The Allergist

“This is a safe and very effective therapy, which is probably underutilized within our own community.” —Dr. Susan Wasserman
Subcutaneous immunotherapy (SCIT) sits in that uncomfortable space between routine and risk. It’s one of the few interventions in allergy that can actually modify disease. But it also carries a small, very real risk of severe reactions. On this episode, Dr. Susan Wasserman, professor at McMaster University and a national leader in immunotherapy, walks through what safety really looks like in practice. And where things still go wrong.
Key Points:
Systemic reactions are uncommon but not rare
Safety has improved through better patient selection, standardized extracts, and clinic preparedness
Uncontrolled asthma is the most important risk factor for severe reactions
Prior systemic reactions require reassessment, especially if the cause is correctable
Build-up dosing carries higher risk than maintenance
Rush and cluster protocols increase risk and need clear justification
The 30-minute observation period captures most but not all reactions
Beta blockers and ACE inhibitors may worsen reaction severity without increasing incidence
SCIT is one of the few tools we have that can actually change the trajectory of allergic disease. But it demands discipline. Careful screening. Reliable processes. And a team that’s ready to act when things go sideways.
Because most of the time, it’s safe.
And the rare times it isn’t—that’s where preparation matters most.

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

"So the future is one IV infusion, likely no chemotherapy, and that'll cure our IEIs." — Dr. Nicola Wright
For children born with inborn errors of immunity, bone marrow transplant has long been the closest thing medicine had to a cure. It works — but it comes with chemotherapy, graft-versus-host disease, and a donor search that doesn't always end well. Gene therapy is changing that calculus. Dr. Mariam Hanna speaks with Dr. Nicola Wright, a pediatric hematologist and clinical immunologist at the Alberta Children's Hospital and holder of the Barb Ibbotson Chair of Pediatric Hematology, whose research focuses on developing gene editing platforms for blood and immune disorders.
On this episode, they discuss:
Why bone marrow transplant is, in Dr. Wright's words, "almost a poor man's gene therapy" and what gene therapy offers instead
The spectrum of technologies: lentiviral insertion, CRISPR, base editing, and prime editing. What each does, and where each falls short
Immune reconstitution outcomes across diseases, including over 90% good immune reconstitution in ADA-deficient SCID treated with lentiviral therapy
How to counsel a family when gene therapy might be an option and why most patients still can't access it
The "valley of death": why therapies that work in trials are failing to reach patients, and what it will take to cross it
CAR T-cell therapy in IEI, including a Canadian trial underway for refractory autoimmune disease
What long-term follow-up looks like and why 15-year post-trial monitoring is now an FDA requirement
The science is outpacing the infrastructure. Dr. Wright's vision of shipping cells instead of patients, in vivo delivery via lipid nanoparticle, no chemotherapy required isn't speculative. The runway is being built. The plane is already flying.

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

"That wholesome conversation that you take a minute or two to go through really creates a physician-patient relationship, expands that communication. Probably will not only improve patient outcomes, but reduce medical-legal risk for physicians in the consent process." — Dr. Lisa Thurgur

A signed form isn't consent. It's paperwork. On this episode, Dr. Mariam Hanna is joined by Dr. Lisa Thurgur — emergency physician, award-winning educator, and a physician advisor with the Canadian Medical Protective Association — to unpack what meaningful consent looks like in daily practice. Inadequate consent is one of the most common allegations in CMPA cases, across every specialty.
On this episode:
The three elements of valid consent — and what capacity actually means
Why a signed consent form is not the same as an informed patient
Implied versus expressed consent: when each applies, and when to re-consent
Why serious risks like anaphylaxis — and death — must be disclosed, and how to frame that conversation
Consent in minors: why maturity — not age — determines capacity (with one exception in Quebec)
What to do when parents disagree — or a minor refuses
Patients recording their visits: what physicians need to know
PARQ: a four-point mnemonic for structuring both the conversation and the chart note
The say-back technique: asking patients what they understood, and why it matters
Done well, consent isn't something you do in addition to practicing good medicine. It improves outcomes, strengthens adherence, and reduces medical-legal risk. In other words, it is good medicine.
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 have come across allergists in different countries who often don't even prescribe epinephrine for very young children that have only had a history of mild reactions." — Dr. Katherine Anagnostou
An inconsolable cry. A baby who's just not acting right. Tongue thrusting. Lip licking. Scratching at their own tongue. These aren't the symptoms that make it into standard diagnostic criteria — but they might be the clearest signal a non-verbal child can give. On this episode, Dr. Mariam Hanna is joined by pediatric allergist and immunologist Dr. Katherine Anagnostou to explore how anaphylaxis presents in infants and toddlers, why the standard criteria don't always apply, and how allergists can help caregivers recognize — and treat — serious reactions in children who can't yet put words to what they're feeling.
On this episode:
Why modified criteria for infant and toddler anaphylaxis matter
Behavioral signs like irritability, clinginess, lethargy, or withdrawal as red flags
The role of context and timing in recognizing reactions
Surrogate symptoms — tongue thrusting and lip licking for oral itching, drooling, horse cry
Why urticaria shows up in 90% of infant anaphylaxis cases
Epinephrine dosing: the 0.1 mg option for infants 7.5-15 kg and safety of 0.15 mg in smaller babies
Why not every infant who receives epinephrine needs the ED
Second-dose timing: five minutes, not ten
Novel delivery routes on the horizon — intranasal and sublingual epinephrine
Dr. Anagnostou returns to one principle throughout: parents generally know their children pretty well. The job of the allergist isn't to create fear or overcomplicate recognition — it's to help families spot what's different, understand the context, and feel equipped to act when it matters.
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

“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 overdiagnosed
When 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 allergy
What makes FPIES to milk tricky, including earlier-than-expected reactions
Why dairy elimination for eczema or EOE needs caution and frequent reassessment
Across 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