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“There is nothing magical that happens in your gut that says, ‘oh, now you’re ready for cow’s milk.’ — Dr. Farah Khan Milk has a special talent for creating chaos in clinic. One day it’s mucousy stools and a terrifying diaper photo, the next it’s hives after yogurt, delayed vomiting with lethargy, or a family that’s been dairy-free for years with no improvement in eczema. On this episode, Dr. Mariam Hanna is joined by pediatric allergist and clinical immunologist Dr. Farah Khan to walk through the many ways “milk problems” show up — and how allergists can avoid overdiagnosis, unnecessary testing, and prolonged elimination diets that may do more harm than good. On this episode: Why allergic proctocolitis (cow’s milk protein intolerance) is often overdiagnosedWhen skin testing and IgE testing are useful Understanding the difference in lactose intolerance How baked milk can be used to improve quality of life in IgE-mediated milk allergyWhat makes FPIES to milk tricky, including earlier-than-expected reactionsWhy dairy elimination for eczema or EOE needs caution and frequent reassessmentAcross each of these scenarios, Dr. Khan returns to the same principle: eliminating dairy should never be a one-and-done decision. Revisiting the diagnosis, retrying thoughtfully, and weighing quality of life alongside risk are essential — especially when prolonged avoidance can set the stage for the very allergy clinicians are trying to prevent. 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’s not about knowing each one. It’s about knowing the patterns, the warning signs, the general pathways, and knowing when to ask a friend when you’re a little bit lost.” —Dr. Tamar  Rubin On this episode of The Allergist, Dr. Mariam Hanna turns the focus to how allergists LEARN to recognize when common presentations may signal a deeper immune problem — and how that diagnostic instinct is built, taught, and sustained. She’s joined by Tamar Rubin, pediatric allergist and clinical immunologist, Assistant Professor at the University of Manitoba, and a national leader in immunology education. Dr. Rubin makes the case that inborn errors of immunity are not a fringe interest, but central to understanding immunology across allergy, asthma, infection, and biologic therapies — and that allergist-immunologists are the specialists uniquely trained to recognize and teach this. On this episode, they discuss: Why allergist-immunologists “own” inborn errors of immunity, and why teaching these conditions is part of the specialty’s responsibilityMoving trainees away from memorizing rare syndromes and toward recognizing immune pathways, patterns, and warning signsHow patient-based teaching, case discussions, OSCEs, and national academic half-day curricula help trainees develop diagnostic “spidey sense”What happens when you build dedicated immunology clinics, and how volume and exposure increase once you start lookingThe importance of national collaboration and collegial networks when managing ultra-rare immune conditionsPractical ways allergists in community practice can stay engaged with inborn errors of immunity, even with limited volume or access to specialized testingKnowing when — and how — to ask for help matters as much as knowing the diagnosis.Because in the end, inborn errors of immunity aren’t just about rare diseases. They sharpen how allergists think, teach, and listen when the immune story doesn’t quite fit. 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

Keeping up with the allergy literature can feel like a second job layered onto an already full clinic day. Between evolving guidelines, expanding biologic options, and long-held assumptions quietly being challenged, it’s hard to know which papers are worth slowing down for. This episode takes a deliberately selective approach. Dr. David Khan — chair of the American College of Allergy, Asthma, and Immunology literature review — walks through five papers from 2025 that stood out not because they were flashy, but because they asked practical questions allergists actually wrestle with in clinic. Timing of repeat epinephrine to inform pediatric anaphylaxis observation periods: a retrospective cohort study For most children treated with epinephrine, prolonged emergency department observation may be unnecessary, with two hours appearing sufficient unless cardiovascular features are involved. Two-year data of tapered dupilumab shows high effectiveness in chronic rhinosinusitis with nasal polyps with NSAID-exacerbated respiratory disease In real-world practice, most patients with CRSwNP maintained excellent control while spacing dupilumab doses far beyond every two weeks, challenging long-term fixed dosing assumptions. Remibrutinib and chronic spontaneous urticaria This trial marks a major shift for CSU, introducing an oral, targeted option that delivers rapid symptom control and meaningful rates of complete remission. A randomized trial comparing direct challenges to penicillin skin testing for outpatient low-risk penicillin allergy evaluations in pregnancy For pregnant patients with low-risk penicillin allergy histories, direct oral challenge proved safe, efficient, and more streamlined than traditional skin testing. Age differences in inducible laryngeal obstruction in adult populations Inducible laryngeal obstruction appears common in older adults, often presents more subtly, and frequently masquerades as asthma or anaphylaxis. Taken together, these papers reflect a broader shift in allergy care: less reflexive caution, more precision, and a growing willingness to question long-standing habits when better data emerge. Whether it’s shortening observation times, tapering biologics, simplifying drug allergy evaluations, or recognizing long-ignored mimics of allergic disease, the 2025 literature nudges allergists toward care that is more precise, less reflexive, and still clinically vigilant. 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

