The Allergist

“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.

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 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.

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

“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.

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 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.

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

"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.

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 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.

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 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!

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

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. 

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 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.

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

"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.

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