems), when to suspect anaphylaxis, and what to do in the moment. We also cover diagnosis and testing (skin prick tests, blood IgE, and when an oral food challenge might be considered), plus the tricky stuff like cross-contact in restaurants, takeaway risks, and food labels.

Whether you’re a parent, teenager, or clinician, you’ll leave with a confident plan—how to avoid shellfish safely, when to carry and use an adrenaline auto-injector, and how to manage school, travel, and eating out without living in fear.

Sources:

1. Gerez, I.F.A., Llanora, G., Yap, G.C., Cheng, Y.K., Thong, B.Y., Tang, C.Y., Van Bever, H.P.S., Shek, L.P.C., Curotto de Lafaille, M.A. and Lee, B.W. (2012) ‘Clinical Characteristics of Prawn Allergy in an Asian Population’,Journal of Allergy and Clinical Immunology [Abstract 643], February.
2. Giovannini, M., Beken, B., Buyuktiryaki, B., Barni, S., Liccioli, G., Sarti, L., Lodi, L., Pontone, M., Bartha, I., Mori, F., Sackesen, C., du Toit, G., Lopata, A.L. and Muraro, A. (2023) ‘IgE-Mediated Shellfish Allergy in Children’, Nutrients, 15(12), p. 2714. doi: 10.3390/nu15122714.
3. Khora, S.S. (2016) ‘Seafood-Associated Shellfish Allergy: A Comprehensive Review’, Immunological Investigations, 45(6), pp. 504–530. doi: 10.1080/08820139.2016.1180301.
4. Lopata, A.L., Kleine-Tebbe, J. and Kamath, S.D. (2016) ‘Allergens and molecular diagnostics of shellfish allergy’, Allergo Journal International, 25, pp. 210–218. doi: 10.1007/s40629-016-0124-2.
5. Lopata, A.L. and Lehrer, S.B. (2009) ‘New insights into seafood allergy’, Current Opinion in Allergy and Clinical Immunology, 9, pp. 270–277.
6. Nguyen, N.N.Q., Nguyen, T.H., Le, M.K., Duong, T.B., Pham, D.L., Tran, T.T. and Trinh, T.H.K. (2025) ‘Integrated Diagnostic Approach Using Basophil Activation Test and IgE Assays for Shrimp and Prawn Allergy’, Medicina, 61, p. 1040. doi: 10.3390/medicina61061040.
7. Shi, J., Ren, F., Zhang, X., Yuan, X., Zhong, Q. and Zhang, J. (2025) ‘A comprehensive review on biological properties of fish and shellfish allergens’, European Food Research and Technology, 251, pp. 3417–3444. doi: 10.1007/s00217-025-04848-1.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Music by - Denys Kyshchuk from Pixabay.

In this episode, we explore a fascinating question in early-life allergy prevention: could colostrum act as a protective factor against peanut allergy? Using evidence from a birth cohort study, we break down what the research actually found, how strong the association is, and what it might mean for parents and clinicians.

We’ll cover:

• What colostrum is and why it matters for immune development
• How a birth cohort study is designed (and what it can and can’t prove)
• Possible biological mechanisms: immune tolerance, gut barrier function, and early microbial influences
• Key limitations and confounders (because correlation ≠ causation)
• Practical takeaways for infant feeding conversations and allergy-risk counselling

Whether you’re a parent navigating feeding decisions or a clinician trying to stay up to date with prevention science, this episode gives you a clear, balanced, evidence-based overview—without the hype.

Source:

• Bhasin, M., Cooper, M., Macchiaverni, P., Joys, R.S., O'Sullivan, T.A., Keelan, J.A., Venter, C., Palmer, D.J., Lowe, A.J., Prescott, S.L., Silva, D. and Verhasselt, V. (2025) ‘Colostrum as a Protective Factor Against Peanut Allergy: Evidence From a Birth Cohort’, Allergy. doi: 10.1111/all.70043.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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Coeliac disease isn’t always a “gut problem.” In this episode of Hope & Histamine: The Paediatric Allergy Podcast, we unpack the extraintestinal manifestations of coeliac disease—the symptoms that show up beyond the digestive tract and can be easy to miss.

We explore the most common non-GI presentations, including iron-deficiency anaemia, fatigue, poor growth or delayed puberty, mouth ulcers, dental enamel defects, bone pain/low bone density, headaches, low mood/brain fog, and the classic skin condition dermatitis herpetiformis. You’ll learn why these symptoms happen, which red flags should prompt testing, and the practical steps to diagnose coeliac disease (including the role of coeliac serology and when to consider referral).

Whether you’re a parent, patient, or clinician, this episode will help you recognise coeliac disease when the gut symptoms are mild—or not there at all—and understand how a strict gluten-free diet can improve whole-body health.

Sources:

1. Durazzo, M., Ferro, A., Brascugli, I., Mattivi, S., Fagoonee, S. and Pellicano, R., 2022. Extra-Intestinal Manifestations of Celiac Disease: What Should We Know in 2022?. Journal of Clinical Medicine, 11, p.258.
2. Jericho, H., Sansotta, N. and Guandalini, S., 2017. Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet. Journal of Pediatric Gastroenterology and Nutrition, 65(1), pp.75–79.
3. Nardecchia, S., Auricchio, R., Discepolo, V. and Troncone, R., 2019. Extra-Intestinal Manifestations of Coeliac Disease in Children: Clinical Features and Mechanisms. Frontiers in Pediatrics, 7, p.56.
4. Salarian, L., Khavaran, M., Dehghani, S.M., Mashhadiagha, A., Moosavi, S.A. and Rezaeianzadeh, S., 2023. Extra-intestinal manifestations of Celiac disease in children: their prevalence and association with human leukocyte antigens and pathological and laboratory evaluations. BMC Pediatrics, 23(1), p.8.

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Disclaimer: The information shared in this podcast and on this website is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions you may have about a medical condition. Please don't ignore or delay seeking medical advice based on content from this podcast or website.

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