The Itch: Allergies, Asthma, Eczema & Immunology

#106: The Risks and Realities of Steroid Overuse for Eczema

Have you ever wondered if steroids are the best choice for managing your eczema? 

While both topical and oral steroids offer quick relief from severe eczema flares, understanding their long-term risks and safer alternatives can dramatically improve your quality of life.

In this episode, Dr. Mondana Ghias joins Kortney and Dr. Gupta to discuss the complex role of systemic corticosteroids in eczema management. They dive deep into the short-term relief that steroids provide for severe eczema symptoms and emphasize why steroids must be approached cautiously due to potential side effects and dependency risks.

Dr. Ghias also highlights the unique challenges of eczema care for individuals with skin of color, addressing differences in treatment response and the common issue of hypopigmentation caused by topical steroids.

What we cover in our episode about steroid use in eczema treatment:

• Role of Systemic Steroids: When steroids are necessary and how they quickly manage severe eczema flares.
• Risks and Side Effects: Understanding the serious long-term effects of systemic and topical steroids.
• Steroid Withdrawal: Recognizing the signs of steroid withdrawal and strategies to manage rebound effects.
• Challenges of Topical Steroids for Skin of Color: The unique risks of steroid use and managing hypopigmentation.
• Alternatives to Steroids and Innovative Treatments: The rise of biologics and targeted therapies offering safer, long-term solutions.
• The Importance of Specialist Care: Working with a dermatologist or allergist will help you find a sustainable long-term management plan.

Made in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today’s episode.

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

#105 - Understanding Oral Corticosteroid Overuse in Asthma

Ever wonder if the “asthma shot” from the ER, or those go-to steroid pills for your asthma flares, might be doing more harm than good?

Dr. Dipa Sheth joins us to discuss the common pitfalls of relying too heavily on oral corticosteroids (OCS), also known as oral steroids. We unpack why these systemic medications should generally be reserved for short-term use. She also shares how improving asthma control can help you avoid frequent steroid use in the first place.

Although oral steroids can effectively treat asthma flare-ups in emergency settings, overuse poses significant risks, from adrenal insufficiency to osteoporosis. We dig into ways patients can proactively manage their asthma, reduce ER visits, and talk to healthcare providers about preventive treatments (like inhalers or biologics for asthma) that keep inflammation in check without the side effects of frequent steroid use.

Note: Although we discuss oral corticoid steroids, they can also be given as injections or via IV drip for asthma. We would also like to refer to them as systemic steroids as they impact the entire body, unlike inhaled steroids, which target the airways and lungs. 

What we cover in our episode about oral steroid overuse

• Understanding Oral Corticosteroids (OCS): Learn what these steroids (often called the “asthma shot” in the ER) are and how they can help with severe flare-ups.
• Why Overusing Steroids Can Be Risky: Discover the potential long-term side effects of relying on systemic steroids (pills, injections, or IV), from adrenal insufficiency and osteoporosis to more frequent infections.
• Short-Term Fix vs. Lasting Relief for Asthma Care: Learn how urgent care or ER visits may mask an under-managed condition and why seeing a specialist can improve asthma control.
• Safer Alternatives to OCS: Explore inhaled corticosteroids, biologics, and other preventive treatments that target asthma at its source, reducing the need for frequent steroids.
• Taking Control and Reducing ER Visits: Get practical strategies for working with your healthcare provider to minimize steroid use, prevent flare-ups, and break free from the cycle of repeated steroid courses.

This podcast is made in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today’s episode.

This podcast is for informational purposes only and does not substitute for professional medical advice. If you have any medical concerns, always consult with your healthcare provider.

#104 - Achieving Control in Type 2 Inflammation

What does "control" mean when managing allergic conditions, and how can you achieve it?

When you have asthma, eczema, nasal polyps, or other conditions caused by type 2 inflammation, reaching a state of control can dramatically improve your quality of life. But what does "control" really mean? Is it the same as a cure? And what steps should you take if your current treatment isn't working?

In this episode, Dr. Payel Gupta and Kortney dive deep into the idea of control in the context of Type 2 inflammation. They explain that control doesn't mean you'll never experience symptoms again. Rather, it's about having fewer, milder flare-ups and the freedom to live your life more comfortably.

