The Allergist

CSACI
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Welcome to your allergy lifeline..."The Allergist."  A show that separates myth from medicine.  Every episode of The Allergist is designed for YOU – the medical professional aiming to stay on the cutting edge of allergy care. We'll clarify, correct, and, most importantly, contextualize the latest evidence.

  1. 3 HR AGO

    The Expanding Toolbox for Food Allergy

    “It’s a fun time to be a food allergist”—Dr. David Fleischer Food allergy treatment is no longer just about avoidance, epinephrine, and hoping for the best. With high-dose OIT, low-dose OIT, SLIT, EPIT, Xolair, and other biologics entering the conversation, allergists now face a more practical question: what are we trying to achieve, and what approach best fits this patient and family? On this episode, Dr. Mariam Hanna is joined by Dr. David Fleischer, section head of allergy and immunology and director of the Allergy and Immunology Center at Children’s Hospital Colorado, and professor of pediatrics at the University of Colorado School of Medicine. He walks through how dose, route, safety, family goals, practicality, and flexibility all shape the choice of therapy. Key Points Low-dose OIT may offer similar protection to higher-dose protocols in some patients, making the dose question more about goals, risk, and fit.Protection is the first goal; clinical remission remains the harder, longer-term hope.Lower-dose approaches may offer practical advantages, including fewer up-doses, fewer clinic visits, and potentially fewer side effects.SLIT and EPIT may be useful options for families looking for more forgiving, lower-burden approaches.Xolair can provide protection for selected patients, but Dr. Fleischer emphasizes that it is not disease-modifying.Food allergy treatment is becoming a shared decision about efficacy, safety, practicality, and what the family actually wants from therapy.With more tools in the food allergy toolbox, the future may not be one perfect protocol for everyone. It may be choosing the right therapy for the right patient, then having the flexibility to change course when life, goals, or tolerance change. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    28 min

  2. 28 APR

    Evidence-Based or Autopilot? A review of systematic reviews

    “We need more than just random care. We need randomized care.” — Dr. Derek Chu For years, the allergy world has been drowning in a sea of data—risk factors, prevention strategies, and enough diagnostic tools to fill a warehouse. But how do you translate 340 different risk factors into a cohesive plan when an anxious parent is sitting in your clinic demanding a skin test for their four-month-old?. On this episode, Dr. Mariam Hanna is joined by "systematic review genius" Dr. Derek Chu to unpack the evidence-based roadmap for food allergy and atopic dermatitis. It’s time to move past the "noise" and start reading between the lines of what our patients actually need. Key Points: Major vs. Minor Signals: Eczema severity and family history are the big players, while being first-born or male are merely minor notes in the risk profile.The Diagnostic Trap: Testing only works if it changes practice; otherwise, you’re just putting a baby through the trauma of an itchy back for a 20% certainty bump.De-escalating Momentum: Be skeptical of previous "avoid all nuts" labels; if the patient is already eating the food, do not skin test them to it.The TITAN Initiative: We need national, high-quality food challenge capacity to provide the clarity that families are actually looking for.Beyond Narrative Synthesis: The new eczema guidelines involve patients as partners and weigh everything from JAK inhibitors to the humble (but low-certainty) bleach bath.Clean Hands, Frequent Moisture: Prevention of atopic dermatitis may be gray, but moisturizing with every diaper change—using clean hands—is a low-stakes winDr. Chu walks us through the "diagnostic momentum" that often leads clinicians to over-test and over-restrict, and why your Royal College exam cutoffs might not be as definitive as you remember. From the major and minor predictors of food allergy to the "multimorbid" patient with eczema, this conversation is a masterclass in being sensible and judicious at the bedside. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    26 min