== Happy holidays to our audience around the world!  As a gift, and a break for The Allergist team, we are replaying our most popular episode from 2025. We hope you enjoy it as much this time around. See you in the New Year! == “We have to keep in mind that urticaria has to be treated until it's completely gone. So, absolute control of the disease.” — Dr. Hermenio 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. Hermenio 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 antihistaminesWhy nearly 40% of patients may need to escalate to biologicsHow remibrutinib compares to omalizumab and what its trials revealedWhat the CUPID studies say about dupilumab, especially in biologic-naive patientsKey safety signals and clinical considerations for the new treatment optionsHow to move toward full disease control—and why suboptimal outcomes are no longer acceptableComplete 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

“We should stop being scared of food, and we really should just let babies eat.”                                                                                                           — Dr. Carina Venter Dr. Mariam Hanna sits down with Dr. Carina Venter, a leading dietitian and researcher in food allergy prevention and management. They get into the everyday realities of feeding infants and children in allergy practice, from early introduction to texture challenges, growth concerns, and the rise of allergen-free processed foods. On this episode How nutrition supports the microbiome and immune system, and helps clinicians navigate the anxiety common in food-allergy clinics.Practical early-feeding strategies: pairing low-allergen foods with allergens, starting early, and keeping allergens in the diet once introduced.How to approach families whose infants reject certain textures or flavours, and realistic ways to incorporate allergens like egg and peanut.Why baby-led weaning may not work well for allergenic foods, especially in babies with eczema.Nutritional red flags: milk allergy, multiple food allergies, and texture delays that warrant dietitian referral.Concerns about ultra-processed allergen-free products and how emulsifiers may affect gut health.This episode brings nutrition back to the centre of allergy practice. Dr Venter’s guidance keeps things practical — diverse diets, consistent allergen exposure, and attention to growth and texture — so families can feel confident and kids can learn to enjoy food safely. 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's kind of like we opened a Pandora's box and trying to close it up again is going to be very hard.” —Dr. Zachary Rubin Dr. Zachary Rubin joins Dr. Mariam Hanna for a candid look at the “difficult and misinformed” patient — the growing phenotype every allergist now manages weekly. A double board-certified pediatrician and allergist-immunologist with a massive social media footprint, Dr. Rubin breaks down how misinformation spreads, why it resonates, and how clinicians can approach these encounters without burning out or burning bridges. From TikTok-fuelled certainty to patients demanding full panels, he offers a practical, clinician-first playbook for navigating the mess. On this episode: Why today’s misinformation is stickier, faster, and more emotionally charged than a decade ago, and how parasocial trust amplifies it. How the “nugget of truth” inside misinformation gives it power and how to dismantle it without escalating conflict. A clinic-ready strategy to approach resistant patients: open-ended questions, triaging what must be corrected now, and focusing on one actionable change at a time. Why continuity, follow-up, and small pieces of information over time often outperform a single “big correction.” How to use shared decision-making to reframe testing and treatment choices, especially when patients arrive convinced they need “the full panel.” Practical tools to support patient understanding, including targeted education resources, structured discharge summaries, and multimodal materials for different learning styles. How teams can protect each other through debriefs, preparation, and collaborative communication during high-stress encounters.A grounded, real-world conversation for clinicians who balance patient frustration, digital misinformation, and the realities of modern allergy 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

