The Allergist

== 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 LimaChronic 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.Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe 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 VenterDr. 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 episodeHow 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.Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe 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 RubinDr. 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.Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe 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 ThambooChronic 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 mattersThe role of CT scans in diagnosis and when to order one before referralWhat nasal endoscopy patterns reveal about atopy and when allergy testing changes the treatment planWhy saline irrigations combined with topical steroids remain the baseline therapy, and why oral corticosteroids are falling out of favourWhen medical management has gone far enough and surgery becomes the next stepThe evolving place of biologics, cost considerations, and how biosimilars could shift the future of careWhy 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.Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe 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 KimTregs 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.Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe Allergist is produced for CSACI by PodCraft Productions