The Itch: Allergies, Asthma, Eczema & Immunology

#67 - How to Diagnose Mast Cell Disease

Put on your detective hat because we will be diving into how to diagnose mast cell disease!

Dr. G and Kortney are joined by Dr. Josh Milner, one of the top experts in the field of mast cell disease, as they dive into the complexities of diagnosing mast cell disorders, focusing on cases of unexplained anaphylaxis and using this as our guide to understanding all of the tests that doctors do to figure out what is happening with your mast cells. 

From histories to blood and urine tests to Darier's sign, bone marrow biopsies and more, we dig into the many tests needed for the detective work diagnosing mast cell disease. We learn that a nuanced approach is required to diagnose mast cell disorders and the importance of thorough evaluation to differentiate between potential causes.

This podcast was made in partnership with Allergy & Asthma Network. We thank Blueprint Medicines for sponsoring this podcast.

What we cover in our episode about diagnosing mast cell disease:

• Unexplained anaphylaxis could be linked to mast cell disorders.

• Diagnostic tools:

  • Blood tryptase test (fast but time-sensitive)

  • Urine metabolite tests (easier, longer window)

  • Skin rash assessment (urticaria pigmentosa)

  • Bone marrow biopsy (serious cases)

• Symptoms: Sudden episodes, chronic issues like fatigue, depression.

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/

#66 - Interview with Dr. Gailen D. Marshall, Jr.

Have you ever wondered why your doctor puts their membership in their bios? Why is it relevant to a patient that your allergist is a member of the ACAAI?

This podcast is made possible through Allergy & Asthma Network’s partnership with the American College of Allergy, Asthma and Immunology.

Dr. G and Kortney had the special privilege of interviewing Dr. Gailen Marshall, the president of the American College of Allergy, Asthma, and Immunology (ACAAI). He explains what the ACAAI, also known as the College, does and why this matters to patients. We learn about the resources provided by the College, which offer patients invaluable support in managing their allergies. From accessing specialized care through the "Find an Allergist" tool to engaging with the ACAAI's educational materials and advocacy opportunities, patients are empowered to take control of their treatment journey.

We also dive into Dr. Gailen Marshall's work in psychoneuroimmunology, which sheds light on how both external and internal environments impact allergic reactions. We touch upon Dr. Marshall's Presidential Initiative, CAAPER, which bridges the gap between community and academic allergists, driving innovation in patient treatment. As allergy research continues to advance, Dr. Marshall's leadership underscores the importance of interdisciplinary collaboration and patient-centred care in navigating the complexities of allergic diseases.

What we cover in the episode

• Dr. Marshall’s field of study: Psychoneuroimmunology
• What does the American College of Allergy Asthma and Immunology (ACAAI) do?
• How is the ACAAI relevant to patients?
• How can a patient take advantage of the resources the ACAAI has?
• How can patients be involved with the ACAAI?
• Why should you see an allergist?
• Dr. Marshall’s Presidential Initiative - Community and Academic Allergist Partnership in Education and Research (CAAPER)

About our guest, Dr. Marshall

Gailen D. Marshall, Jr. MD, PhD, FACP, is the president of the American College of Allergy, Asthma and Immunology and holds distinguished roles as Chair of Allergy and Immunology, Professor of Medicine and Pediatrics, Vice Chair for Research, Director of the Division of Clinical Immunology and Allergy, and Chief of the Laboratory of Behavioral Immunology Research at the University of Mississippi Medical Center in Jackson. 

With a background in both Immunology and Medicine from the University of Texas Medical Branch in Galveston and extensive training at institutions like the University of Iowa and the University of Tennessee at Memphis, Dr. Marshall is renowned for his expertise in integrative approaches to managing inflammatory diseases. His research delves into the impact of psychological stress and environmental factors on immune responses, aiming to identify biomarkers for stress susceptibility.

With over 200 publications and active engagement as a speaker in regional, national, and international forums, Dr. Marshall also served as Editor-in-chief of the Annals of Allergy, Asthma and Immunology, showcasing his leadership in the field. Additionally, he plays a vital role in professional societies like the Southern Society for Clinical Investigation, where he serves as Secretary-Treasurer and contributes to various committees, highlighting his commitment to advancing clinical research and education.