“People know that asthma sucks. They don’t know that sinus disease sucks. It really impacts people's quality of life. It impacts their function. It needs to be taken very seriously.” — Dr. Andrew Thamboo Chronic sinusitis doesn’t just clog the nose—it can drag down quality of life, complicate asthma, and leave patients caught between specialists. Dr. Mariam Hanna talks with Dr. Andrew Thamboo, rhinologist at St. Paul’s Sinus Centre in Vancouver and clinical associate professor at UBC, about how to identify, manage, and treat this stubborn condition. A leader in chronic sinus disease research, Dr. Thamboo explains how understanding inflammation, using the right investigations, and choosing the right therapies can make a real difference for patients who feel like nothing works. In this episode: How to distinguish chronic rhinosinusitis from acute sinusitis, and why type 2 inflammation matters The role of CT scans in diagnosis and when to order one before referral What nasal endoscopy patterns reveal about atopy and when allergy testing changes the treatment plan Why saline irrigations combined with topical steroids remain the baseline therapy, and why oral corticosteroids are falling out of favour When medical management has gone far enough and surgery becomes the next step The evolving place of biologics, cost considerations, and how biosimilars could shift the future of care Why managing sinus disease seriously improves both airway and overall healthSinus disease may suck, but as Dr. Thamboo explains, understanding inflammation, anatomy, and timing can make all the difference for patients and physicians alike. 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 immune system generally likes to be a well-balanced machine. It’s kind of like Goldilocks — too much is no good, too little is no good, and it’s finding that balance.”  Dr. Vy Kim Tregs have been called therapists, peacekeepers, and now—thanks to this year’s Nobel Prize—front-page immunology. Dr. Vy Kim joins Dr. Mariam Hanna to unpack why these cells might hold the key to everything from tolerance to therapy response, and what allergists should be watching for next. How Tregs bridge central and peripheral tolerance—and why that matters in allergy.What their dysfunction reveals about the origins of allergic disease.Why allergen-specific Tregs could signal immunotherapy success.How far we are from clinical testing and therapeutic manipulation.What “Goldilocks” balance really looks like inside the immune system.The unanswered questions that will shape the future of Treg-based interventions.It’s not every day the Nobel Prize lines up with what’s happening in your clinic. This is one of those days. 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

“Don't just rely on the textbook definition of when the pollen seasons are. You need to have reliable data to know when the pollen seasons are starting, when they're ending, and when they're peaking.”  Dawn Jurgens Allergy season may be winding down, but for allergists, the work never really stops. This is the moment between ragweed and winter — a brief respite before the cycle begins again. On this episode, Dr. Mariam Hanna is joined by Dawn Jurgens, Director of Operations and Quality Management at Aerobiology Research Laboratories. She breaks down the science behind pollen and spore counts, why forecasts matter, and how shifting seasons are changing the game for patients and clinicians alike. Timothy grass is the most common and potent trigger globally, while birch remains the most clinically relevant pollen in Canada. Pine releases large amounts of pollen but isn’t highly allergenic. Pollution and thunderstorms can make pollen more potent by breaking it apart and exposing allergenic epitopes, intensifying symptoms. Cross-reactivity stems from conserved epitopes, meaning patients sensitized to one pollen may react to related species — or even certain foods. Mold spores, especially Alternaria, Cladosporium, and Basidiospores, can mimic ragweed season and are major fall culprits. Canada’s pollen seasons are starting earlier than they did 30 years ago, though the fall season hasn’t yet extended. Simple strategies — like showering before bed, keeping windows closed, using filters, brushing pets outside, and checking reliable forecasts — can meaningfully reduce exposure.Pollen season may be taking a break, but planning for the next wave starts now. 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

