The Itch: Allergies, Asthma, Eczema & Immunology

Getting a diagnosis of systemic mastocytosis takes about 8 years on average. The symptoms aren't specific, many doctors rarely see it, and each test tells only part of the story.

Kortney and Dr. Payel Gupta are joined by Dr. Tony Hunter, a hematologist at Winship Cancer Institute of Emory University. This episode builds on our first episode (#67) about testing. We walk through each test, what it can and cannot tell you, and what happens once you have a diagnosis.

What we cover in this episode about diagnosing systemic mastocytosis

Why would I see a cancer doctor? Systemic mastocytosis is technically a blood cancer, but the indolent type is a long-term condition. It does not usually shorten your life or damage your organs.

What does a high tryptase level mean? It can point to mastocytosis. But the most common cause is hereditary alpha-tryptasemia (HAT), an extra copy of the tryptase gene that a simple blood test can now find.

What if my KIT test came back negative? Most people with mastocytosis have the KIT D816V gene change, but some tests aren't sensitive enough to detect it. Newer, more sensitive tests are still being studied.

Do I really need a bone marrow biopsy? It is the main test to confirm the diagnosis. Dr. Hunter explains what doctors look for and what the procedure actually feels like.

What happens after a diagnosis? Urine tests can show mast cell activity, but they do not confirm the diagnosis. Once you are diagnosed, Dr. Hunter makes sure you have epinephrine and get a bone density scan.

More resources on systemic mastocytosis 

The Itch guide to diagnosing mast cell disease

What is Mastocytosis?

Mast Cell Disease Toolkit

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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.

Many parents worry about using eczema creams on young kids for a long time. In this episode of The Itch Review, we look at a study of roflumilast cream. 

Kortney and Dr. Payel Gupta are joined by allergist Dr. Michael Blaiss to review "Long-Term Safety and Efficacy of Once-Daily and Proactive Twice-Weekly Roflumilast Cream 0.05% for Mild-to-Moderate Atopic Dermatitis in Children Aged 2-5 Years From a 52-Week, Phase 3 Trial (INTEGUMENT-OLE)," published in Pediatric Dermatology, March 2026. 

The FDA approved roflumilast cream 0.05% (Zoryve) for mild to moderate atopic dermatitis in kids ages 2 to 5 in October 2025.

What we cover in this episode about eczema treatment for young kids

The study design and what OLE means. 

Why parents stop eczema creams early. Warnings on eczema creams can scare families. Many stop treatment too soon, even when their doctor says to keep going.

How roflumilast works. Dr. Blaiss explains it as easing off the gas pedal for inflammation. Young kids use a lower strength because their skin soaks up more.

Safety over a year. Only 2.5% of kids had cream-related side effects. Stinging or burning happened in less than 1% of kids. 

Secondary endpoint. Kids whose skin cleared moved to twice-weekly use. Half of them stayed clear for close to 8 months or longer.

DOWNLOAD THE INFOGRAPHIC

Ep. 106: The Risks and Realities of Steroid Overuse for Eczema

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Made in partnership with The Allergy & Asthma Network.

Thanks to Arcutis 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.

Atopic dermatitis is the most common type of eczema. It is not just dry skin. A weak skin barrier and an overactive immune system work together to cause dry, itchy, inflamed skin.

Kortney and Dr. Payel Gupta are joined by Dr. Ted Lain, a board-certified dermatologist and host of the Science of Skin podcast. We go back to the basics: what atopic dermatitis is, why it itches so much, what it looks like, and what really sets off a flare.

What we cover in this episode about atopic dermatitis

Eczema vs. atopic dermatitis. Eczema is an umbrella word for itchy, scaly rashes. Atopic dermatitis is the most common type. Either word is fine at the doctor's office.

What is happening in the body to cause atopic dermatitis. Dr. Lain explains the skin barrier as water balloons held together by mortar. In atopic dermatitis, water gets out, and things like dust, pollen, and germs get in.

Is eczema just dry skin? The immune system overreacts like “a train without brakes.” That is why moisturizer alone is not enough, and why newer treatments target the immune system.