Dr. Gupta explains what control means for various conditions, why it matters, and how recognizing signs of poor control can protect against long-term complications. Kortney shares her own experience managing asthma and eczema with biologics, highlighting why symptom tracking and regular check-ins with your doctor are essential, even when you’re feeling good.

What we cover in our episode about achieving control over Type 2 inflammation:

• Defining Control in Type 2 Inflammation: Learn what control actually looks like. Discover the difference between controlling symptoms and curing the condition entirely.
• Why Achieving Control Matters: Find out why uncontrolled Type 2 inflammation can lead to worsening symptoms, frequent hospital visits, increased medication needs, and significantly impact your day-to-day life.
• Managing Multiple Conditions and the Role of Specialists: Understand why having more than one Type 2 inflammatory condition can lead to a "domino effect," worsening overall health. Learn how specialists like allergists can help you manage multiple conditions effectively.
• Treatment Options for Controlling Type 2 Inflammation: Get an overview of available treatments, including biologic therapies specifically designed to target underlying inflammation pathways. Understand the role these medications play in improving quality of life.
• Practical Tips for Managing Symptoms at Home: Learn ways to reduce inflammation by identifying and minimizing triggers, allergy-proofing your environment, and adopting healthier lifestyle practices.

More episodes that will help you: 

• Ep. 101 What is Type 2 Inflammation
• Ep. 98 Food Allergy Treatment and Management
• Ep. 87 What biologic therapies are available for allergic conditions?
• Ep. 85 Navigating Biologic Therapy – What You Need to Know
• Ep. 78 Chronic Spontaneous Urticaria Treatments
• Ep. 56 Biologic Therapies for Asthma

Made in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today’s episode.

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

#103 - Pediatric Type 2 Inflammation: can we slow or stop allergic conditions in children?

Can you slow down the atopic march and prevent kids from developing more allergic diseases?

Type 2 inflammation plays a central role in allergic diseases, which impact children from infancy through adulthood. From eczema and asthma to food allergies and allergic rhinitis, these conditions are all connected through an underlying immune response: Type 2 inflammation. But is there a way to prevent the progression of these diseases?

In this episode, Dr. Payel Gupta and Kortney are joined by Dr. Priya Bansal to explore how Type 2 inflammation manifests in children, the concept of the atopic march, and whether treatments like immunotherapy or biologics can alter the course of the diseases.

Many parents aren’t aware of the atopic march until their child starts developing multiple allergic conditions. Understanding how Type 2 inflammation progresses and when to intervene can be crucial in managing these diseases early. Dr. Bansal shares her expert insights on the best time to seek treatment and how biologics may help some children break the cycle of inflammation.

What we cover in our episode about type 2 inflammation in children

• Understanding Type 2 Inflammation in Children: Understand type 2 inflammation’s role in conditions like eczema, asthma, allergic rhinitis, and food allergies. Learn why children with one allergic condition often develop others over time.
• The Atopic March: Discover why some children with eczema go on to develop asthma and food allergies. Learn why early intervention can make a difference.
• Immunotherapy and Biologics: Can They Change the Course of Disease? Understand how allergy shots, OIT, SLIT and biologics work, when they are recommended, and whether they can stop or slow down the atopic march in children.
• When to See an Allergist & Parental Concerns About Treatment: Learn the signs that indicate your child may need an allergist evaluation. Plus, we address common concerns about aggressive treatment options, including steroids and biologics.
• Managing Type 2 Conditions at Home & School: Practical tips for parents navigating food allergic diseases.

Made in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today’s episode.

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

 

#102 - Comorbidities of Type 2 Inflammation

Why do conditions like asthma, nasal polyps, or eczema become more severe when they coexist?

Kortney and Dr. Payel Gupta are joined by Dr. Michael Blaiss to explore the common thread linking multiple allergic and inflammatory diseases: Type 2 Inflammation. If you’ve ever wondered why certain conditions often appear together, this deep dive will help you connect the dots.

Type 2 Inflammation is a hot topic in immunology because it’s the engine that drives many allergic and inflammatory diseases. It’s also the key to modern treatment strategies, including targeted biologic therapies. Dr. Blaiss explains how clinicians recognize multiple Type 2-driven conditions in the same patient, why it is important to know the connection between multiple conditions and Type 2 inflammation, and the big-picture benefits of treating inflammation aggressively to prevent complications.

