The Allergist
Welcome to your allergy lifeline..."The Allergist." A show that separates myth from medicine. Every episode of The Allergist is designed for YOU – the medical professional aiming to stay on the cutting edge of allergy care. We'll clarify, correct, and, most importantly, contextualize the latest evidence.
The smoke detector problem
“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 nov...
ENCORE: The many faces of milk problems
“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 allergist...
Stopping strictures before they start
"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...
Breaking down the epithelial barrier hypothesis
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 developme...
Drop the SABA-only reliever. It’s not worth the risk
"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...
ENCORE—Epinephrine Essentials: Balancing Confidence, Safety, and Misconceptions
“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 cli...
Milk and egg: different ladders, different outcomes
"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 pa...
Managing the child-to-adult transition
"...these are chronic conditions that are not going to magically go away when a patient turns 18 or 21." — Dr. William Anderson
Adolescence and early adulthood tend to be a rough stretch for patients with allergic disease. Asthma that used to be well controlled can start to drift. Teenagers take more chances with foods they are meant to avoid, and they show up for fewer of their appointments. Meanwhile the daily management is sliding off the parent and onto a patient who often is not ready to carry it, from refills to the action plan to knowing what to do...
New Epinephrine Options. Fewer Fears?
“If you are willing to use it and use it quickly, that's what I want you to have.”
— Dr. Jay Lieberman
Epinephrine is everywhere in allergy practice. Prescribed, refilled, demonstrated, repeated. And still, it carries a strange kind of fear. Patients hesitate. Clinicians sometimes hesitate too. Is it dangerous? Is it a last resort? How bad does the reaction have to be before it counts?
On this episode, Dr. Mariam Hanna is joined by Dr. Jay Lieberman, professor of pediatrics at the University of Tennessee and interim division chief of allergy and immunology at Le Bon...
CVID? No. SAD? Maybe.
“You can have a patient that has normal immunoglobulins and abnormal responses to protein antigens as well. Historically, I’ve seen these patients. They do happen. They are out there.” — Dr. Benjamin Prince
Specific antibody deficiency (SAD) has never been a clean diagnosis. Some patients carry normal immunoglobulins and still land in clinic with recurrent infections and poor vaccine responses. The newer pneumococcal vaccines have scrambled the old testing pathways. This episode covers which parts of the workup still hold up, and where a titre should actually change what you do next.
Dr. Mariam Hanna is joine...
When It’s Not Asthma, Think Larynx
“If the asthma is under good control but they are still having these episodes, then I do think that maybe they have a PVFMD component to their breathing issue.” Dr. R. Jun Lin
Patients come into clinic short of breath. It hits during exercise, it looks dramatic, and they may even describe noisy breathing or the feeling that they “can’t get air in.” So we do what clinicians do: we think asthma. We try inhalers. But sometimes, no matter how many puffers are thrown at the problem, nothing changes.
That’s when it may be time to l...
When AI meets the allergy clinic
“AI might feel like magic at times, but mostly it's just powerful technology, and with any technology, it's a tool.” —Merlijn van Breugel
AI is no longer a future-tense possibility for allergists. It is already shaping diagnosis, prediction, documentation, patient communication, and the way clinicians think through complex decisions. But if AI can process more than we can, what still belongs to the clinician?
On this episode of The Allergist, Dr. Mariam Hanna is joined by Merlijn van Breugel, a data scientist and philosopher whose work focuses on AI in allergy and immunology. Togeth...
The Expanding Toolbox for Food Allergy
“It’s a fun time to be a food allergist”—Dr. David Fleischer
Food allergy treatment is no longer just about avoidance, epinephrine, and hoping for the best. With high-dose OIT, low-dose OIT, SLIT, EPIT, Xolair, and other biologics entering the conversation, allergists now face a more practical question: what are we trying to achieve, and what approach best fits this patient and family?
On this episode, Dr. Mariam Hanna is joined by Dr. David Fleischer, section head of allergy and immunology and director of the Allergy and Immunology Center at Children’s Hospital Colorado, and profes...
Evidence-Based or Autopilot? A review of systematic reviews
“We need more than just random care. We need randomized care.” — Dr. Derek Chu
For years, the allergy world has been drowning in a sea of data—risk factors, prevention strategies, and enough diagnostic tools to fill a warehouse. But how do you translate 340 different risk factors into a cohesive plan when an anxious parent is sitting in your clinic demanding a skin test for their four-month-old?. On this episode, Dr. Mariam Hanna is joined by "systematic review genius" Dr. Derek Chu to unpack the evidence-based roadmap for food allergy and atopic dermatitis. It’s time to mo...