The itch, scratching, and sleep. Scratching hurts the skin even more, but “just don't scratch” is not real advice. Itch often feels worse at night, when there is less to distract you.

Flares, triggers, and food. Fragrances, harsh products, scrubbing, and rough fabrics can trigger flares. Food rarely causes eczema, so strict diets and online food tests usually do more harm than good.

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Made in partnership with The Allergy & Asthma Network.

Thanks to Evommune 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.

The pharmacist is often the first person you talk to about allergies. So what are they thinking about when they hand you that box of antihistamines?

Dr. Gupta and pharmacist Dr. Suzanne Soliman went to the World Congress of Pharmacy in Montreal. They asked pharmacists from the UK, Ghana, Portugal, Argentina, Uruguay, and Malaysia about three patients they might meet at the counter. Kortney joins Dr. G to talk through what the pharmacists shared: check that it’s really allergies, skip the older antihistamines, and look at the whole person.

What we cover in this episode about pharmacist recommendations for allergy medicine

Allergies or a cold? Pharmacists ask three questions: Is there a fever? Is it itchy? Does it keep coming back? Itch and symptoms that return every season point to allergies.

When to see a doctor. A fever, pain on one side of your face, or coughing and wheezing can mean an infection. You may need a medicine the pharmacist can't give you.

Old vs. new antihistamines. Older antihistamines can make you sleepy and slow your reaction time. Pharmacists around the world now choose the newer, non-drowsy ones, like fexofenadine and loratadine.

Anticholinergic side effects. Older antihistamines can also cause dry mouth, constipation, trouble peeing, blurry vision, and confusion. These side effects hit older adults harder.

Bring your medicine list. If you have kidney or liver disease or take other medicines, your pharmacist can still help. Bring a list of everything you take, including what you buy yourself.

Thank you to the pharmacists who shared their thoughts with us: Ahuti Lakhani (UK), Bernard Opoku Ware (Ghana), Adwoa Mensah (Ghana), David Pires (Portugal), Romina Takesyan (Argentina), Cecilia Maldonado (Uruguay), and Susan YH Pan (Malaysia).

More resources

Ep. 151: What Allergists Think About Antihistamines

Ep. 150: What Allergists Really Think About Your Allergy Nasal Spray

Ep. 116: Why Fexofenadine Is Considered a Truly Non-Sedating Antihistamine

Ep. 116 infographic: Which antihistamines cross into the brain

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Made in partnership with The Allergy & Asthma Network.

Thanks to Opella 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.

Hereditary angioedema (HAE) is a rare genetic condition that causes attacks of swelling in the skin, the belly, and sometimes the throat. Because it looks like an allergic reaction, it is often missed for years.

Kortney and Dr. Payel Gupta are joined by Dr. Marc Riedl, Professor of Medicine and Clinical Director of the US HAEA Angioedema Center at UC San Diego, to set the stage for our three-part series on HAE. We cover what HAE is, what is happening in the body, and symptoms that tell you it is HAE and not an allergy.

What we cover in this episode about hereditary angioedema

Why HAE is not an allergy. HAE swelling comes from a different system in the body. That's why antihistamines, steroids, and epinephrine don't stop it.

HAE is genetic. HAE comes from a change in one gene, and it can be passed from parent to child. Each child of a parent with HAE has a 50-50 chance of having it. About 1 in 4 people are the first in their family to have it, so family testing matters. 

What happens in the body. People with HAE don't have enough working C1 inhibitor, the "brakes" on a chemical called bradykinin. Too much bradykinin makes tiny blood vessels leak fluid, and that fluid is the swelling. 

HAE swelling and where it happens. It usually doesn't itch or come with hives, and it can last two to five days. It can show up in the hands, face, feet, belly, or throat. Belly attacks can be very painful, and throat swelling needs emergency care.

Triggers and warning signs. Injury, dental work, estrogen, and stress can set off attacks. Some people notice a red rash that doesn't itch, or tingling, before the swelling starts.

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Made in partnership with The Allergy & Asthma Network.

Thanks to Phavaris 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.