“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.

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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