 

#65 - The Symptoms and Triggers of Mast Cell Disease

Have you ever considered whether your nasal congestion, IBS, brain fog, and hives are related? 

This podcast was made in partnership with Allergy & Asthma Network. We thank Blueprint Medicines for sponsoring this podcast.

Dr. Anne Maitland joins us as we delve into the complex world of mast cell disease. From the confusing range of symptoms to the unpredictable nature of each person's experience, we unravel the mysteries that make mast cell disorders so uniquely difficult to tackle.

Dr. Maitland is an expert in allergy and immunology and sheds light on the diverse manifestations of mast cell dysfunction, from headaches and nasal congestion to gastrointestinal issues and skin reactions like hives.Dr. Maitland emphasizes the importance of recognizing mast cell dysfunction's impact across different organs for accurate diagnosis and management.

What we cover in our episode about mast cell disease:

• Symptoms of mast cell disease

• How to connect the dots of mast cell disease symptoms

• What is a sign that your symptoms are related to mast cells

• The job of mast cells and their scientific history

• Is an anaphylactic reaction a mast cell disease?

• What triggers mast cell disease? 

• Mast cell targetted medications and how this can hide your symptoms

About our guest - Dr. Maitland

Dr. Maitland is a highly respected physician and a Fellow of the American College of Allergy, Asthma, and Immunology. She was named New York Times' Super Doctors in 2011 and one of America's Top 21 Women's Doctors by Lifescript.com in 2009. Dr. Maitland is actively involved in creating awareness of immune-mediated disorders and researches to enhance treatments for allergies, asthma, and recurrent infections. She specializes in allergic skin disorders, allergic rhinitis, drug allergies, food allergies/sensitivities, asthma, and recurrent infections. 

Dr. Maitland holds an MD and PhD from the University of Pennsylvania and completed her residency in Internal Medicine at Brigham and Women's Hospital in Boston. She also pursued a Fellowship in Allergy and Immunology at Brigham and Women's Hospital and Mount Sinai Hospital in New York.

More about Dr. Maitland: 

• https://www.metrodora.co/anne-maitland

• https://www.drannemaitland.net/dr-anne-maitland

More resources about mast cell disease:

• Mast Cell Disease page: 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/

#64 - Eyelash Extension Allergy

Are you allergic to your eyelash extensions?

Eyelash extensions have become increasingly popular in recent years, offering a way to achieve fuller, longer lashes without the hassle of applying mascara every day. However, some potential risks are associated with eyelash extensions, including allergic reactions.

Dr. Janice Luk joins Dr. G and Kortney to discuss eyelash extensions and what happens when things go wrong. We dive into eyelash extension allergies and contact dermatitis, what the reactions look like, how to treat the reactions best and why you need to take care of your biofilm.

No one wants to play with their vision or have an allergic reaction around the eye; this episode will help you better understand what could happen and how to prepare your lash extensions properly.

What we cover on eyelash extension allergies:

• What are eyelash extensions?

• How eyelash extensions differ from what you can do at home

• What does the allergic reaction to eyelash extensions look like?

• Contact dermatitis versus an IgE-mediated allergic reaction

• What glues are being used, and what would cause the reaction?

• Symptoms and treatment for a lash extension allergy

• Why you don't want to use over-the-counter medication for your eyes

• The importance of keeping a clean biofilm

• Eyegiene

• Traction alopecia caused by lash extensions

• When should you seek medical attention for eyelash extension reactions

• What is the difference between an ophthalmologist and an optometrist

#63 - Mast Cell Diseases & Systemic Mastocytosis: The Basic Science

The basic science of mast cells is the first episode in our 6-part series exploring Mast cell diseases. To start the series, we explore the intricate workings of mast cells by diving into how they work and what happens when something is off balance.

Have you ever wondered what releases histamine and how this happens? Then this episode is for you!

What we cover in our episode about mast cell disease:

• What are mast cells, and what do they do?

• What are the different types of mast cell diseases?

