The Allergist

The pandemic was many things to many people, but to Dr. Jonathan Hourihane, it was an exciting natural experiment. The prospect of an entire cohort of new babies, isolated, lacking exposure to people, other babies and the viruses they carry was very enticing to a world-renowned researcher. His wife, Yvonne, wondered, would allergy rates go up? That question turned into the CORAL study and its post-pandemic counterpart, FLORAL.
On this episode of The Allergist, Dr. Hourihane walks us through the findings, and their implications for allergy care. Dr. Hourihane is Professor of Paediatrics and Child Health at the Royal College of Surgeons in Ireland and Children’s Health Ireland at Temple Street.
We cover:
The pandemic’s extreme isolation had little impact on allergy rates in infants
Post-pandemic babies are getting allergens earlier than ever, with no rise in food allergy
Why the hygiene hypothesis may need to become the “sibling hypothesis”
Egg ladders are widely used in Ireland, with only one or two egg-allergic children out of 350 at age one
Breastfeeding in Ireland rose from fewer than 10% of babies at six months pre-pandemic to more than 55%
FLORAL suggests those gains have held
Why babies should be eating exactly what their parents eat by their first birthday
Dr. Hourihane’s advice: Eat the peanut, eat the egg, and by age one, eat what your parents eat. Allergy prevention starts at the family table.

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

“Allergy tests are evidence toward a verdict, but they are not the verdict themself.”
 Dr. Nicole Chase
There’s no shortage of tests allergists use. Skin prick tests, component testing, serum-specific IgE. These are all go-to tools for allergists. But are we asking too much from them and are we changing the test meaning with some of our interventions?
Dr. Nicole Chase thinks so. Dr. Chase is associate professor of medicine at the University of Minnesota and a partner at St. Paul Allergy and Asthma, with clinical expertise in anaphylaxis, atopic dermatitis, chronic urticaria and novel therapeutics. She walks through what these tests can and cannot tell us, and how there’s no substitute for old-fashioned clinical skill.
 On this episode:
Skin prick tests and serum-specific IgE measure sensitization. They don’t predict threshold or severity.
Biologics change the numbers. On dupilumab or omalizumab, a negative test may not mean what it used to
Population data, n of 1 patients
We don’t routinely repeat-test after venom or aeroallergen immunotherapy. So why do we with food?
Stop omalizumab and protection in food allergy can start slipping within about three months. Remember the asterisk when counselling patients after challenges.
Dupilumab drags total and food-specific IgE down over time. That can hide more than food allergy; don’t forget ABPA!
Tests are a smoke detector. What we want to know is how big the fire is. Dr. Chase’s rule before ordering anything: what are you going to do with the result? A better test doesn’t get you out of that question.
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

"This is an allergic disease, and allergists need to help take care of this person." Dr. Seema Aceves
Found yourself scratching your head about how to approach EoE in young patients? Who will go on to develop chronic disease, facing stricture and food impaction from remodelling? Our current approach can feel like it is stuck in the Stone Age. But not to worry, Dr. Seema Aceves will rocket us to the cutting edge of EoE diagnostics and treatment.
Dr. Seema Aceves is Professor of Pediatrics and Medicine at the University of California, San Diego, and Rady Children's Hospital. She directs the Eosinophilic Gastrointestinal Disorders Clinic and leads an NIH- and CURED-funded research program focused on the mechanisms and clinical impact of tissue remodelling in eosinophilic esophagitis.
On this episode, they discuss:
EoE is a type 2 inflammatory disease, and allergists need to help treat it.
How remodelling happens when EoE persists.
Between 95 and 99 per cent of patients have chronic disease.
The limits of eosinophils as a biomarker.
Where gastroenterologists fit into EoE care, and where they don't.
OIT causes EoE in 4 to 5 per cent of cases.
The role of elimination diets in treating EoE.
Emerging tools to identify which patients will develop remodelling.
Dr. Aceves keeps returning to one idea: this disease starts early and builds quietly, and allergists have a key role in detecting its advance in time to prevent strictures.

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’s a question that’s been circulating widely these days. It’s in the clinic, it’s in the news, and it’s on patients' minds. Why do allergies appear to be increasing? Enter the epithelial barrier hypothesis. This is a developing theory that sees a connection between the ‘atopic march’ and the breakdown of the epithelial barrier.
On today’s episode we speak with Professor Cezmi Akdis. Professor Akdis is a director of the Swiss Institute of Allergy and Asthma Research in Davos and professor at the University of Zurich. His research has been instrumental in the development of the epithelial barrier hypothesis.
We cover:
What epithelial barrier integrity looks like when it is working
What epithelial dysfunction looks like
Evidence for epithelial barrier breakdown 
Connection between epithelial barrier dysfunction and the atopic march
Environmental factors common to Western societies, such as detergents, processed food and air pollution, that impact the epithelial barrier
Opportunities for early intervention to repair the barrier
It can seem like the sources of epithelial dysfunction are just about everywhere but the solution may begin at home.

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