Microbiome in IEI, Much More Than Probiotics
“We came up with the idea of testing a ketogenic diet… which in mice, it’s basically a lot of Crisco… giving a keto diet to mice with CGD… led to a decreased susceptibility to colitis.” —Dr. Emilia Liana Falcone
The microbiome isn’t something sitting on the sidelines. It’s part of the immune system, interacting with the barrier, shaping responses, and, in IEI, reflecting the underlying defect.
On this episode, Dr. Mariam Hanna is joined by Dr. Emilia Liana Falcone, physician-scientist and director of the Microbiome and Mucosal Defense Research Unit at the Montreal Cl...
Small Risks Big Rewards with SCIT
“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...Rewriting the Immune Code
"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, whos...
Consent is a Conversation
"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...
Infant anaphylaxis: What it looks like when they can't tell you
"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...
The many faces of milk problems
“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 allergist...
Developing that immunology spidey sense
“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 edu...
Highlights from the 2025 allergy literature
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 pediat...
ENCORE: New Rules for Old Hives
== 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...
Nutrition and food allergy with Dr. Carina Venter
“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 keep...Managing the Confident but Incorrect
“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-fi...
Can sinusitis be solved? The view from the ENT clinic
“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 ex...
Tregs: The Peacekeepers of Immunity
“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 dysfunct...A Clear-Eyed Look at the Red-Eye Culprit
“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 for...
Standard Vaccines And Special Cases
“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...
No to Olive Oil, Yes to What Works in Eczema Care
“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 cornerst...Solving the Mystery of Mastocytosis — Tests, Treatments and Triggers
“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 al...Finding the Fix for Chronic Cough
“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 f...
Going viral for the right reasons: join the fight against misinformation
“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 meet...
The GI Guide for Allergists: A Deep Dive with Dr. Avinashi
“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...What Allergies to Expect When You’re Expecting
“They may worsen, they may improve, or they might not change at all, and it really is patient-dependent.” —Dr. Lana Rosenfield
On this episode of The Allergist, Dr. Mariam Hanna welcomes Dr. Lana Rosenfield to unpack the complexities of managing allergic conditions during pregnancy and postpartum. With hormones shifting, the immune system recalibrating, and anxiety about medication safety running high, allergic disease can be especially tricky to manage during this time. Dr. Rosenfield offers practical insights for clinicians supporting pregnant patients with conditions like asthma, rhinitis, chronic urticaria, and food allergy, while navigating a landscape of limited data a...
Taking the sting out of diagnosing contact dermatitis
“Have a high clinical suspicion for contact allergens or irritants in anyone presenting with eczematous rash.” —Dr. Rebecca Pratt
Creams that sting and rashes that won’t quit —welcome to the complex world of contact dermatitis. Dr. Rebecca Pratt joins Dr. Mariam Hanna to unpack why diagnosing and managing this condition is anything but straightforward.
Dr. Pratt is an allergist and clinical immunologist in St. Catharines, Ontario, with a passion for dermatoimmunopathology and practical tools that empower patients. She breaks down when to patch test, what to suspect, and how to help patients take control.
On th...
Trust your gut and test for primary atopic disorders
“If you're already wondering if a patient has an underlying inborn error of immunity, then it’s worthwhile to do that testing.” — Dr. Catherine Biggs
What if that tough case in your allergy clinic isn’t just unusually severe, but fundamentally different? On this episode of The Allergist, Dr. Mariam Hanna speaks with pediatric immunologist Dr. Catherine Biggs about primary atopic disorders, rare inborn errors of immunity that masquerade as everyday allergy but demand a very different approach.
Dr. Biggs breaks down the clinical signs that should raise your suspicion and explains why early recognition and genetic...
How to accidentally become a researcher
“It doesn’t have to start with a huge trial. It starts with a patient and it starts with a problem.” —Dr. Gord Sussman
How do we move from the exam room to the frontlines of discovery? On this episode of The Allergist, Dr. Mariam Hanna talks with Dr. Gord Sussman about how curiosity—not a research grant—launched his decades-long contribution to allergy science. From identifying the early signs of latex allergy to shaping the treatment landscape for urticaria and hereditary angioedema, Dr. Sussman shares what keeps him asking the next question, and how any allergis...
New Rules for Old Hives
“We have to keep in mind that urticaria has to be treated until it's completely gone. So, absolute control of the disease.”
— Dr. Herminio 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. Herminio 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 contro...
Biologics, Polyps, and the Power of Collaboration
"The emergence of biologics has really significantly transformed the management of these patients for me."
— Dr. Yvonne Chan
When it comes to nasal polyps, the landscape is shifting fast. On this episode of The Allergist, Dr. Mariam Hanna is joined by otolaryngologist Dr. Yvonne Chan to talk about how biologics, surgery, and multidisciplinary care are working together to reshape care for this stubborn condition. From recognizing key symptoms to navigating the latest therapeutic options, Dr. Chan shares practical insights to help physicians better support patients with nasal polyps.
On this...
