The Itch: Allergies, Asthma, Eczema & Immunology

Mast cell disorders can feel confusing, especially with so much information floating around online and on social media. In this episode, we cut to the chase and tackle the most common mast cell disorder FAQs, straight from the community.

Dr. Dareen Siri joins us to work through community questions on mast cell disorders one by one, from what a mast cell actually is to testing, treatment, diet, and long-term outlook.

What we cover in this episode about mast cell disorders

What is a mast cell. Dr. Siri breaks down what mast cells do in the body and why an overactive one causes symptoms.

The different mast cell disorders. Allergies, autoimmune activation, and clonal disorders like indolent systemic mastocytosis each work differently.

Which tests actually matter. Blood tests, the KIT D816V mutation test, and when a bone marrow biopsy comes into play. Plus, should you consider a urine test?

Treatment and long-term outlook. What targeted treatment (avapritinib) looks like now, and whether a mast cell disorder shortens your lifespan.

Diet, supplements, and bone health. Whether a low-histamine diet helps, what the evidence says about supplements, and why bone density matters long term.

More resources about mast cell diseases

All of our mast cell disease episodes

About the PIONEER Trial for Avapritinib

Mast Cell Disease Toolkit

Mental Health and Mast Cell Disorders

Symptoms, Diagnosis & Treatment Options for Mast Cell Disorders (Recording)

************

Made in partnership with The Allergy & Asthma Network.

Thanks to Blueprint Medicines for sponsoring today’s episode. 

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

How do you decide what is the right medication for you after antihistamines are not working to manage your chronic hives?

Dr. David Lang, one of the authors of the new chronic urticaria guidelines (still in review), walks through every advanced treatment option the way he would if he had as much time as possible with a patient in his office. Along with Dr. Gupta, they cover the three treatments available when antihistamines are not enough, what each one asks of you week to week, and how to walk into your appointment ready to choose.

Dr. Lang’s patient guide: Choosing an Advanced Treatment for Chronic Hives 

What we cover in our episode about  chronic hives treatment

What to think about when choosing a medication: benefit, harm, and burden. Dr. Lang explains why these are three different things, and why the one most patients are never asked about is what a treatment costs them in time, appointments, and schedule.

The three advanced options side by side. Omalizumab (Xolair), dupilumab (Dupixent), and remibrutinib (Rhapsido) compared on how often you take them, how fast they work, and what the side effects really are.

What the scary side effects actually mean. Dr. Lang walks through the anaphylaxis, cancer, and heart risks tied to omalizumab, and explains how likely each one really is.

When blood tests for chronic hives come into the picture. Testing will not tell you why you have hives, but it may hint at which of the three treatments is more likely to work for you.

Insurance may choose your starting point. All three treatments are approved for chronic hives, so if your plan covers one over another, that is a reasonable place to start, not a compromise.

************

Made in partnership with The Allergy & Asthma Network.

Thanks to Genentech & Novartis for sponsoring today’s episode. 

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

Starting a biologic can feel intimidating, especially if you are worried it means being on medication forever, or wondering if it will actually replace your inhaler or your next sinus surgery. After this episode, we hope your biggest biologics questions are answered.

Kortney and Dr. Payel Gupta are joined by Dr. Giselle Mosnaim, an allergist and immunologist, to walk through the united airway, what uncontrolled disease really means, and the most common questions patients have before starting a biologic.

What we cover in this episode about biologics for asthma, COPD, and nasal polyps

The united airway. Why the nose and lungs share the same lining, and why the same biologics can treat conditions in both.

What a biologic actually is. How it targets one specific part of the immune system instead of suppressing the whole thing like steroids.

What uncontrolled disease means. Why taking your medication as prescribed does not always mean your asthma, COPD, or nasal polyps are under control.

The goal of starting a biologic. What results to expect, how biologics work alongside your inhaler or nasal spray instead of replacing it, and how they can reduce the need for repeat sinus surgery.

Common myths and fears. Answers to real patient worries about weight gain, needles, side effects, pregnancy, and being on a biologic long term.

________

Made in partnership with The Allergy & Asthma Network.

Thanks to AstraZeneca for sponsoring today’s episode. 

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

Needing oral steroids for your asthma is a signal, not just a setback. It could be a sign that your asthma is not actually under control, even if you feel like you're managing it day to day.

Dr. Wes Sublett joins us to talk about why relying on steroid bursts is a warning sign, not a solution. Dr. Sublett breaks down what actually counts as an asthma exacerbation, the real risks of frequent oral steroid use, and the treatment options available so patients can avoid repeat trips to the ER.

What we cover in this episode about oral steroids and asthma control

Steroid bursts as a warning sign. Needing oral steroids for asthma is a signal your maintenance treatment may not be working.

What actually counts as an exacerbation. Dr. Sublett explains the difference between a flare and a true asthma exacerbation, and why that distinction matters.

The real risks of oral steroids. Repeated courses are linked to bone loss, diabetes, cataracts, and other long-term health risks.

Why your specialist doesn't automatically know. ERs and urgent cares don't notify your asthma specialist when you're treated, so you have to share that history.

Treatment options beyond steroid bursts. Triple therapy and biologics can reduce or eliminate the need for oral steroids for many patients.

More resources

Oral Corticosteroids (OCS) for Asthma, a deeper explainer from Allergy & Asthma Network

What if I Can't Afford My Asthma Medication?

________

Made in partnership with The Allergy & Asthma Network.

Thanks to AstraZeneca for sponsoring today’s episode. 

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

For decades, the rescue inhaler was simple: feel tight, take a puff, breathe easier. But the newest asthma guidelines have changed what's actually recommended inside that inhaler, shifting away from plain albuterol toward a combination inhaler that treats symptoms and inflammation at the same time.

Kortney and Dr. Payel Gupta are joined by Dr. Bill McCann, allergist and CEO of Allergy Partners, to break down why this combo inhaler approach is now preferred, what it actually contains, and why auto-refilling your old rescue inhaler might be working against you.

What we cover in this episode about rescue inhalers

Understanding asthma: the boiling pot analogy. Dr. McCann explains asthma inflammation using a pot of water on the stove, and why a bronchodilator alone never turns down the heat.

Why a combo inhaler is now preferred. The newest guidelines recommend a single inhaler containing both a fast-acting bronchodilator and a low dose of anti-inflammatory steroid.

AIR and MART, explained simply. Two ways doctors are using this combo inhaler: either as-needed only, or as a daily plus as-needed routine.

The myth of "mild" asthma. Why intermittent or infrequent symptoms don't mean you're free from risk.

The auto-refill trap. Why an automatic pharmacy refill on your old rescue inhaler can quietly hide worsening asthma control from your doctor.

More resources

GINA 2026 Strategy Report (official source)

What is asthma?

Listen to the BATURA Trial

________

Made in partnership with The Allergy & Asthma Network.

Thanks to AstraZeneca for sponsoring today’s episode. 

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