What We Cover in our Episode about The Diseases Related to Type 2 Inflammation

• Conditions Related to Type 2 Inflammation: Explore how chronic rhinosinusitis with nasal polyps (CRSwNP), rhinitis, asthma, atopic dermatitis (eczema), prurigo nodularis, eosinophilic esophagitis (EoE), and food allergies can all share a common inflammatory pathway.
• The Likelihood of Having Multiple Type 2 Conditions: How often do patients have more than one condition related to Type 2 Inflammation, and why is recognizing overlap a potential game-changer for diagnosis and treatment?
• Treating the Root Inflammation vs. Individual Symptoms: Discover how clinicians decide whether to address each condition separately or tackle the underlying Type 2 inflammatory process affecting them all.
• Markers & Personalized Medicine: Dr. Blaiss discusses whether potential tests, such as eosinophil counts or IgE levels, can confirm Type 2 inflammation. He also explains how knowing you have Type 2 Inflammation can help guide targeted therapy.
• Prevention & Aggressive Intervention: Understand why it’s crucial to treat inflammation early to reduce the risk of developing multiple Type 2 conditions and how this proactive approach benefits long-term health.

Want to know more? Type 2 Inflammation Overview – Explains the role of Type 2 inflammation in conditions like asthma and nasal polyps.

This podcast is for informational purposes only and does not substitute for professional medical advice. If you have any medical concerns, always consult with your healthcare provider.

Produced in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today’s episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.

#101 - What is Type 2 Inflammation?

What do asthma, eczema, EoE, and nasal polyps have in common? They all stem from Type 2 inflammation!

Type 2 inflammation is a major cause of many allergic and inflammatory conditions, yet it remains widely misunderstood. In this first episode of our four-part series on Type 2 Inflammation, we discuss the basics, unpack its impact on the immune system, explain how it contributes to chronic inflammation in the body, and explain why it matters for treatment and management.

What we cover in our episode about Type 2 Inflammation

• Understanding Inflammation: Inflammation is your body’s natural defence mechanism, but it can become problematic when it turns chronic.
• Normal vs. Chronic Inflammation: Not all inflammation is bad! Learn the difference between the body’s normal immune response and long-term chronic inflammation.
• What Sets Type 2 Inflammation Apart? Unlike other immune responses, Type 2 inflammation involves a specific pathway.
• Key Players in Type 2 Inflammation: Th2 cells, cytokines (IL-4, IL-5, IL-13), IgE antibodies, and eosinophils.
• Measuring Type 2 Inflammation: How blood tests can help determine if Type 2 inflammation is contributing to your symptoms.

Want to know more? Type 2 Inflammation Overview – Explains the role of Type 2 inflammation in conditions like asthma and nasal polyps.

This podcast is for informational purposes only and does not substitute for professional medical advice. If you have any medical concerns, always consult with your healthcare provider.

Produced in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today’s episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.

 

#100 🎉 100 Episodes of Allergy Education: Lessons from an Allergist & Patient

We’re celebrating 100 episodes and six years of The Itch Podcast! 

In this special episode, Dr. Payel Gupta and Kortney reflect on their journey—sharing insights from their experiences as a doctor-patient duo. Dr. G talks about how the podcast has influenced her as a provider, while Kortney shares how it has literally changed her life.

We also introduce The Journal Club, a brand-new series in which we unpack the latest journal articles in our famous, easy-to-digest style.

What We Cover in This Episode:

• Why Kortney decided to share her story about allergies, asthma, and eczema.
• Why Dr. Gupta became an allergist and how her personal journey shaped her career.
• The impact of patient advocacy—why Dr. G is passionate about empowering patients.
• The Itch Podcast's partnership with Allergy & Asthma Network and how it’s raising awareness and education.
• Lessons from six years of podcasting—what we’ve learned from our guests, experts, and YOU, our listeners.
• Introducing The Journal Club—a new series unpacking medical research in a simple and relatable way.

#99 - Understanding Infant Anaphylaxis

What would you do if your baby had a severe allergic reaction?

Recognizing and treating anaphylaxis in babies can be overwhelming, but knowing the right signs and symptoms can help you decide when to use epinephrine or distinguish it from a cold. Pediatric allergist Dr. Michael Pistiner joins us to discuss how to recognize anaphylaxis in infants, when to use epinephrine, and why early food introduction matters.

