The Allergist

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“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.

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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

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

The Allergist is produced for CSACI by PodCraft Productions

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 “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.

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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

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“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.

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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

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“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. 

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

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"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!

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

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“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.

Visit the Canadian Society of Allergy and Clinical Immunology

Find an allergist using our helpful tool

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

The Allergist is produced for CSACI by PodCraft Productions

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“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.

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

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“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.

Visit the Canadian Society of Allergy and Clinical Immunology

Find an allergist using our helpful tool

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

The Allergist is produced for CSACI by PodCraft Productions

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“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.

Visit the Canadian Society of Allergy and Clinical Immunology

Find an allergist using our helpful tool

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

The Allergist is produced for CSACI by PodCraft Productions