The Allergist

“At least 60% don't respond to anything or who have been to somebody else before and they've come to me and they've tried everything and failed” — Dr. Imran Satia

Dr. Imran Satia, Respirologist and Associate Professor at McMaster University and Canada Research Chair in Chronic Cough, joins Dr. Mariam Hanna to walk clinicians through a practical, evidence-based approach to diagnosing and managing chronic cough. With decades of research and clinical experience, Dr. Satia explains how to define chronic cough and its subtypes, recognize red flags, and navigate the common — and less common — causes that keep patients coughing for years.

On this episode, you’ll hear:

• The difference between chronic cough, refractory chronic cough, and unexplained chronic cough — and why the terminology matters for treatment.
  
  
• The key investigations every patient with chronic cough should have, and how to interpret results in the context of cough hypersensitivity.
  
  
• The role and real-world value of methacholine challenge, FeNO, induced sputum, and sputum culture in refining diagnosis and guiding therapy.
  
  
• Why empiric ICS–LABA and PPI trials aren’t always the right move — and when they are.
  
  
• Management strategies for patients who don’t respond to initial treatment, starting with a low-dose morphine trial, followed by neuromodulators, speech therapy, and clinical trial options.

By the end of the episode, you’ll have a clear, step-by-step framework for assessing chronic cough, avoiding unnecessary treatments, and helping even the most refractory patients find relief.

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

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

“Putting yourself out there online as a doctor is not easy. But staying silent while misinformation spreads—that felt worse.” —Dr. Amiirah Aujnarain

Dr. Amiirah Aujnarain has built a community of 80,000 followers by blending evidence-based allergy education with a candid, human presence online. On this episode of The Allergist, she joins Dr. Mariam Hanna to examine how social media is shaping allergy conversations—sometimes for better, sometimes for worse.

From Benadryl challenges to dupilumab searches on TikTok, patients are turning to social media for answers long before they see a specialist. Dr. Aujnarain shares how she’s meeting them where they are, and why she sees it as both a responsibility and a creative outlet.

This episode covers:

• How allergy misinformation spreads on social media—and what physicians can do about it
  
  
• Why patients are using TikTok like Google, and how that’s changing referral patterns
  
  
• What physicians should consider before joining social media, including boundary-setting, time commitment, and emotional labour
  
  
• The upside of being a visible, human face of allergy care—and the backlash that can come with it

Whether you’re thinking about launching your own account or simply wondering how your patients are being influenced online, this conversation is an honest look at the power and pitfalls of digital engagement.

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

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

“I can’t think of any medical condition where you can have this type of fry but not that type of fry.” —Dr. Vish Avanashi

Pediatric gastroenterologist Dr. Vish Avinashi joins Dr. Mariam Hanna for an episode that jumps head first into the overlapping world of allergy and GI. From ARFID to EOE, they talk about the murky middle ground where food fears, immune triggers, and gut symptoms collide—and how allergists can better navigate it all with the help of a friendly gastroenterologist.

• How to recognize ARFID and why history, not testing, is your best diagnostic tool
• Common pitfalls in celiac diagnosis—and why a positive TTG doesn’t always mean celiac
• New, and surprising treatments for IBS, including nerve stimulation and gut-directed hypnotherapy
• What the microbiome research does—and doesn’t—tell us
• Understanding fibrosis in EOE and when to skip dietary elimination

When it comes to navigating the overlap between allergy and GI, remember: always learning, always listening, always befriending a gastroenterologist.

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

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

“They may worsen, they may improve, or they might not change at all, and it really is patient-dependent.” —Dr. Lana Rosenfield

On this episode of The Allergist, Dr. Mariam Hanna welcomes Dr. Lana Rosenfield to unpack the complexities of managing allergic conditions during pregnancy and postpartum. With hormones shifting, the immune system recalibrating, and anxiety about medication safety running high, allergic disease can be especially tricky to manage during this time. Dr. Rosenfield offers practical insights for clinicians supporting pregnant patients with conditions like asthma, rhinitis, chronic urticaria, and food allergy, while navigating a landscape of limited data and heightened patient concerns.

On this episode:

• How the maternal immune system changes during pregnancy—and why it may exacerbate allergic conditions
  
  
• Safe options for managing allergic rhinitis, including which medications to avoid
  
  
• Asthma in pregnancy: monitoring frequency, preferred inhalers, and why under-treatment is riskier than treatment
  
  
• Atopic dermatitis: mimics to watch for, which topicals are safe, and what we know (or don’t) about dupilumab
  
  
• Managing chronic urticaria with second-generation antihistamines and omalizumab
  
  
• Food allergy and anaphylaxis: fetal risks, symptom variations, and why epinephrine remains essential
  
  
• What to do with patients already on immunotherapy, and why it should never be initiated during pregnancy
  
  
• Biologics and breastfeeding: limited evidence, but emerging reassurance
  
  
• Preconception counselling and postpartum care: optimizing control while minimizing risk
  
  

Dr. Rosenfield emphasizes shared decision-making, lowest effective dosing, and the clinical resources she trusts when evidence is limited. It’s a thoughtful and clinically grounded conversation to support allergists managing allergic conditions through pregnancy and beyond.

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

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

“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.

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

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

“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.

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

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

“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.

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

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

“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.

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

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

 "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.

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

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

"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.

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

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