Understanding food allergies in infants, anaphylaxis symptoms, and emergency treatment is essential for parents and caregivers to act quickly and confidently. This episode will give you the confidence to respond in an emergency.

What We Cover in Our Episode on Infant Anaphylaxis

• What is anaphylaxis, and how does it present differently in infants vs. older children?
• How to differentiate an allergic reaction from common childhood illnesses.
• Why early allergen introduction is crucial and
• How over-testing can lead to unnecessary worry.
• When to use epinephrine vs. antihistamines for treating reactions.
• Parental fears about epinephrine and why it’s always the safest choice in an emergency.
• When to call 911 after administering epinephrine.
• Why carrying two epinephrine auto-injectors is essential for managing severe reactions.

More resources about infant anaphylaxis: 

• More from Dr. Pistiner about infant anaphylaxis
• What is Epinephrine
• More About Food Allergies
• More About Anaphylaxis
• Food Allergy Treatment & Management
• Living with Food Allergies Guide
• What Can You Do If You Can’t Afford Allergen-Free Foods?
• What if I Can’t Afford My Allergy Medications?
• Early Introduction Guidelines

This podcast is made in partnership with The Allergy & Asthma Network. Thanks to Kaléo for sponsoring today’s episode. 

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

#98 - Food Allergy Treatment and Management

Is there a cure for food allergies? Unfortunately, not yet. However, exciting new treatments are emerging that offer hope and improved quality of life for those managing food allergies.

Dr. Maya N. Gharfeh joins us to explore innovative options for treating food allergies. In this episode, we cover comprehensive strategies ranging from traditional avoidance techniques to cutting-edge treatments like omalizumab (Xolair) and Oral Immunotherapy (OIT).

While these treatments are promising, they are not cures. Dr. Gharfeh shares valuable insights on integrating these options into your allergy management plan. She also discusses how to determine whether Xolair or OIT might be the right choice for you or your child. Despite advancements, avoidance remains the cornerstone of food allergy management and must still be practiced even while undergoing treatment.

What We Cover in the Episode about Food Allergy Treatment Options

• Effective methods for food allergy avoidance
• Deciphering packaged food labels and "may contain" statements
• Understanding cross-contamination and cross-contact
• Insights into Xolair and its role in food allergy treatment
• An overview of Oral Immunotherapy (OIT)
• Guidance on choosing between Xolair and OIT

GUIDE: Food Allergen Alternative Names on Labels

Produced in partnership with The Allergy & Asthma Network.

Thanks to Genetech for sponsoring today’s episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.

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

#97 - The Nuances of Food Allergy Testing

Think diagnosing food allergies is as simple as running a test? Think again. Food allergy testing is a maze of gray areas, false positives, and, hopefully, a clear food allergy diagnosis.

Navigating food allergy testing can feel overwhelming, with skin pricks, blood tests, and conflicting advice. How do you determine which tests are truly useful? How can you avoid unnecessary dietary restrictions from false results?

In this episode, Dr. David Stukus, a board-certified allergist and immunologist, joins Dr. Gupta and Kortney to demystify the science of food allergy testing. From the importance of patient history to the latest diagnostic tools, Dr. Stukus provides clear guidance to help you make informed decisions while navigating food allergy testing.

What we cover in our episode about food allergy testing

• The Crucial Role of History in Food Allergy Diagnosis: Dr. Stukus highlights why understanding a patient’s reaction history (symptoms, timing, and context) is critical for guiding effective testing decisions.
• Choosing the Right Tests: We break down skin prick testing, blood tests like IgE and component testing, and innovations like epitope mapping. Dr. Stukus explains why IgG testing is untrustworthy and emphasizes oral food challenges as the gold standard for diagnosis.
• False Positives and Negatives: Learn why expert interpretation of test results is crucial and how overtesting can lead to unnecessary restrictions and confusion.
• When to See an Allergist: Practical advice on when to consult a specialist and what to expect during your visit for evidence-based care.

This podcast is made in partnership with The Allergy & Asthma Network. Thanks to Genentech for sponsoring today’s episode.

About Our Guest

Dr. David R. Stukus is a renowned allergist and immunologist at Nationwide Children’s Hospital and a professor at Ohio State University College of Medicine. He is known for his dedication to patient education and myth-busting in allergy care and is a trusted expert in food, asthma, and environmental allergies.

Follow Dr. Stukus on Instagram: @allergykidsdoc