The Itch: Allergies, Asthma, Eczema & Immunology The Itch: Allergies, Asthma & Immunology

As temperatures rise and weather patterns become more unpredictable, the effects of climate change on respiratory health become even more noticeable.
Dr. Stephanie Lovinsky-Desir, an expert in respiratory health, joins Dr. G and Kortney to discuss how climate change exacerbates respiratory conditions like asthma, particularly affecting vulnerable populations. 
The episode explores why we should consider the connection between climate change and asthma. Understanding the mechanisms behind it is crucial. Dr. Lovinsky-Desir explains how increased temperatures lead to higher levels of air pollution and create “heat islands" in urban areas. Heat islands are urban areas that are significantly warmer than their surrounding rural areas due to human activities. These islands intensify health risks by trapping heat and pollutants, worsening air quality and increasing respiratory distress.
Dr. Lovinsky-Desir and Dr. G share practical measures that are easy to implement and can significantly help us navigate poor air quality. These include wearing masks during high pollution and monitoring air quality through initiatives like the State of the Air Report or your weather app. She also highlights the role of organizations like the American Lung Association in providing resources and support for improving indoor air quality.
We hope this episode helps you better understand climate change's impact on air quality, the overall environment, and lung health. Hopefully, you can take meaningful steps towards a healthier future for all. If you are in doubt about the impacts of climate change, this episode is for you!
What we cover in our about climate change, air pollution and lung health
The relationship between air pollution, air quality and climate change
The impact of climate change on season allergies
The effect of air quality on lung health
The populations most impacted by poor air quality
Poor housing and its effects on lung health
Programs and resources help make housing healthier 
What you can do to keep your lungs safe
How to explain to someone why they need to care about climate change and asthma
Helpful links
More about our sponsor, Chiesi: https://www.chiesiusa.com/
Pollen Report from Allergy Asthma Network: https://allergyasthmanetwork.org/weather/ 
State of the Air Report from The Lung Association: https://www.lung.org/research/sota
Tips to Manage Asthma and Allergies Caused by Climate Change: https://allergyasthmanetwork.org/news/climate-change-what-you-can/
Lifestyle Changes to Manage Asthma: https://allergyasthmanetwork.org/what-is-asthma/lifestyle-changes-to-manage-asthma/

Have you ever searched for information on mast cell disease only to be overwhelmed by alarming topics like cancer and stem cell transplants? Then this episode is for you!
Our guest, Dr. Marina Kremyanskaya, joins hosts Dr. G and Kortney to provide insight into the progression of systemic mastocytosis and the available treatment options to improve quality of life and extend lifespan.
Dr. Kremyanskaya distinguishes between indolent and aggressive systemic mastocytosis, shedding light on warning signs indicating disease progression. She offers a detailed exploration of treatment approaches for aggressive mastocytosis, highlighting the evolving treatment plan and differing prognosis from indolent cases. Additionally, Dr. Kremyanskayaa delves into the concept of myeloid malignancy, providing insight into the more challenging aspects of advanced systemic mastocytosis progression.
We also dive into stem cell transplants as a potential cure for advanced systemic mastocytosis. Dr.  Kremyanskaya explains why this option is not immediately pursued due to the complexity of the procedure and the risk of graft-versus-host disease (GvHD), a potential complication associated with stem cell transplants.
What we cover in this episode about advanced systemic mastocytosis:
Understanding indolent systemic mastocytosis
Signs indicating progression to advanced mastocytosis.
Treatment strategies for aggressive mastocytosis and associated prognosis.
Explanation of advanced systemic mastocytosis with or without hematologic malignancy.
Definition of myeloid malignancy.
Understanding the impact of advanced systemic mastocytosis on organs.
The effectiveness of early treatment in slowing down the progression.
The role of stem cell transplant in treating mastocytosis.
Stem cell transplant and associated risks
Role of chemotherapy in stem cell transplant.
Overview of graft-versus-host disease.
Addressing whether stem cell transplant serves as a cure for mast cell disease.

Resources about mast cell disease:
Mast Cell Disease Overview: https://allergyasthmanetwork.org/health-a-z/mast-cell-diseases/
What is Anaphylaxis? https://allergyasthmanetwork.org/anaphylaxis/
What is Epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/
The Mast Cell Disease Society: https://tmsforacure.org/

Why talk to a hematologist about mast cell disease and systemic mastocytosis treatment?
Dr. Douglas Tremblay, a leading hematologist, joins Dr. G and Kortney to discuss the role of a hematologist-oncologist in diagnosing and treating mastocytosis. We discuss bone marrow's vital role in diagnosing and treating systemic mastocytosis. 
Dr. Tremblay discusses the latest KIT inhibitors, a promising group of medications, and explains the difference between indolent and advanced systemic mastocytosis. He clarifies how KIT inhibitors work and emphasizes the importance of managing side effects. Finally, Dr. Tremblay provides insights into the future of KIT inhibitor approval and explores the possibility of participating in a clinical trial for Bezulastinib. 
What we cover in this episode about treating systemic mastocytosis:
What is a hematologist looking at with mast cell disease patients?
Mast cell diseases and the role of bone marrow
Bone marrow biopsy for systemic mastocytosis 
What is a bone marrow biopsy?
Information bone marrow biopsy provides for diagnosis

KIT mutation 
KIT mutation testing in bone marrow and blood (digital droplet PCR)
Indolent Mastocytosis versus Advanced Mastocytosis
Current research for treating mast cell disease
How KIT inhibitors work
Do KIT inhibitors weaken the immune system?
KIT Inhibitors discussed in this episode:
Avapritinib
Bezulastinib
Elenestinib

