The Itch: Allergies, Asthma, Eczema & Immunology

Ep. 150: What Allergists Really Think About Your Allergy Nasal Spray
If you have ever grabbed a nasal spray off the pharmacy shelf, used it for a few days, and given up because nothing seemed to be happening, you are not alone. And according to the allergists we spoke to at the AAAAI conference in Philadelphia, that is not uncommon.

In this episode, Kortney and Dr. Payel Gupta share real conversations with allergists from across the US about what they actually think about allergy nasal sprays.

What we cover in this episode about allergy nasal sprays

Why allergists love nasal steroid sprays. They work at the source of the problem by calming swelling inside the nose before your symptoms have a chance to take hold, and you can pick them up at the grocery store without a prescription.

You may not feel the nasal spray work right away. Nasal steroid sprays need about two weeks of consistent daily use before you feel a difference. The medication is working, you just cannot feel it yet. Do not give up early.

When to start before allergy season. Starting your spray a couple of weeks before your season hits means you go in with as little swelling inside your nose as possible, giving the medication the best chance to work.

Why so many patients stop using their spray. Incorrect technique causes irritation and nosebleeds, and means the medication is not landing where it needs to.

Not all nasal sprays smell or feel the same. If the smell or taste of your spray puts you off, there are options without it, and that is worth a conversation with your allergist or pharmacist.

Thank you to our allergists

A huge thank you to every allergist who stopped what they were doing at the AAAAI conference to talk to us. We could not make this episode without you.

Dr. Jessica Hui, Instagram | LinkedIn

Dr. Jamie Rutland, Instagram | Instagram: The Health Exchange Podcast

Dr. Juan Carlos Murillo, Instagram | LinkedIn

Dr. Tobi Olayiwola 

Dr. Jake Rosenblum, LinkedIn

Dr. David Wertheim

Dr. Sonali Majmudar, Instagram | LinkedIn

Thanks to Opella for sponsoring today’s episode. 

This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

Chronic sinusitis without nasal polyps is the most common form of chronic sinusitis. Even so, most patients spend years without a clear explanation, cycling through antibiotics that do not address what is actually going on.

In this episode, Kortney and Dr. Payel Gupta are joined by Dr. Michael Blaiss and Dr. Anju Peters, an allergist and immunologist at Northwestern University who co-authored the 2025 Adult Sinusitis Clinical Practice Guideline. Together, they break down what chronic sinusitis without nasal polyps (CRSsNP) actually is, what the real quality-of-life impact looks like, and how a proper diagnosis is confirmed.

What we cover in this episode about chronic rhinosinusitis without nasal polyps

Not an infection. Chronic sinusitis without nasal polyps is driven by inflammation lasting 12 weeks or more, not by bacteria or a virus, which is why antibiotics often do not help.

The hidden quality of life burden. Beyond congestion and sinus pressure, patients commonly experience fatigue, poor sleep, anxiety, depression, and social isolation.

Why so many patients go years without a correct diagnosis. Symptoms overlap significantly with conditions like allergic rhinitis or migraines. Many patients adapt to feeling unwell rather than seeking answers.

How doctors confirm the diagnosis. A diagnosis requires objective evidence of inflammation, as seen on nasal endoscopy or a CT scan of the sinuses, not symptoms alone.

The connection between sinusitis and asthma. The nose, sinuses, and lungs share one connected airway, and about 60% of people with this condition also have asthma, with each capable of making the other worse.

***********

Made in partnership with The Allergy & Asthma Network.

Thanks to Insmed for sponsoring today’s episode. 

This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

Chronic hives that come and go without warning are exhausting physically and emotionally. But here is something many patients don't realize: feeling "okay" is not the same as being well controlled.

Kortney and Dr. Gupta are joined by Dr. Tom Chacko, a board-certified allergist and immunologist based in Atlanta, to discuss what good hives control actually looks like and what to do when you are not there yet. From "just living with" your condition to managing a bad flare, tracking your symptoms, and preparing for your follow-up appointment, this episode gives you the tools to stop just coping and start getting better care.

What we cover in our episode about what chronic hives control looks like:

Chronic spontaneous urticaria. The plain-language definition of CSU, including why hives appear without a clear trigger and what angioedema is.

The trap of normalizing symptoms. Why patients adjust their lives around hives without realizing it, and how to spot the signs that your condition is not actually controlled.

How to track your hives. Why symptom tracking helps with diagnosis and better care, and how to use tools like the UAS7 score.