  • Mastocytosis

  • Mast Cell Activation Syndrome

  • Hereditary Alpha-tryptasemia

• The 7 types of mastocytosis

• The cause of mast cell disease

  • KIT gene mutation in Mastocytosis

More resources about mast cell disease:

• Mast Cell Disease page: 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/

We thank Blueprint Medicines for sponsoring this podcast.

#62 - Why is anxiety around anaphylaxis so common?

Fear and anxiety are very common when managing food allergies and anaphylaxis. It can come from the unknown, where the allergen can show up. It can also come from the way your allergies are discussed.  How do you motivate patients to use their epinephrine without causing crippling anxiety?

Dr Golden joins us as we explore the delicate balance of doctors using fear to underscore the urgency of administering epinephrine during anaphylaxis. We discuss the crucial interplay between fear and anxiety, emphasizing the need for a sensitive approach to motivate patients to use their epinephrine without overwhelming those already grappling with anxiety. 

We discuss the mind-body connection and the similarities between anxiety attacks and allergic reactions when talking about anxiety caused by the fear of having an anaphylactic reaction. Dr. Golden also provides more information about the risk and co-factors associated with severe anaphylaxis.

What we cover in this episode about anxiety related to anaphylaxis:

• Balance of fear and anxiety to get patients to use Epinephrine 
• Mind-body connection around anxiety and anaphylaxis - anxiety attack’s similarity to a reaction 
• Environment allergies - why you do  not need to carry an Epinephrine device 
• Risk factors and co-factors of severe reaction 
• Epinephrine option for severe asthma

Helpful links:

• More about our guest Dr. David Golden
• What is Anaphylaxis? https://allergyasthmanetwork.org/anaphylaxis/
• What is Epinephrine? https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/
• What is a Food Allergy? https://allergyasthmanetwork.org/food-allergies/
• What If I Can’t Afford my Epinephrine Medication? https://allergyasthmanetwork.org/anaphylaxis/what-if-i-cant-afford-my-epinephrine/
• Episode sponsored by https://aquestive.com/anaphylm/.

#61 - New ways to administer epinephrine - what is on the horizon

Is a needle-free option for administering epinephrine coming out? Yes! 

Dr. Golden joins us again in this episode to explore the new products in development for administering epinephrine.

What we cover in our episode about anaphylaxis and epinephrine:

• The new types of ways to administer epinephrine:

  • Inhaler

  • Nose spray

  • Sublingual film 

• Why it has been challenging to find alternative ways to administer epinephrine other than an autoinjector.

• How do we know the new forms of delivery will work? 

• How are companies proving that the new delivery method will work like the auto-injectors do?

• How will studies be done to show the FDA that the new methods should be approved for patients to use?

• Why do we need new ways to administer epinephrine? 

• Will there be hesitation to use the new forms of epinephrine delivery?

• The importance of having doctors on board with these new forms of delivery.

More Resources about anaphylaxis and epinephrine:

• More about our guest Dr. David Golden

• More about Anaphylaxis: https://allergyasthmanetwork.org/anaphylaxis/

• More about Epinephrine: https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/

• What if I can’t afford my epinephrine? Learn more here: https://allergyasthmanetwork.org/anaphylaxis/what-if-i-cant-afford-my-epinephrine/

We want to thank Aquestive for sponsoring this episode.

 

Listen to episode 59 for more information on Anaphylaxis and Epinephrine

#60 - Can you travel while on a biologic medication?

Biologic medications are supposed to help you live your life as normally as possible, but still, one has to wonder, can you travel while taking biologic medicines?

After releasing the episode on biologics for asthma, Dr. G and Kortney decided to explore how to travel while on a biologic successfully. They unpack what considerations patients need to take when planning their trip. 

What we cover in our episode about traveling while taking a biologic medication

• Can you travel while on biologics, or can you only travel between doses?
• Can you travel with biologics that need to be administered by IV?
• Should patients get the green light from their doctor to travel?
• Is it possible to travel out of state or internationally?
• What should a patient consider when thinking about traveling

More about biologics, check out episode 56: https://www.itchpodcast.com/episodes/56-asthma-biologics 

 

#59 - What is anaphylaxis, and when to use epinephrine?

