The Itch: Allergies, Asthma, Eczema & Immunology

Chronic hives guidelines give doctors a roadmap for treatment, but not everyone fits the same path. Pregnancy, breastfeeding, menopause, childhood, getting older, and living with more than one chronic condition can all change how chronic spontaneous urticaria (CSU) is treated.

Kortney and Dr. Payel Gupta are joined by Dr. Allison Ramsey, an allergist and immunologist, to walk through the special populations section of the chronic urticaria guidelines. 

What we cover in this episode about chronic hives in special populations

Why it's not your fault. Dr. Ramsey explains how she "absolves" patients of hunting for a trigger, because CSU starts with the immune system, not with anything outside the body.

Why women are more burdened by chronic hives. About 70% of people with CSU are women. Estrogen can push the immune system toward autoimmunity, and hives can shift with the menstrual cycle and become less common after menopause.

Pregnancy and breastfeeding. Non-drowsy antihistamines are considered safe, and pregnancy data from asthma suggest omalizumab (Xolair) and dupilumab (Dupixent) are too.

Adults 65 and older. Higher antihistamine doses can cause sleepiness and raise the risk of falls, so share every medication you take. Biologics don't interact with other medicines.

Living with more than one condition. People with CSU are more likely to have other autoimmune conditions. If you also have asthma, eczema, nasal polyps, or food allergy, one medication may treat more than one condition, so tell your doctor about everything.

Chronic hives in children. Most hives in kids come from viruses and go away quickly. When kids do have CSU, they often respond better to antihistamines than adults.

More resources

What is Chronic Urticaria?

Chronic Idiopathic Urticaria – CIU

Allergy & Asthma Network Chronic Urticaria Toolkit

More episodes about urticaria

Ep. 164: New Chronic Hives Guidelines: A Look at What's Changing

Ep. 128: Is Chronic Spontaneous Urticaria an Autoimmune Disease?

Ep. 122: Mortality in adult patients with chronic spontaneous urticaria - A real-world cohort study

Ep. 80: Chronic Spontaneous Urticaria Myths & Misconceptions

Ep. 78: Chronic Spontaneous Urticaria Treatments

Ep. 75: Understanding Chronic Spontaneous Urticaria: Hives Demystified

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Made in partnership with The Allergy & Asthma Network.

Thanks to Genentech and Novartis for supporting 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.

We hear a lot about the struggles patients face on their systemic mastocytosis journey, the years of normal labs, the feeling of not being believed. But have you ever wondered what that feels like from the doctor's side?

Kortney and Dr. Payel Gupta are joined by Dr. Alexander Kim, an allergist and immunologist who co-directs the Mast Cell Disorders Program at UC San Diego, for an honest look at what it's like to sit on the other side of the exam table and untangle a diagnosis of this complex condition.

What we cover in this episode about treating systemic mastocytosis

Why "your labs look fine" doesn't mean nothing's wrong. Dr. Kim explains why this journey can be challenging for doctors when labs are normal, but symptoms are severe. 

Why systemic mastocytosis is still hard to diagnose, even with better tools. SM has a clearer testing path than mast cell activation syndrome (MCAS) does, but the overlap between the two still creates real diagnostic uncertainty in practice.

What “dismissiveness” looks like from a doctor's side. From time constraints and busy schedules to the gap between meaning to listen and actually making a patient feel heard.

Practical fixes for short appointments. Asking for a double appointment slot, bringing a written summary instead of hundreds of pages of records, and scheduling shorter, more frequent follow-ups instead of one long visit.

What each side wants the other to understand. What it takes to build a trusting, lasting relationship with a healthcare provider when you're living with systemic mastocytosis.

More resources about mast cell disease

About the PIONEER Trial for Avapritinib

Mast Cell Disease Toolkit

What is Mastocytosis?

What is Mast Cell Activation Syndrome (MCAS)?

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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.

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)

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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.

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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.

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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.