Are KIT inhibitors a cure for mast cell disease?
Determining the tolerance for side effects of medications when researching and adding new medicines for diseases 
The meaning of ‘NIB’ in the medication names
The timeline for the new KIT inhibitors approval
The type of patient that can participate in the clinical trials for Bezulastinib
Resources about mast cell disease:

Dr. Tremblay: https://profiles.mountsinai.org/douglas-a-tremblay

Dr. Tremblay’s email: douglas.tremblay@mssm.edu 



Mast Cell Disease Overview: https://allergyasthmanetwork.org/health-a-z/mast-cell-diseases/


What is Anaphylaxis? https://allergyasthmanetwork.org/anaphylaxis/


What is Epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/


The Mast Cell Disease Society: https://tmsforacure.org/


Current studies enrolling patients: https://tmsforacure.org/clinical-trials/

What is it like when an unpredictable disease like systemic mastocytosis forces you to change the trajectory of your life?
As we continue to unpack mast cell disease, Dr. G and Kortney wanted to get the patient's perspective on living with such a complex disease. Tammie joins the podcast to discuss her journey battling mastocytosis, a rare condition affecting mast cells in the body.
If you ever feel alone on your chronic health journey, know you aren’t! Tammie's resilience and wisdom serve as a beacon of hope. We hope this inspires you to approach your health journey with determination and a sense of community.
 
What we cover in this episode:

Tammie’s mastocytosis journey


The challenges of not getting a proper diagnosis


The pros and cons of being able to google medical conditions


What do to when a doctor does not want to take you on as a patient 


How Tammie separates the disease from her life 


How do you navigate work with a chronic disease?


Working with a mental health team


How do you ask your family/friends for help


Patient's relationship with their healthcare team


Pros and cons of an online community for chronic disease and the importance of a real-life community


 
Connect with Tammie online:
TikTok https://www.tiktok.com/@rachelllargentphillips
Instagram https://www.instagram.com/tammie_rachell/
 
Resources about mast cell disease:

Mast Cell Disease Overview: https://allergyasthmanetwork.org/health-a-z/mast-cell-diseases/


What is Anaphylaxis? https://allergyasthmanetwork.org/anaphylaxis/


What is Epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/


The Mast Cell Disease Society: https://tmsforacure.org/

Can a low-histamine diet help with mast cell disease? Why is stress a big trigger for mast cell disease?
Dr. Milner joins us again to discuss two hot topics in managing mast cell disease. We start by demystifying the low histamine diet and sharing when appropriate. The answer may be different from what you expect or want to hear. We also talk about stress, a topic we are learning impacts so many chronic diseases, especially those related to mast cells. Stress can worsen symptoms, and in this episode, both doctors emphasize the importance of stress management techniques.  
What we cover in this episode about low histamine diet and stress management
Why go on a low histamine diet?
What is histamine intolerance? 
How well do low histamine diets work for mast cell disease?
The impact of stress on mast cell disease
Stresses impact on the gut
Stress management is integral in mast cell disease treatment 
More resources about mast cell disease:
Mast Cell Disease Overview: https://allergyasthmanetwork.org/health-a-z/mast-cell-diseases/
What is Anaphylaxis? https://allergyasthmanetwork.org/anaphylaxis/
What is Epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/
The Mast Cell Disease Society: https://tmsforacure.org/

Where do you begin with mast cell disease treatment when there is such variation among patients? 
Dr. Milner is back with us to discuss the difficulties in treating mast cell activation syndrome and mastocytosis. We will discuss the different approaches to treating mast cell disease and the medications used for mastocytosis treatment. Since no single treatment plan works for everyone, we will explore multiple strategies that can be helpful in managing this condition.
A note: when you hear MCAS mentioned, it stands for Mast Cell Activation Syndrome.
What we cover in our episode about treating mast cell diseases:

What are the steps taken to treat mast cell diseases?


Histamine blockers: antihistamines for mast cell disease and H2 blockers


Mast cell stabilizers: Cromolyn and Ketotifen


Xolair 


Other medications that have been used but not recommended: aspirin, steroids, Singulair


Epinephrine and anaphylaxis


Tyrosine kinase inhibitors (TKI) for Mastocytosis: Avapritinib, Midostaurin


Safety concerns and side effects of Tyrosine kinase inhibitors


 Multidisciplinary approach to managing mast cell disease

About our guest - Dr. Josh Milner
Joshua Milner, MD, is a renowned leader in discovering and understanding genetic diseases leading to allergic symptoms, including Hereditary Alpha Tryptasemia Syndrome, PLAID, PGM3 deficiency, ERBIN mutation, and others. With a background in biology from MIT and an MD with distinction in immunology from Albert Einstein College of Medicine, Dr. Milner has extensive experience in pediatrics and allergy and immunology, serving as chief of the Laboratory of Allergic Diseases at NIAID.
His vision is to leverage genetic variation to improve diagnosis and care for patients with allergic diseases through comprehensive genetic sequencing and functional studies, aiming for personalized medicine and interdisciplinary collaboration in pediatric allergy, immunology, and rheumatology.

More about Dr. Milner: 

https://www.pediatrics.columbia.edu/profile/joshua-milner-md

More resources about mast cell disease:

Mast Cell Disease Overview: https://allergyasthmanetwork.org/health-a-z/mast-cell-diseases/


What is Anaphylaxis? https://allergyasthmanetwork.org/anaphylaxis/


What is Epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/


The Mast Cell Disease Society: https://tmsforacure.org/


FDA Approves AYVAKIT® (avapritinib) as the First and Only Treatment for Indolent Systemic Mastocytosis: https://ir.blueprintmedicines.com/news-releases/news-release-details/fda-approves-ayvakitr-avapritinib-first-and-only-treatment