Have you ever wondered if it's anaphylaxis or just a severe allergic reaction? And how do you know when to use epinephrine? Diagnosing anaphylaxis can be challenging, and in this episode, we dive into this topic with our guest, Dr. David Golden.

What we cover in this episode:

• What is anaphylaxis
• When to use an Epinephrine device?
• How to determine if it is an allergic reaction or an anaphylactic reaction?
• How safe is it to use Epinephrine?
  • Why is epinephrine used to treat anaphylaxis?
  • Does epinephrine always work to treat anaphylaxis? Why would it not work?
  • What are the side effects of Epinephrine?
  • Do you have to go to the hospital after using Epinephrine?
• How does Epinephrine work?
• Why antihistamines do not work to treat anaphylaxis or a severe asthma attack
• Other treatments that are in the pipeline for anaphylaxis?
• Epinephrine dosing - how to know the right dose for kids and adults.
• When do you need a second dose of Epinephrine?
• Carrying two epinephrine devices
• Will the next anaphylactic reaction be worse?
• Why should we encourage having stock Epinephrine in schools, on planes, etc?

Helpful links:

• More about our guest Dr. David Golden
• More about Anaphylaxis: https://allergyasthmanetwork.org/anaphylaxis/
• More about Epinephrine: https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/
• What if I can’t afford my epinephrine? Learn more here: https://allergyasthmanetwork.org/anaphylaxis/what-if-i-cant-afford-my-epinephrine/

#58: What is controlled Asthma? Everything you need to know!

In the second episode of the Allergy, Asthma & Immunology Innovations Podcast Series, Dr. G and Kortney dive into the critical topic of controlled and uncontrolled asthma. They shed light on various aspects of asthma, including its types, severity levels, medications, and the importance of asthma action plans.

This episode is especially important to our hosts as asthma has personally impacted them.

What we cover about controlled asthma:

• A quick review of asthma

• Types and severity levels of asthma

• Asthma can manifest in various forms, including:

  • Allergic asthma (triggered by allergens).

  • Non-allergic asthma (triggered by factors other than allergens).

  • Occupational asthma (caused by workplace exposure).

  • Exercise-induced asthma.

  • Cough-variant asthma (primarily chronic cough).

  • Aspirin-exacerbated respiratory disease (AERD).

  • Late-onset asthma (developing in adulthood).

  • Eosinophilic asthma (inflammation-related).

  • Asthma can be categorized as mild, moderate, or severe based on symptoms and lung function tests. Severity impacts treatment strategies.

• Medications for asthma management

  • Rescue or emergency medication (for mild asthma).

  • Controller medication (for moderate to severe asthma). Controller medications include inhaled steroids, other medications, and biologics for severe cases.

• Assessing asthma control

• Asthma control is evaluated based on the "Rule of 2s". If you have two or more of the following, your asthma may not be controlled;

  • Symptoms more than two days a week.

  • Quick-relief medication usage more than two times a week.

  • Nighttime awakenings due to asthma more than two times a month.

  • Asthma exacerbations require oral steroids twice a year.

• What is good asthma control, and why is this important

• The long-term effects of uncontrolled asthma

• Asthma Peak Week.

• Creating an asthma action plan

• Working with healthcare providers and asthma coaches

Resources to help you with your asthma control:

Asthma Management and Control: https://allergyasthmanetwork.org/what-is-asthma/asthma-management-and-control/ 

Asthma Action Plan: https://allergyasthmanetwork.org/what-is-asthma/asthma-action-plan/  This page is great because it has multiple types of Asthma Action Plans.

Infographic about asthma peak in September: https://allergyasthmanetwork.org/images/Asthma/September_Asthma_Peak_July2023v1.pdf

Asthma Coach: www. AsthmaCoach.org and https://allergyasthmanetwork.org/free-asthma-coach-program/.

Lifestyle Changes to Manage Asthma: https://allergyasthmanetwork.org/what-is-asthma/lifestyle-changes-to-manage-asthma/

Biologic medications: www.BiologicMeds.org

Type 2 Inflammation: eosasthma.org https://allergyasthmanetwork.org/news/when-asthma-more-than-asthma-type-inflammation/