“Vaccine counseling is really a team sport. — Dr. Anne Pham-Huy Vaccines can stir anxiety for patients and confusion for clinicians, especially when biologics enter the mix. Dr. Mariam Hanna is joined by Dr. Anne Pham-Huy, clinical immunologist at CHEO, member of the Special Immunization Clinic Network, NACI member, and chair of Immunize Canada. Together, they break down the science of vaccine responses and tackle some of the trickiest questions allergists face in daily practice. On this episode: The major types of vaccines — from live attenuated to mRNA — and what sets them apart. Why live vaccines often produce strong, durable protection, but may require caution in certain patients. How adult immunization is still underutilized, with gaps in boosters, pneumococcal, HPV, and influenza coverage. Which “special populations” need tailored vaccine strategies, including patients on immunosuppressants, transplant recipients, and those with chronic disease. Practical guidance on timing vaccines around biologic use and which precautions truly matter. When to check titers and antibody responses — and why it’s only relevant for select patient groups. Strategies for counselling vaccine-hesitant patients with empathy, focusing on disease risk and building trust. What’s next: combination mRNA vaccines and nirsevimab for RSV prevention in infants.The questions are simple — are they vaccinated, special, or special enough — but the answers matter. 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

“Atopic dermatitis is not just about what you see on the skin. It's about what the patient's experiencing.” Dr. Melinda Gooderham Eczema care has become a world of creams, cleansers, oils, and myths — but what actually works? Dr. Mariam Hanna is joined by Dr. Melinda Gooderham, assistant professor at Queen’s University and consultant physician at the Peterborough Regional Health Centre. As principal investigator for more than 250 clinical trials, Dr. Gooderham brings both evidence and practical wisdom to the table. On this episode, they explore: Why barrier repair remains the cornerstone of therapy, and how humectants, emollients, and occlusives play distinct roles The evidence behind natural oils (and why olive oil is out while coconut, sunflower seed oil, and shea butter may have a place) Bathing basics: frequency, water temperature, and whether bleach baths still matter How to choose topical steroid potency and when to pivot toward non-steroidal options The promise of newer agents: calcineurin inhibitors, PDE-4 inhibitors like roflumilast, and topical JAK inhibitors When to escalate to systemic therapy, with itch and quality of life as key markersEczema may be complex and misunderstood, but Dr. Gooderham reminds us that consistent barrier care, adequate product use, and asking the right questions about itch can simplify management and improve patient outcomes. 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

“You will think it is mastocytosis much more often than you'll actually diagnose mastocytosis.” — Dr. Matthieu Picard Mastocytosis is rare, complex, and often confused with other mast cell disorders. To help clinicians cut through the confusion, Dr. Mariam Hanna welcomes Dr. Mathieu Picard, allergist and clinical immunologist, who has built a dedicated practice caring for patients with mast cell diseases. Together, they explore what physicians need to know about diagnosis, monitoring, and management. On this episode: Adults: Around 80% of adults with skin lesions have systemic mastocytosis, and the disease typically persists.Children: Pediatric cases are almost always cutaneous and often resolve by puberty.When to order a tryptase — and why a normal result doesn’t rule out systemic diseaseThe role of KIT D816V mutation testing and why biopsy technique mattersKey risks to monitor in indolent systemic mastocytosis: anaphylaxis, osteoporosis, and rare progression to advanced diseasePractical tips for patient care, including venom immunotherapy considerations, osteoporosis screening, and symptom control strategiesMastocytosis may be rare, but it doesn’t take uncommon skill to spot — just the right tools, a sharp eye, and maybe a tongue depressor scratched five times. 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

“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 itWhether 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 toolCommon pitfalls in celiac diagnosis—and why a positive TTG doesn’t always mean celiacNew, and surprising treatments for IBS, including nerve stimulation and gut-directed hypnotherapyWhat the microbiome research does—and doesn’t—tell usUnderstanding fibrosis in EOE and when to skip dietary eliminationWhen 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