  3. 14 APR

    Microbiome in IEI, Much More Than Probiotics

    “We came up with the idea of testing a ketogenic diet… which in mice, it’s basically a lot of Crisco… giving a keto diet to mice with CGD… led to a decreased susceptibility to colitis.” —Dr. Emilia Liana Falcone The microbiome isn’t something sitting on the sidelines. It’s part of the immune system, interacting with the barrier, shaping responses, and, in IEI, reflecting the underlying defect. On this episode, Dr. Mariam Hanna is joined by Dr. Emilia Liana Falcone, physician-scientist and director of the Microbiome and Mucosal Defense Research Unit at the Montreal Clinical Research Institute, to walk through how these host–microbe interactions drive disease. From early-life immune programming to microbial signals that activate inflammatory pathways, this is a shift from association to mechanism. And a step toward therapies that target both sides of the equation. Key Points: The microbiome reflects the underlying immune defect in IEIFocus on what microbes are doing, not just which ones are presentMicrobiome changes both result from—and contribute to—diseaseEarly life is a critical window where these interactions are setLoss of protective microbial functions matters more than specific bacteriaMicrobial signals can directly drive inflammation (including inflammasome activation)Future treatments will likely combine immune therapy with microbiome-targeted approachesThis is not about adding a probiotic. It’s about understanding how immune defects reshape the microbial environment, and how that environment feeds back into disease. Get that interaction right, and you’re not just managing symptoms. You’re changing the system driving them. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    26 min

  4. 31 MAR

    Small Risks Big Rewards with SCIT

    “This is a safe and very effective therapy, which is probably underutilized within our own community.” —Dr. Susan Wasserman Subcutaneous immunotherapy (SCIT) sits in that uncomfortable space between routine and risk. It’s one of the few interventions in allergy that can actually modify disease. But it also carries a small, very real risk of severe reactions. On this episode, Dr. Susan Wasserman, professor at McMaster University and a national leader in immunotherapy, walks through what safety really looks like in practice. And where things still go wrong. Key Points: Systemic reactions are uncommon but not rareSafety has improved through better patient selection, standardized extracts, and clinic preparednessUncontrolled asthma is the most important risk factor for severe reactionsPrior systemic reactions require reassessment, especially if the cause is correctableBuild-up dosing carries higher risk than maintenanceRush and cluster protocols increase risk and need clear justificationThe 30-minute observation period captures most but not all reactionsBeta blockers and ACE inhibitors may worsen reaction severity without increasing incidenceSCIT is one of the few tools we have that can actually change the trajectory of allergic disease. But it demands discipline. Careful screening. Reliable processes. And a team that’s ready to act when things go sideways. Because most of the time, it’s safe. And the rare times it isn’t—that’s where preparation matters most. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    28 min

  5. 17 MAR

    Rewriting the Immune Code

    "So the future is one IV infusion, likely no chemotherapy, and that'll cure our IEIs." — Dr. Nicola Wright For children born with inborn errors of immunity, bone marrow transplant has long been the closest thing medicine had to a cure. It works — but it comes with chemotherapy, graft-versus-host disease, and a donor search that doesn't always end well. Gene therapy is changing that calculus. Dr. Mariam Hanna speaks with Dr. Nicola Wright, a pediatric hematologist and clinical immunologist at the Alberta Children's Hospital and holder of the Barb Ibbotson Chair of Pediatric Hematology, whose research focuses on developing gene editing platforms for blood and immune disorders. On this episode, they discuss: Why bone marrow transplant is, in Dr. Wright's words, "almost a poor man's gene therapy" and what gene therapy offers insteadThe spectrum of technologies: lentiviral insertion, CRISPR, base editing, and prime editing. What each does, and where each falls shortImmune reconstitution outcomes across diseases, including over 90% good immune reconstitution in ADA-deficient SCID treated with lentiviral therapyHow to counsel a family when gene therapy might be an option and why most patients still can't access itThe "valley of death": why therapies that work in trials are failing to reach patients, and what it will take to cross itCAR T-cell therapy in IEI, including a Canadian trial underway for refractory autoimmune diseaseWhat long-term follow-up looks like and why 15-year post-trial monitoring is now an FDA requirementThe science is outpacing the infrastructure. Dr. Wright's vision of shipping cells instead of patients, in vivo delivery via lipid nanoparticle, no chemotherapy required isn't speculative. The runway is being built. The plane is already flying. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    28 min

  6. 3 MAR

    Consent is a Conversation

    "That wholesome conversation that you take a minute or two to go through really creates a physician-patient relationship, expands that communication. Probably will not only improve patient outcomes, but reduce medical-legal risk for physicians in the consent process." — Dr. Lisa Thurgur A signed form isn't consent. It's paperwork. On this episode, Dr. Mariam Hanna is joined by Dr. Lisa Thurgur — emergency physician, award-winning educator, and a physician advisor with the Canadian Medical Protective Association — to unpack what meaningful consent looks like in daily practice. Inadequate consent is one of the most common allegations in CMPA cases, across every specialty. On this episode: The three elements of valid consent — and what capacity actually meansWhy a signed consent form is not the same as an informed patientImplied versus expressed consent: when each applies, and when to re-consentWhy serious risks like anaphylaxis — and death — must be disclosed, and how to frame that conversationConsent in minors: why maturity — not age — determines capacity (with one exception in Quebec)What to do when parents disagree — or a minor refusesPatients recording their visits: what physicians need to knowPARQ: a four-point mnemonic for structuring both the conversation and the chart noteThe say-back technique: asking patients what they understood, and why it mattersDone well, consent isn't something you do in addition to practicing good medicine. It improves outcomes, strengthens adherence, and reduces medical-legal risk. In other words, it is good medicine. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    25 min

