The Allergist

"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

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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

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

"I don't think any asthmatic in this world should have a SABA, ever." 
                                                                                                                —Dr. Paul O'Byrne
Is it asthma? Is it a cold? Will symptoms go away? Will they come back even worse? And how about an inhaler? Do we give one? Which one? And for how long?
Diagnosing and managing mild and moderate asthma can feel like a game of what-ifs. Worse, the treatment only works if patients stick with it, and that's hard when they feel fine.
On this episode of The Allergist, we speak with one of the world's leading authorities in asthma research. Dr. Paul O'Byrne is a professor of medicine at McMaster University whose landmark START and SYGMA trials reshaped how we think about treating mild asthma.
Key points:
Our understanding of mild asthma has fundamentally shifted.
SABA-only relief, used as needed, is riskier than we assumed.
Daily inhaled steroids sharply cut the risk of severe exacerbations.
But daily adherence is poor. People just don't take it consistently.
The SYGMA trials were the breakthrough.
An as-needed ICS-LABA reliever matched daily steroids, with far better uptake.
More SABA use, more risk. More ICS-LABA use, less. Same reliever, opposite outcome.
Ease patients in rather than fighting their SABA attachment.
Most drop the SABA once they see the new approach working.
Getting the diagnosis right takes time but is critical because it's a potentially lifelong label. Keep patients off SABA alone, and make sure every reliever carries a steroid. Simple? Not quite, but a lot clearer.

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

“If that medicine is associated with fear of an injection, then we are giving the impression that a diagnosis of food allergy is worse than a life sentence.” 
— Dr. Paul Turner
When it comes to managing anaphylaxis, epinephrine is the gold standard. But even with its life-saving potential, misconceptions abound, and newer delivery methods like nasal and sublingual formulations are raising questions for allergists and patients alike. In this episode, Dr. Mariam Hanna sits down with Dr. Paul Turner, pediatric allergist, clinical immunologist, and global expert on anaphylaxis, to explore the science, controversies, and clinical realities surrounding epinephrine use.
On this episode:
Anaphylaxis demystified: Why the "ABC" symptoms (airway, breathing, circulation) are crucial for timely diagnosis.
Epinephrine explained: How it works, why timing matters, and when it’s not enough.
Alternative delivery methods: Intranasal and sublingual epinephrine—why Dr. Turner is skeptical about their use in clinical practice without robust evidence of efficacy.
When epi fails: Understanding the limitations of autoinjectors in severe reactions and the role of IV infusions.
Improving patient confidence: Strategies for addressing fears and teaching appropriate use to improve outcomes.
Whether you're an allergist navigating these evolving treatment landscapes or a clinician seeking clear guidance for patient care, this episode provides critical insights and practical advice. Tune in to strengthen your understanding of epinephrine’s role in anaphylaxis management and gain clarity on when—and how—it should be used.

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

"Food, milk and egg ladders look the same, but they're not the same." — Dr. Juan Trujillo
Ladders are close to standard in some clinics now. The evidence that they change the course of anything is still thin. So families are climbing, clinicians are advising, and nobody has settled the question underneath: is a ladder modifying the disease, or is it keeping everyone busy while a child outgrows it on schedule? On this episode, Dr. Mariam Hanna puts that to someone who has lived with the question longer than most.
Dr. Juan Trujillo is a consultant paediatric allergist at Cork University Hospital and a senior lecturer at University College Cork. He is careful not to oversell. There isn't much literature to go on, he says, so ladder practice ends up tracking something else: how many appointments a clinic can offer. In a stretched service, a ladder can mean fewer visits rather than more. When it comes to egg and milk allergies, different ladders, different timelines, different success rates. Clinics tend to treat them as one thing. Trujillo doesn't.
Key points
The evidence base is incomplete. Practice moved ahead anyway, largely because indefinite avoidance is not a neutral default.
In resource-limited systems, ladders can reduce appointments rather than generate them.
Milk and egg are not interchangeable and should not be presented to families as though they are.
Skin testing, specific IgE and components will diagnose the allergy. They will not give you the threshold, and they will not tell you who is going to climb.
Counting milligrams of protein overcomplicates what is, for most young children, dietary advancement.
Age matters. The younger the child, the better the prospects. Older than five, Trujillo approaches with caution.
Patient selection is doing more of the work than any step-by-step protocol.
In young children, selected carefully and supported properly, ladders are worth doing on practical grounds, whether or not they turn out to be disease modifying. 

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