What to bring to your follow-up appointment. The concrete information your doctor needs to work with you to find the best treatment plan. This includes information about sleep, daily activity, and medication side effects.

How to ask for more help. What to say when antihistamines are not enough, and what newer treatment options exist for CSU patients today.

More resources about chronic hives

UAS-7 Urticaria Activity Score worksheet

Allergy & Asthma Network chronic urticaria resources

More episodes about hives

***********

Made in partnership with The Allergy & Asthma Network.

Thanks to Novartis for sponsoring today’s episode. 

This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

If you have chronic hives and antihistamines aren't helping, there's a new treatment option to know about. In this episode of The Itch Review, we spotlight "Remibrutinib in Chronic Spontaneous Urticaria" published in The New England Journal of Medicine, March 2025.

This article looks at the REMIX trials, which tested whether remibrutinib, a BTK inhibitor, can help adults whose chronic spontaneous urticaria (CSU) is not controlled by antihistamines alone. Remibrutinib works differently from antihistamines. Instead of blocking histamine after it's released, it stops mast cells from releasing those itch-causing chemicals in the first place.

The FDA approved remibrutinib in September 2025. 

What we cover in our episode about the REMIX trial:

Understanding CSU: Chronic spontaneous urticaria causes itchy hives and swelling for more than 6 weeks with no clear trigger, and antihistamines don't work for everyone.

How remibrutinib works: This BTK inhibitor stops mast cells from releasing chemicals like histamine, rather than blocking histamine after it's already released.

Why do two identical trials: Running the same study twice (REMIX-1 and REMIX-2) with different patients helps prove the results are real, not a fluke.

Key results: About half of patients reached well-controlled disease, and about 1 in 3 became completely clear of hives and itch.

Safety and side effects: Petechiae (tiny dots of bleeding under the skin) were the main thing to watch for, but most cases were mild and went away on their own.

DOWNLOAD THE INFOGRAPHIC

More resources about chronic hives

Chronic Spontaneous Urticaria - Allergy & Asthma Network

Chronic Urticaria Toolkit

What are hives?

All episodes on urticaria

***********

The Itch Review, hosted by Dr. Gupta, Kortney, and Dr. Blaiss, explores allergy and immunology studies, breaking down complex research in conversations accessible to clinicians, patients, and caregivers. Each episode provides key insights from journal articles and includes a one-page infographic in the show notes for easy reference.

***********

Made in partnership with The Allergy & Asthma Network.

Thanks to Novartis for sponsoring today’s episode. 

This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.

Chronic rhinosinusitis with nasal polyps, or CRSwNP, is a condition driven by ongoing inflammation. That is why treatment is not a one-time fix and why polyps can come back even after surgery. In this episode, Dr. Payel Gupta and Kortney are joined by Dr. Maeve O'Connor, a board-certified allergist and immunologist, to walk through CRSwNP treatment options.

This episode is released around World Anosmia Day because loss of smell is one of the most frustrating and most common symptoms of CRSwNP, and one that treatment can actually help with.

What we cover in this episode about nasal polyps treatment

Nasal therapies as your base management: Saline rinses and nasal steroid sprays are the foundation of CRSwNP treatment. They need to be used consistently as part of your daily routine, not just when symptoms flare.

Why nasal polyps keep coming back: CRSwNP is driven by ongoing inflammation, not just the polyps themselves, so removing them does not address the root cause.

When surgery is the right choice: Sinus surgery can open blocked passages and help nasal sprays reach deeper into the sinuses, but works best as part of a long-term plan, not a one-time fix.

What biologic medications actually do: Biologics target the underlying inflammation causing CRSwNP. Four are currently approved for CRSwNP: dupilumab, omalizumab, mepolizumab, and tezepelumab.

Why follow-up care matters even when you feel better: Inflammation can return before symptoms become noticeable, so regular check-ins with your allergist or ENT are key to catching early signs of polyp regrowth.

About our guest 
Dr. Maeve O'Connor, MD, FACAAI, FAAAAI, is a board-certified allergist and immunologist and founder of Allergy Asthma & Immunology Relief (AAIR) of Charlotte, North Carolina. She treats patients of all ages, practices integrative medicine, and has been named a Top Doctor by Charlotte Magazine since 2007.

More resources

What is Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)?

What are nasal polyps?

What is AERD?

Biologics for Allergic Disease

What to know before starting a biologic 

Oral Corticosteroid Stewardship

 

*********

Made in partnership with The Allergy & Asthma Network.

Thanks to Sanofi-Regeneron for sponsoring today’s episode. 

This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.