  7. 17 FEB

    Infant anaphylaxis: What it looks like when they can't tell you

    "I have come across allergists in different countries who often don't even prescribe epinephrine for very young children that have only had a history of mild reactions." — Dr. Katherine Anagnostou An inconsolable cry. A baby who's just not acting right. Tongue thrusting. Lip licking. Scratching at their own tongue. These aren't the symptoms that make it into standard diagnostic criteria — but they might be the clearest signal a non-verbal child can give. On this episode, Dr. Mariam Hanna is joined by pediatric allergist and immunologist Dr. Katherine Anagnostou to explore how anaphylaxis presents in infants and toddlers, why the standard criteria don't always apply, and how allergists can help caregivers recognize — and treat — serious reactions in children who can't yet put words to what they're feeling. On this episode: Why modified criteria for infant and toddler anaphylaxis matterBehavioral signs like irritability, clinginess, lethargy, or withdrawal as red flagsThe role of context and timing in recognizing reactionsSurrogate symptoms — tongue thrusting and lip licking for oral itching, drooling, horse cryWhy urticaria shows up in 90% of infant anaphylaxis casesEpinephrine dosing: the 0.1 mg option for infants 7.5-15 kg and safety of 0.15 mg in smaller babiesWhy not every infant who receives epinephrine needs the EDSecond-dose timing: five minutes, not tenNovel delivery routes on the horizon — intranasal and sublingual epinephrineDr. Anagnostou returns to one principle throughout: parents generally know their children pretty well. The job of the allergist isn't to create fear or overcomplicate recognition — it's to help families spot what's different, understand the context, and feel equipped to act when it matters. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    28 min

  8. 3 FEB

    The many faces of milk problems

    “There is nothing magical that happens in your gut that says, ‘oh, now you’re ready for cow’s milk.’ — Dr. Farah Khan Milk has a special talent for creating chaos in clinic. One day it’s mucousy stools and a terrifying diaper photo, the next it’s hives after yogurt, delayed vomiting with lethargy, or a family that’s been dairy-free for years with no improvement in eczema. On this episode, Dr. Mariam Hanna is joined by pediatric allergist and clinical immunologist Dr. Farah Khan to walk through the many ways “milk problems” show up — and how allergists can avoid overdiagnosis, unnecessary testing, and prolonged elimination diets that may do more harm than good. On this episode: Why allergic proctocolitis (cow’s milk protein intolerance) is often overdiagnosedWhen skin testing and IgE testing are useful Understanding the difference in lactose intolerance How baked milk can be used to improve quality of life in IgE-mediated milk allergyWhat makes FPIES to milk tricky, including earlier-than-expected reactionsWhy dairy elimination for eczema or EOE needs caution and frequent reassessmentAcross each of these scenarios, Dr. Khan returns to the same principle: eliminating dairy should never be a one-and-done decision. Revisiting the diagnosis, retrying thoughtfully, and weighing quality of life alongside risk are essential — especially when prolonged avoidance can set the stage for the very allergy clinicians are trying to prevent. Have an idea for the show or a comment, send us a text! Visit the Canadian Society of Allergy and Clinical Immunology Find an allergist using our helpful tool Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca The Allergist is produced for CSACI by PodCraft Productions

    29 min
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Trailer

About

Welcome to your allergy lifeline..."The Allergist."  A show that separates myth from medicine.  Every episode of The Allergist is designed for YOU – the medical professional aiming to stay on the cutting edge of allergy care. We'll clarify, correct, and, most importantly, contextualize the latest evidence.

Information

  • Creator
    CSACI
  • Years Active
    2023 - 2026
  • Episodes
    71
  • Rating
    Clean
  • Copyright
    © 2026 The Allergist
  • Show Website
    The Allergist

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